Preparing for Health Care II

LAST Friday, aides in the Clinton administration's health-care ``war room'' packed up the last of the voluminous files that had fed their health-care reform effort and sent them over to the National Archives for safekeeping.

``We've been told we can get them back within an hour,'' one aide says. A most important service, because the Clintons might need those files when they pick up the health-care reform issue with the 104th Congress.

``Health-care reform is not a boxing match that goes 15 rounds and then it is over. It is a journey,'' Hillary Rodham Clinton said at a recent meeting of the Association of American Medical Colleges.

The struggle to reform the unfair system will continue, she said, something that was echoed by numerous lawmakers.

But this time, the debate should start early, involve small steps, and be bipartisan, many lawmakers and observers say.

``It will be very tough, even to do anything incremental, especially if the Republicans get control of both chambers,'' one Democratic aide says.

Bipartisan groups hope their bills to reform the insurance marketplace - considered a big step by its sponsors but a small step by Democratic leaders - will be at the center of the debate.

Also, incrementalism is what many Republicans had wanted and still want. For success in the new Congress, the administration and Democratic leadership must be willing to ``start in the [ideological] middle,'' said Rep. Nancy Johnson (R) of Connecticut.

It is unclear whether this is the path the Clintons will choose. They have not yet decided on an approach, and they probably won't until after Nov. 8, officials say.

Others, including single-payer advocates, will push for federal waivers for states that want to experiment with their own health-reform plans.

Christopher Dodd (D) of Connecticut and colleagues plan to introduce a children's health-care reform bill at the beginning of the session.

Democrats also are talking up the merits of the Federal Employees Health Benefits Plan, which could signal future action there.

``We need a unified message so we are not divided and conquered,'' pediatrician Dr. Irwin Redlener, director of New York's Montefiore Medical Center, said to children's health advocates who were meeting on Capitol Hill last month to salvage a health-care reform strategy out of the political wreckage of the 103rd Congress.

Economist Henry Aaron of the Brookings Institution warns that if health care reform backers want success, they should not repeat the mistakes made by the White House and the 103rd Congress.

``Expecting a large bill to be passed was exceedingly optimistic,'' he says. The health-care system comprises one-seventh of the nation's economy and reforming it is a massive undertaking, he says.

The Clintons also got a late start with their bill, pushing the debate ever closer to the 1994 elections.

``It had to be bipartisan right from the beginning in order for there to be success. Rather than a Democratic administration proposal being dumped in the lap of a bipartisan Congress,'' Mr. Aaron says.

A Democratic aide on Capitol Hill agrees. ``It was doomed from the beginning,'' he says. ``[The Clintons] held secret meetings from both the Democrats and Republicans and then sprung it on them.''

At a meeting of the American Bar Association in Washington last week, White House policy adviser Walter Zelman defended the administration's health care reform strategy.

``We saw it as our opportunity to take a big step in a nation that favors little steps,'' Mr. Zelman said. ``We held meetings with everybody.''

He argued that the US needed strong leadership to get over their fear of full-scale reform. ``I know we had that, but when we got to the crunch time [President Clinton] wasn't as popular,'' Zelman said.

But the real problem was the special interests, who spent $300 million to upset the administration's effort, according to Zelman. ``The interest group activity softened up the public.... Then Bob Dole had a clear shot.''

Sen. Jay Rockefeller (D) of West Virginia, a strong supporter of health care reform before Clinton took office, criticized health-care supporters for not being more united. ``We were also fractious,'' he said at a recent meeting of children's health advocates.

Retiring Senate majority leader George Mitchell of Maine (D) said during a recent Monitor breakfast that the press allowed Republicans to get away with labeling the Clinton plan a government takeover of the health-care system, while ``each and every one of them is covered by the Federal Employee Health Benefit Plan.''

``I've never heard one [reporter] ask that question and I've raised it 50 times,'' he added.

But an aide to Republican conference chairman Dick Armey of Texas says the problem rested with the bill itself. ``It was an anachronism,'' he says. ``All around the world people are moving away from centralized solutions.''

An aide to Rep. Michael Bilirakus (R) of Florida, who helped draft a bipartisan bill, hopes next session's debates can start on higher ground.

``When working on our bill, there were six or seven weeks of meetings where guys were arguing and refining what we thought were minor details,'' he says.

Pediatrician Redlener also urged child advocates to compromise.

``We can't look like we're a divided, disagreeable coalition,'' he says.