White House Eyes Some Less Ambitious Health-Care Bills

Clinton might consider a minimalist or incremental plan

AFTER a couple of teeth-clenching weeks of late nights and heavy arm-twisting, the Senate chamber is quiet, the caucus rooms are empty. The hovering reporters and camera crews have abandoned the richly tiled floors of the lobby.

The push for health-care reform is moving on quietly now during the next two weeks in negotiations between Sen. George Mitchell (D) of Maine and a handful of centrist senators.

But their ambitions are only a ragged remnant of what they were even a couple weeks ago. The question now is not whether any bill will achieve universal insurance coverage or national cost controls.

The question now is whether the 103rd Congress will close down this year at a total health-care stalemate or will make some incremental reforms to the health-insurance market and perhaps expand insurance subsidies to more families.

The White House is preparing the ground for an outcome of far narrower scope than it claimed it would accept. At a Monitor lunch on Friday, White House Chief of Staff Leon Panetta suggested that the president might consider a minimalist or incremental bill as long as it did not fly under the grander flag of health-care reform. (Minimum of reform, Page 6.)

The president set an unforgiving standard for himself in his state-of-the-union address last February when he waved a pen and vowed to veto any bill that fell short of guaranteeing every American private health insurance.

That standard holds, Mr. Panetta says. If a health-care reform bill does not lead toward coverage of everyone with a decent benefit package and cost control, then the president will not support it.

``I know there are probably some members [of Congress] who would like to get something through that has health-care reform in the title. That's not good enough.''

But he added: ``If they decide to can health-care reform, if they basically decide that they can't do it, and they fall back to perhaps trying to do some kind of minimal approach, then obviously that's a different ball game.''

Still optimistic

Panetta remains optimistic that a more comprehensive health-care reform package can be achieved this year. The White House draws encouragement from its bipartisan victory in the Senate late Thursday that wrested the crime bill from the brink of oblivion and passed it.

Senate majority leader Mitchell, who is retiring this year and pulled his name from consideration as a Supreme Court justice in order to shepherd health-care reform, conceded on Friday that a comprehensive bill would not pass this year.

The basis of the talks Mitchell is conducting with Senate Republicans John Chafee of Rhode Island and Dave Durenberger of Minnesota, and Democrat John Breaux of Louisiana is not his own plan. Instead it is a relatively modest plan of subsidies and insurance market reforms dubbed the ``mainstream'' plan.

The compromise plan would tax as income health benefits above a certain standard level, and its subsidies would drop as necessary to avoid adding to the federal budget deficit.

If the season is more bitter than sweet for the White House and Democratic leaders, at least both the House and Senate went home on the heels of dramatic, bipartisan victories on the crime bill.

The saving of the crime bill showed that the White House and its allies can build a bipartisan coalition, says chief lobbyist on the White House staff, Patrick Griffin. ``I think people went home with a more positive attitude than if they had left even a week ago,'' he said Friday.

Bipartisan coalitions figure large in the future of the Clinton program, if it is to succeed. As Panetta acknowledges, the next Congress is likely to have ``a more conservative edge.''

Elections this fall are expected to put perhaps 25 more Republicans in the House - not a majority, but enough for working majorities with conservative Democrats.

``I think the ability of the administration to work with moderate Republicans in the Congress is going to hold the key to whether we're going to be able to get legislation through,'' Panetta says.

Shift to the right

The center of gravity of health-care reform has shifted a long way to the right since last September, when President Clinton outlined his proposal in a well-received prime-time speech to Congress. Then, few members of Congress readily argued with the need for guaranteeing universal health coverage.

``I think people really didn't stop to think how you get universal coverage,'' says Gail Wilensky, who headed the Health Care Financing Administration, which runs Medicare and Medicaid, in the Bush administration.

To get universal coverage, she says, has always meant that government must either mandate it or create an entitlement to it. Many politicians ``didn't understand the implications of what they were saying.''

Meanwhile, the public became more secure about its health insurance as the economy improved, taking the urgency out of passing a health-care reform bill this year and sapping popular support for universal coverage.

Uwe Reinhardt, a Princeton (N.J.) University economics professor and member of the national board that sets the rates Medicare pays physicians, sees the rightward shift more simply: ``We are a hard-hearted nation. We are writing off the lower-middle class.''