Wofford may have picked the right analogy, and certainly the Clintons regard health reform as a warlike crusade. But in Congress, it’s going to be a long, hard war, and almost no one is expecting unconditional victory. It is becoming increasingly clear that the best President Clinton can hope for is a compromise that falls short of his own plan for universal health coverage.
Last week the Clintons learned they would almost surely lose a critical ally. Just as he was beginning to draw up the actual legislation that would implement health reform, Dan Rostenkowski, the powerful chairman of the House Ways and Means Committee, virtually admitted that he may be going to jail instead. This week Rosty may be indicted by a federal grand jury for misusing public funds. He allegedly embezzled money from the House Post Office and used office money to hire ghost employees and buy personal furniture and gifts. Rosty last week was telling friends he would fight the charges, but there’s still a chance that he’ll take his lawyer’s advice and accept a plea bargain. Either way he is certain to be stripped of his chairmanship.
The Clintons had been counting on Rostenkowski to ramrod health reform through the House. The gruff boss of Ways and Means had been patiently walking members of Congress through a delicate exercise designed to make them face up to reality. Most lawmakers want health reform, but don’t want to pay for it. The White House’s plan would require employers to pick up 80 percent of the cost of insuring their employees. The powerful small-business lobby has naturally been trying to kill these ““employer mandates.’’ When frightened lawmakers tell Rosty they can’t possibly vote for mandates, Rostenkowski has been shooting back, ““You want to raise taxes?’’ The congressmen usually come around to making employers pay, in return for business tax breaks in the congressman’s district.
Still, few members of the House want to go first in voting for employer mandates. They are afraid that if they climb out on a limb, their colleagues in the Senate will cut it off. They are especially suspicious of Rosty’s counterpart in the Senate, Daniel Patrick Moynihan of New York, the chairman of the Senate Finance Committee. Never a true believer in health reform, Moynihan is highly mercurial and independent. (Asked whether Moynihan was brilliant or a crackpot, a White House aide responded, ““I have to pick?’’) A shrewd politician, he has been scheming with moderate Republicans on what amounts to a fudge on health care.
Moynihan’s co-conspirator is Sen. Bob Packwood, the ranking Republican on Finance, who would rather be remembered for health reform than for the allegations that he sexually harassed his female employees. Moynihan and Packwood are working up a bill that would finesse employer mandates. It would still try to protect workers who have been laid off or disabled. Insurance would ostensibly be made affordable to all. But ““universal’’ coverage might be defined loosely. Already, 85 percent of Americans have some form of health coverage. Even Clinton’s bill would miss some Americans, transients and workers in the underground economy. In Hawaii, which has a highly touted universal-health-care system, 6 percent of the people still lack insurance. Moderates looking for a compromise want to fudge the strict definitions. Why not a plan that covers, say, 93 percent, and call it universal?
Another approach would be to vote for a ““trigger’’: if the plan fails to cover a certain percentage of Americans by a certain date, then mandates would kick in. Even Clinton’s bill doesn’t promise universal coverage until 1998. Some lawmakers are talking about pushing the deadline past the year 2000. The beauty of a trigger is that it puts off the hard choices for later Congresses, especially if the trigger is ““soft,’’ or not automatic. There has been a lot of talk of soft triggers on Capitol Hill lately.
This is a neat solution in the classic smoke-and-mirrors style of Congress (literally: it would be financed partly by a cigarette tax). But it has one big drawback. When he introduced the original health-reform proposal last fall, Clinton declared that universal health care was his ““bottom line.’’ In his State of the Union address in January, the president literally waved his veto pen at the suggestion that Congress might vote to provide anything less.
The White House is starting to wobble a little. Asked exactly what the White House meant by universal coverage, spokesperson Dee Dee Myers responded, ““We’re certainly not going to define it as a percentage.’’ The big question is whether Hillary Clinton will back down. The First Lady came off as fierce and unyielding in a profile published last week in The New Yorker by Connie Bruck. At a meeting last September, health-care-industry lobbyist Michael Bromberg, a protege of Rostenkowski’s, tried to persuade the First Lady to be flexible, to perhaps accept a bill that made health care affordable and easy to buy, but not mandatory. ““Any bill that passes Congress will be a credit to you,’’ he said. Mrs. Clinton coldly replied, ““Bill and I didn’t come to Washington to play the game as usual – and to fuzz the difference between universal coverage and access.''
Now the First Lady and her husband are faced with a difficult choice: whether to stick to their ““bottom line’’ demand or accept something less – and call it victory. The Clintons and their liberal allies in Congress have been counting on the pressure of the ballot box to swing wavering votes. If lawmakers fail to pass health reform, this threat goes, the voters will decide that Congress really is hopeless and vote to throw out the incumbents. The same lesson, of course, applies to Clinton – which is why, in the end, he is likely to accept a watered-down bill over nothing at all.
