Key Vote for Clinton Presidency

White House has set health-care reform as its defining test, at a time of waning influence

THE debate has engaged as if in slow motion, as one by one senators take their turn in the well for opening remarks stretching across several days.

It marks the nearing of the end of a health-care battle that President Clinton has set up as the defining test of his presidency.

He is entering it politically weak and facing the prospect in coming months of getting politically weaker.

He has staked his reputation on a Roosevelt-scale feat now at hand - a feat at least one Democratic veteran considers unfinished business of the New Deal social-security agenda.

Yet he is operating in a very different climate from that of Roosevelt who passed Social Security 60 years ago.

Faith in government has collapsed over the past 15 years. Faith in Mr. Clinton is not faring much better.

Given the relatively prosperous economy, notes presidential scholar Colin Campbell of Georgetown University here, Clinton's public-approval ratings should be in the mid-60-percent range. Instead, they are in the mid-40-percent range, and no clear-cut explanation lies at hand for the missing 20 points - no Vietnam, no Watergate.

Personal distrust of Clinton runs especially high in polls. As if to keep that point fresh, the Senate speeches on health care are following two weeks of televised congressional hearings probing the integrity of the Clinton administration on Whitewater-related business.

Time is not on his side. In mid-term elections less than three months away, Democrats could lose 25 seats and effective control of the House of Representatives.

Discomfort runs high at the White House, where staffers are awaiting a shake-up at the hands of new chief of staff Leon Panetta. At the Democratic National Committee, dissatisfaction among Democratic politicos has put party chairman David Wilhelm on the way out, as former House leader Tony Coelho moves in to coordinate fall campaign activities.

Most Democrats would much rather face voters in November having achieved a major reform of the health-insurance system. It may be even more critical for Clinton himself, because he has tied his presidency so closely to achieving health-care reform on a grand scale.

``He has identified it as the flagship component of his whole mandate,'' Dr. Campbell says. Hillary Rodham Clinton has invested much political capital in it as well. ``He's really boxed himself into a corner on that one pretty badly.''

Jimmy Carter promised in 1976 a wholesale reform of the welfare system during his first 100 days. He failed, but never suffered serious political damage from it, because he managed to avoid staking his reputation on it, Campbell says.

CLINTON could still win his health-care battle, and his political capital would presumably rise as it did last fall after he won approval of the North American Free Trade Agreement. But he may also have to square a compromise bill with his dramatic veto threat last February against any plan that falls short of guaranteeing full coverage to everyone.

The power of the president, even a strong one, is easy to exaggerate in battles such as this. But these battles are won and lost at the margins, often by winning or losing a few key members of Congress, says George Edwards III, a political scientist at Texas A&M University. The prestige of a president can make a difference at these margins.

But Clinton holds poor leverage these days. No Republican need fear incurring the wrath of voters by opposing Clinton, whose disapproval is as wide and much stronger than his approval. For the same reason, Democrats cannot return to their districts and expect credit for supporting the president.

Clinton's is a public presidency, Dr. Edwards says, built around mobilizing the public with continuous campaigns and events, such as the current Health Security Express bus tour. ``When he doesn't get a response, that sends an eloquent message to Congress,'' Edwards says. ``It takes about a nanosecond to get there.''

Clinton's strength in this battle is that a large majority of Americans want universal health-insurance coverage, and Congress has received that message too.

Arthur Flemming, who served in the Roosevelt administration, told Monitor Radio this week: ``From the point of view of many of us, health care will round out the Social Security program.''