Health-Care Battle: All Hands on Deck

FLIP through recent copies of Roll Call, a Capitol Hill newspaper, and you'll see the tip of a public-relations iceberg.

A full-page advertisement funded largely by health insurers tells us that, in fact, their industry supports just about every aspect of President Clinton's forthcoming plan. It's just the ``exclusive health alliances,'' ``flat community rating,'' and ``artificial price controls'' they don't like.

On another page, the Employment Policies Institute, a new think tank funded by the hospitality industry, tells us that ``80 percent of America's economists know that mandating employers to pay for health care will destroy many entry-level jobs.''

Then there's the Pharmaceutical Manufacturers Association (PMA), whose ad touts the development of an antidepressant by Eli Lilly and Company. The ad doesn't even mention health-care reform, but the message is clear: that the pharmaceutical companies are not the bad guys in America's health-care crisis, and that apparently high drug prices are necessary to fund research.

``A lot of the public doesn't understand what the pharmaceutical industry does and the advantages of a free market in pharmaceuticals, not price controls,'' says John Gibbons, the PMA's media director.

The race is on to reach the hearts and minds of the American public - and ultimately the members of Congress who will negotiate the final shape of the package.

Even though it will be months before a final vote is taken, the wide array of players in the health-care debate are spending millions of dollars now on print and television ads and on fees for high-priced lobbyists and public-relations consultants who have been snatched up in a hiring frenzy that began with Mr. Clinton's election.

``You never know what the incremental effect of all this will be when there are so many players,'' says Ed Howard, executive vice president of the Alliance for Health Reform, a nonpartisan clearinghouse of information. ``But they can't afford not to be doing what they're doing. There's too much at stake.'' Huge industry at stake

On the line is a $900 billion-a-year industry that accounts for one-seventh of the nation's economy. So scores of associations representing doctors, hospitals, insurers, drug companies, medical-supply companies, and lawyers are supplementing their in-house lobbying shops with hired guns from top firms like Patton, Boggs & Blow and Akin, Gump.

Anyone with an Arkansas connection, regardless of his or her knowledge of the health industry, is in hot demand. For example, the American Hospital Association has hired former Rep. Beryl Anthony (D) of Arkansas. Ethics rules prohibit Mr. Anthony, who left Congress at the end of last year, from lobbying his former colleagues. But he can provide ``insights into the Clinton administration'' and the ``ins and outs of Congress,'' says Rick Wade, the AHA's senior vice president for communications.

The Federation of American Health Systems, which represents private hospitals, hired J. Jackson Williams Jr., a former law partner of Bill Clinton's from the Little Rock, Ark. firm of Williams & Anderson, even though Mr. Williams doesn't have special expertise on health issues - or even live in Washington.

In some cases, individual companies are not relying on their trade associations and taking on additional lobbyists themselves. The registration list for lobbyists shows legions of companies registering new in-house lobbyists and outside firms. Many of the new lobbyists have been hired right out of their congressional staff posts.

The Health Insurance Association of America (HIAA) went one better and hired a member of Congress, Rep. Bill Gradison (R) of Ohio, as its new head in February. Mr. Gradison, who resigned to take the position, was the ranking Republican on the House Ways and Means Subcommittee on Health. He brought with him several top aides.

Another boon to the Washington influence industry is the proliferation of new alliances. Health insurers, one industry that could face a particularly strong shake-up under Clinton's plan, are no longer represented just by the HIAA. The five largest insurers have split off to form the Alliance for Managed Competition, which has hired the new lobbying firm of Oldaker, Ryan & Leonard (whose principals are former senior Capitol Hill aides).

The HIAA has attracted the most enmity with a TV ad called ``apocalyptic'' by AFL-CIO president Lane Kirkland. The ad shows a couple sometime in the future poring over a stack of bills, expressing frustration and anger over how their new health plan doesn't cover as much as their old one did. ``For reforms that protect what we have, call toll-free,'' the announcer intones as an 800 number appears.

The Democratic National Committee is furious about the ad, which it accused of ``promoting mischaracterizations and distortions.'' In response, the Democrats' $30 million National Health Care Campaign launched its own TV ad called ``Fine Print,'' which it says ``calls attention to the insurance industry's special-interest stake in fighting change.''

Some observers question the wisdom of spending a lot of money on media now, well before the final details of the plan are worked out in congressional committees. ``Those ads will have little effect on the plan Clinton sends up,'' says an aide to a moderate Senate Republican. Clinton's health-care reform team is tinkering with the draft merely to ``seem bipartisan and responsive.''

The HIAA disagrees. In the White House's 47-page memo about health-care reform released before the August congressional recess, the HIAA saw what it calls ``inaccuracies'' about the insurance industry, which was blamed for high costs. ``We felt we had to be aggressive; if we waited we might not be heard,'' says Chip Kahn, HIAA executive vice president in charge of lobbying and a former aide to Gradison. The TV and print campaigns are costing $1.7 million. 2,000 calls a day

The HIAA says it's getting about 2,000 calls a day on its 800 number, which asks callers to leave their names and addresses so they can receive a brochure. Mr. Kahn says it's too soon to mobilize these callers to contact lawmakers, but it may do so when crunch time comes.

The HIAA has also hired two lobbying firms to help make its case: O'Brien & Calio and Winburn & Jenkins. These lobbyists bring ``added value'' to HIAA both in their knowledge of the health industry and their connections in Congress. One, former Rep. Ed Jenkins (D) of Georgia, had served until last year on the key Ways and Means Committee. So far, though, says Kahn, ``no heavy lifting yet'' for lobbyists. ``Next year.''

For now, lobbyists can roam the halls of Congress and keep their contacts fresh. The Republican Senate aide tells of how he desperately tried to get a copy of the White House's draft plan right after it had been sent to all Democratic members. He called Senate minority leader Robert Dole's office and came up empty. He tried the White House. No luck. Then he saw a lobbyist in the hallway who is active on health care.

``I knew he'd have it, but asking him would be an admission of defeat,'' the aide recounts. So he swallowed his pride and asked. A copy of the draft was on the aide's desk a half-hour later.