A Bloody Clash of Egos

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To everything there is a season. And on Capitol Hill, where legislators are eager to reap the rewards of passing landmark health-care legislation, this is the season to sow -- discord, that is. Currently, five Senate and House committees, each with jurisdiction over health-care legislation, are jostling over the details of "purchasing alliances," "payroll taxes" and "employer mandates," all in an effort to invent the plan that will eventually supplant the Clintons' hopelessly complicated 1,342-page proposal. The lawmakers all know the President is intractable on only one point: universal coverage. Each senses that the American public will balk at a plan that is too bureaucratic, too byzantine or too pricey for taxpayers. And each hopes to make the books as the brains behind historic legislation. Not surprisingly, all of this is rapidly giving way to a bloody clash of egos.

Take, for instance, the long knives that flashed last week. Eager to be the first legislators to craft a concrete proposal, the Democratic members of the House Subcommittee on Health have been slaving late nights for two months. But before the panel's four Republicans would let their objections go down to defeat, they staged a bit of theater last Wednesday that was pointedly designed to embarrass President Clinton. Calling for a formal vote on the White House plan, the Republicans each voted nay. The seven Democrats, as unwilling to join the mutiny as they were uneager to embrace Clinton's expensive proposal, were forced to vote "present."

Later that day, the Democrats got their revenge. Prodded by subcommittee chairman Fortney (Pete) Stark of California, they pushed through a plan that expands Medicare to achieve universal coverage while cutting back substantially on the White House's proposed benefits to hold down costs. Gone are such high-price items as long-term care and limits on out-of-pocket expenses for catastrophic illness. Under this plan, Medicare patients would foot 20% of their home-health-service bills, which is double what Clinton envisioned. The resulting savings of $6 billion, coupled with a cigarette-tax hike of $1.25 a pack, which would raise $16 billion in annual revenues, provides enough wiggle room to ease the burden on small-business owners. As Clinton had hoped, Stark's plan still requires all companies to pay 80% of insurance-premium costs for their employees; those with fewer than 100 employees have until 1998 to comply while larger employers must meet a 1996 target date.

The survival of two central elements of the White House plan -- universal coverage and employer mandates -- gives Clinton's health-care campaign a much needed boost. But the subcommittee's nipping and tucking bodes ill for some of the President's bolder schemes. Purchasing cooperatives, which would have been mandatory for small and mid-size companies, were made optional. Clinton's vague talk of a broadly-based payroll tax was trimmed back to a 1% levy on self-insured companies with more than 1,000 employees. And parity for mental- health costs was dropped. Still, says House majority leader Richard Gephardt, "it's clear that for all of the public pronouncements and cynical assessments, Congress is actually moving forward on health reform, quietly, deliberately and responsibly."