Democratic Governors Focus on Health Care

IN this unlikely setting - a resort town that probably has few uninsured residents - the Clinton administration did some gearing up last week for what could be its biggest selling job: the coming reform package that will aim at universal health coverage for Americans.

The keynoter at Friday's session here of the Democratic Governor's Association was the first lady, Hillary Rodham Clinton. Mrs. Clinton - the administration's lead person on health care - vigorously laid out the fundamental points she and the president will use to gain backing for their reforms:

* That overhaul of the health-insurance system and economic recovery are inseparable. "This is an economic issue as well as a human one," she said.

* That the job is too big for the federal government to accomplish by itself. She assured the 12 governors in attendance that their own efforts to deal with escalating health-care costs were appreciated by the White House and would be accommodated in the Clinton plan.

* That the public's overriding interest is in "health security." The message here was that the promise of universal health benefits, unaffected by job change and other factors, will subordinate public worries about how the new system will be financed.

* And that to attain this kind of security, all individuals and all businesses will have to shoulder part of the burden of paying for it. "Responsibility is at the root of what it means to be an American," said the first lady, emphasizing that everyone will have to get aboard the new reforms.

The administration's top adviser on health-care issues, Ira Magaziner, rattled off statistics that underscore the problems in the current system: Health-care costs are "eating up well over 100 percent of the total increases in workers' wages;" 50 percent of doctors' expenses are administrative costs, compared with 25 percent two years ago. The increasing mass of governmental regulation is "strangling the system right now," said Mr. Magaziner.

Mrs. Clinton's endorsement of a "state-flexible" national plan was heartening, said Barbara Roberts, governor of Oregon. Her state has gone farther along the reform trail than most by devising a plan that specifies which medical procedures will be paid for by government and which won't. There are "different correct answers" to the problem of health Governor Roberts told a reporter.

When it is clear that everyone will pay and everyone will benefit, she said, public support follows.

State approaches to health-care reform are remarkably varied.

Gov. Brereton C. Jones of Kentucky said his state, in order to extend coverage, had no choice but to levy a 3.75 percent payroll tax on employers who were not providing health benefits.

Gov. Lawton Chiles of Florida said his state is requiring community-based insurance ratings that rule out discrimination because of individual or family medical histories.

Missouri's Gov. Mel Carnahan pointed out that his state's cost-cutting negotiations with health-care providers included an agreement to give nurses "much more latitude in giving primary care."

Tennessee has taken the extraordinary step of filing a formal request to get out of the federal medicaid program, which helps states pay for health care for the poor, in favor of its own program, "Tenn-Care."

Gov. Ned McWherter said that he is convinced that the state's "managed care" approach can control costs and take care of the needs of the "working poor" better than medicaid, with its persistent 14 to 16 percent yearly cost increases.

The Democratic governors are clearly supportive of the Clinton reform initiative - at least the outlines of it as described here.