Ready to Operate

Not since Moses came down from the mountain bearing the Ten Commandments, Hillary Clinton joked last week, has a document been so anxiously awaited as her husband's proposal to reorganize radically the nation's ailing health-care system. That plan -- a 239-page brick of plain white paper printed last Tuesday and stamped PRIVILEGED AND CONFIDENTIAL -- would represent the boldest, most expensive social initiative since the New Deal, bigger even than F.D.R.'s institution of Social Security half a century ago. It would intimately affect the health and livelihood of every American, while shifting billions of dollars in costs and savings among the country's biggest industries and tiniest shops. And despite occasional press leaks, the First Lady, assigned by the President to oversee health reform, jealously guarded the full text of the proposal.

Until last Thursday. On that day, Mrs. Clinton visited Capitol Hill to persuade key Congressmen that she welcomed their suggestions. But Fortney Stark, the irascible California Democrat who chairs the House health subcommittee, complained that he could not seriously study the plan under Mrs. Clinton's ground rules: that legislators could see it only in guarded "reading rooms" in the Capitol, where they would be forbidden to make copies or take notes. By early evening, majority leader Dick Gephardt ordered that they be given copies of the plan. And by 6 p.m., copies of those copies began making their way to news organizations, including Time.

While many details had been published earlier, those stories failed to convey the proposal's sheer size, audacity and intrusiveness into personal and business decisions. The plan, which President Clinton is scheduled to announce next Wednesday night, would push Americans away from private doctors and into less expensive group medical practices such as health-maintenance organizations. It would hold down the income of many doctors, hospitals, insurers and drug manufacturers through stringent federal cost controls. It would dramatically cut health-care costs for many large, high-wage companies such as automakers. But those costs would increase for many mom-and-pop businesses that now pay nothing toward their workers' health insurance and would be forced to do so under Clinton's proposal.

Overall, the President's plan would cost a budget-boggling $700 billion over five years, half of which represents new spending. Clinton proposes to cover the cost mainly through a new $1-a-pack tax on cigarettes and savings in existing federal health-care programs, with $91 billion left over to reduce the federal budget deficit. Meanwhile, the plan promises to:

Guarantee a generous, minimum package of health insurance to all Americans. The 37 million people who now lack health insurance would be covered either through their employer (85% of the uninsured are workers and their dependents) or through expanded welfare schemes. The basic package of benefits would be comparable to that offered by most major corporations and would include extra benefits for primary and preventive care. Well-baby visits and annual physicals, for example, would be covered with no out-of-pocket cost. The U.S. is the only industrial democracy that does not provide such universal coverage, a situation that Clinton has decried as "a national disgrace" and that spurred him more than anything else to reform the system.