Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, August 21, 1994 TAG: 9408210063
SECTION: NATIONAL/INTERNATIONAL PAGE: A-8 EDITION: METRO
SOURCE: Associated Press
DATELINE: WASHINGTON LENGTH: Medium
In the beginning, came President Clinton's grand scheme.
In the middle, there was Senate Majority Leader George Mitchell's less sweeping vision.
In the end, it appears, there's a budget-conscious alternative that's light-years away from the guaranteed universal insurance coverage abels ANALYSIS the president once set as his bottom line.
The new bottom line is a whole lot more basic: keeping some type of health reform alive in the face of insistent conservative demands to put it off until next month, next year, perhaps forever.
The new heroes are the Democratic and Republican senators who locked themselves in a room last week and drew up a modest "mainstream" plan many believe is the last, if not best, hope to achieve reform this year.
Universal coverage takes a back seat to deficit reduction in this latest phase of health reform. Even some liberals are prepared to consider the bipartisan plan, though it strongly resembles a market-oriented, managed competition plan they once spurned.
The debate "is becoming more and more about less and less," said an anxious Ron Pollack, executive director of Families USA, a consumer group allied with Clinton. "It's really become an exercise in minimalism."
The Clintons started their health reform odyssey with a 1,300-page bill and a six-word mantra: security, simplicity, choice, savings, quality and responsibility.
They eventually distilled their pitch to one non-negotiable demand: universal coverage, also described as guaranteed private insurance and "health care that's always there."
With 15 percent of Americans uninsured, Clinton pledged to veto any bill that did not cover them all. But as political complications mounted, so did the president's flexibility.
He began talking of a bill that "puts us on the road" to universal coverage - and not necessarily his way, which was to require employers to provide worker insurance.
When Mitchell set a goal of 95-percent coverage through subsidies to low-income families, with stronger measures required to kick in if this didn't work, Clinton swallowed hard and insisted this, too, was universal coverage.
The "mainstream" blueprint doesn't even go that far. It proposes subsidies to expand coverage, but it isn't clear yet how many people would benefit.
Furthermore, the subsidies would be curbed if deficit reduction were at risk, and there's no fallback employer requirement if millions still fell between the cracks. The moderates also dropped expensive prescription drug and long-term care programs.
Gone from both Mitchell and mainstream are the mandatory purchasing alliances Clinton had considered vital to driving down insurance costs. The alliances, flashpoint for fiery rhetoric about new bureaucracies, have evolved into voluntary co-ops.
The government would have controlled health spending under the Clinton plan by setting alliance budgets and payment rates for providers and by limiting increases in private premiums.
Mitchell diluted that to a national commission to monitor health spending and proposed a tax on high-cost health plans.
The mainstream plan uses the tax code to discourage high health spending. Employers would face new limits on deductibility of health expenses, and employees who got free benefits would have to pay taxes on them.
Liberals generally are skeptical that such steps will hold down costs, or that subsidies can solve the core problem of tens of millions of Americans without insurance.
But with conservative Republicans saying the Mitchell bill "belongs in an outhouse" and vowing to kill the moderates' proposal as well, the rightward drift of the debate seems unstoppable.
Some liberals say they're ready to do business under those conditions. Others are angry and demoralized.
But all recognize that the reform drive has changed from a crusade to a salvage operation.
"Clearly, the direction that it's going is a further watering down, a further weakening," said Sen. Paul Wellstone, D-Minn.
"I hope I'm wrong, but I do not think we're going to enact fundamental reform in this Congress."
Clinton has not granted that point, yet.
"The so-called `something less' approach often does more harm than good," the president said Friday, in what seemed to be a discouraging word for the mainstreamers.
But then he added, "Give the process time to unfold."
by CNB