WORLD

THE BATTLE AHEAD

BILL CLINTON PLOTS STRATEGY TO WIN PUBLIC AND CONGRESSIONAL APPROVAL OF HIS HEALTH-CARE PLAN

WILLIAM LOWTHER August 30 1993
WORLD

THE BATTLE AHEAD

BILL CLINTON PLOTS STRATEGY TO WIN PUBLIC AND CONGRESSIONAL APPROVAL OF HIS HEALTH-CARE PLAN

WILLIAM LOWTHER August 30 1993

THE BATTLE AHEAD

WORLD

BILL CLINTON PLOTS STRATEGY TO WIN PUBLIC AND CONGRESSIONAL APPROVAL OF HIS HEALTH-CARE PLAN

The TV images showed a man at leisure: playing golf at the local country club, strolling along the beach and swimming in the ocean with his 13-year-old daughter. But the pictures were deceptive. Ostensibly enjoying the start of an 11-day vacation late last week in Martha’s Vineyard, Mass., Bill Clinton off camera was plotting strategy for the legislative battle of his lifetime. The outcome, he has told friends, could determine the success or failure of his presidency. And either way, the congressional agenda will be dominated for the next year by a single issue: the reform of America’s ailing health-care system, a $ 1-trillion-plus industry that includes doctors, insurers, pharmaceutical companies, hospitals, medical-equipment manufacturers, suppliers—and more than 200 million patients.

In addition to his public displays of relaxation at Martha’s Vineyard, where he celebrated his 47th birthday last week, senior staff members say that the workaholic President is spending late nights and early mornings with his wife, Hillary, delving into the contentious politics of medical insurance. The plan that he promises to unveil in midSeptember—he has missed two earlier selfimposed deadlines—is the one that the First Lady has worked on over the past six months as head of the White House Task Force on National Health Care. But it is not just her issue. As much as any other single factor, it was the promise of affordable health care for all Americans that helped Clinton win the election last year. “Fundamental change has to come soon,” says Robert Shapiro, vice-president of the Washingtonbased Progressive Policy Institute and a close adviser to the President. “In no other advanced country does one of every seven persons have to manage without routine [health] care.”

The campaign to get his health-care legislation through the fractious Congress began in earnest early last week when Clinton delivered a 45-minute opening salvo to the annual meeting of the National Governors’ Association in Tulsa, Okla. For the first time, he outlined the options he has chosen. “Our plan starts from a simple premise, that all Americans must be guaranteed the security of knowing they will never lose their health coverage even if they switch jobs, lose a job, get sick, move to a new city or start a small business,” said Clinton. Without providing details, he added that the new plan would provide universal health coverage, establish a national health-spending budget, restructure the insurance industry and promote significant increases in research technology. The President went on to promise that there would be no new broad-based taxes to pay for the scheme.

Instead, White House health-care adviser Ira Magaziner later told the governors in private meetings that the plan will be paid for on a co-operative basis, with the federal government picking up 20 per cent of the tab and most private employers carrying the remaining 80 per cent. Magaziner said that it would cost between $80 billion and $130 billion annually and added that the employer contribution would amount to a seven-percent payroll tax for companies, but there would be federal subsidies to make sure that small companies are not too hard-hit. (Large U.S. companies that now provide health care for their employees generally pay about 5 per cent of payroll for the benefit.)

However, a Republican source who attend-

ed a subsequent meeting with Magaziner told Maclean’s that the White House adviser had also hinted that a “sin tax” on cigarettes was “probable,” while a special health tax on alcohol was “possible” to help pay for longterm care for the elderly. And Tom Scully, associate director of the Office of Management and Budget in the Bush administration, added: “The fundamental problem is you are going to cover 35 million new people. Currently, those people are getting roughly half the health care in the uncom-

pensated system that they would get if they had insurance, so costs can be reduced only by eliminating programs or putting caps on their growth.”

If the Clinton plan has any chance of surviving in a recognizable form, the President must achieve bipartisan support. That will not be easy. The bitter, close fight over the budget that Clinton won last month has heightened legislators’ aversion to new taxes, sharply split Congress along party lines and revealed the President as vulnerable to special-interest groups. Says John Rother, legislative director for the American Association of Retired Persons: “We have to see a greater leadership and a greater public will to stand against all the exceptions and loopholes that will inevitably threaten the health-reform effort.”

Most significantly, the major business lobbies are opposed to the plan. John Motley, a vice-president of the National Federation of

Independent Businesses, says that the 600,000 businesses he represents “find this plan frightening.” Adds Motley: ‘We can’t afford it. You will see companies forced out of business and employees left jobless.” It will be the President’s biggest task to persuade Congress that such dire predictions will not come true. In fact, last week Democratic party officials announced the appointment of former Ohio governor Richard Celeste to lead a national campaign to promote the health plan and assuage public fears that it will cost jobs and bring new taxes. Much will depend on Clinton’s political credibility at a time when opinion polls reflect a pervasive national skepticism about the President—and a public disapproval rating of 49 per cent.

Some two dozen Republican senators are now working on a health-care package of their own. Under the leadership of Senator John Chafee of Rhode Island, they are preparing to introduce their plan within days of Clinton’s proposal. While no details have been released, Chafee’s staff says that it will centre on health insurance purchasing co-operatives—large groups of people banding together to get cheaper rates— and will oppose any requirement that employers provide insurance, the main plank of the Clinton plan.

Still, following the partisan budget battle, the Republicans are striving to avoid the impression that they favor gridlock. Senate Minority Leader Robert Dole of Kansas made that clear last week when he insisted that he is ready to co-operate with the President on health care if Clinton is prepared to change some aspects of the plan to accommodate Republican “genuine concerns.” Dole also hinted that his support would be influenced by speedy Democratic action on the North American Free Trade Agreement, to which the President has given only lukewarm backing.

While legislators are widely expected to pass some version of health-care reform, even Clinton’s closest aides concede that the congressional debate will run well into next year. Even then, Clinton is prepared to allow between five and seven years for a new scheme to be gradually introduced to avoid financial disruption in the companies that must pay for it. As a result, it will be the end of the century—and likely under a new president—before the plan that Clinton hopes will be his major political “legacy” is fully in place.

WILLIAM LOWTHER