Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, September 18, 1993 TAG: 9309180138
SECTION: NATIONAL/INTERNATIONAL PAGE: A1 EDITION: STATE
SOURCE: JACKIE KOSZCZUK FORT WORTH STAR-TELEGRAM
DATELINE: WASHINGTON LENGTH: Medium
His may be the most prominent political neck on the line, but there is no shortage of others. The Washington establishment is about to begin tinkering with the way Americans receive and pay for their medical care, and voters always have been pretty touchy on that subject.
"This whole debate - how to reform health care - has been going on for 50 years, since Harry Truman, and no one has been able to do it," said Michael Bromberg, a leading hospital lobbyist.
"Even in the less controversial areas, there are thousands of questions and details," he said. "We're talking about a massive undertaking in one-seventh of the economy."
The president day will address a joint session of Congress on Wednesday to officially unveil a reform plan that would impose dramatic changes on the $850 billion health-care industry, including an unparalleled level of government involvement.
The plan is the fruit of nine months of work by the president's health-care team, headed by his wife, Hillary Rodham Clinton.
When it arrives in Congress, the president can expect no pats on the back from fellow Democrats, though they control both chambers. He can forget about party loyalty. Lawmakers are well aware that health care is a make-or-break issue, and many of them face re-election contests a year from now.
"This is an initial proposal and I think the administration is going to have to be flexible," said Rep. Martin Frost, D-Texas. "People have a lot concerns."
They also have memories of what has come to be known as the catastrophic-health disaster. In 1988, lawmakers earnestly passed changes in Medicare that expanded catastrophic health benefits and also raised premiums. Back in their districts, they were met by angry hordes of seniors citizens and ordered back to Washington to repeal the law, which they did.
"Some of the freshman members don't remember that, but some 320 of us do," said House Republican leader Robert Michel of Illinois.
In interviews this week, key players in health-care reform predicted the process will be deliberate. No one expects legislation to be passed until next year.
But the reassuring news for Clinton is that many say a consensus will grow and a final plan is possible, even if it is a radically altered version of the one Clinton puts on the table next week.
"I think compromise already is developing," said Pamela Bailey, president of the Healthcare Leadership Council, a leading industry coalition. "While the administration has been developing its plan, there's been a bipartisan process at work."
Compromise is expected to fall between the two political extremes in the debate: a conservative do-little approach and a liberal government-does-all approach.
Conservatives advocate IRA-style "Medisave" accounts, which would encourage people to set aside pre-tax dollars to pay for medical care. But the plan does not solve the problem of 37 million uninsured Americans.
Liberals advocate abolishing the health insurance industry altogether. They would replace it with the federal government, which would guarantee medical care to all Americans and collect taxes and pay negotiated fees to doctors and hospitals.
Sen. Phil Gramm, R-Texas, a conservative Republican who supports the minimalist approach, said, "The only experience we have with the government being a single buyer of anything is with the Defense Department. If government is doing such a great job, why does the B-2 bomber cost so much?"
The middle ground likely is to be found among proposals, including Clinton's, that call for a blend of public control and private marketplace forces.
There are significant points of agreement between Clinton's approach and the plans being advanced by two other political blocs - a group of Republicans in the Senate led by Sen. John Chafee of Rhode Island and a group of conservative Democrats in the House led by Jim Cooper of Tennessee and Mike Andrews of Texas.
"If you take the Chafee bill and ours, you will see they are more similar than dissimilar," Andrews said. "And we have a president who is fully engaged on this issue."
by CNB