The Clinton Reducing Plan

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Merchants say the Clinton mandate would require them to spend an extra $18 billion a year on health insurance. And confidential, computer-aided studies by the White House estimate that the mandate would reduce employment growth by 300,000 to 600,000 jobs. Robert Moffit, a health-care expert at the Heritage Foundation in Washington, calls mandates a "sham" and a "delusion." Says he: "The major game in health-care financing is to hide the costs by making sure that other people appear to be paying the bills. Well, any increase in employer mandates will be passed on to workers in the form of reduced compensation or job loss."

Moffit's group proposed expanding health coverage through an "individual mandate" like the one that requires drivers to carry liability insurance. It would require coverage only for medical bills in excess of $3,000 a year, which would make such insurance more affordable. The Heritage plan has attracted few sponsors in Congress, but Senator John Chafee, the Rhode Island Republican, calls for an individual mandate in his health-reform plan, which has drawn support as a vehicle for bipartisan compromise.

Majority leader Mitchell, after sitting through weeks of Moynihan's professorial perorations without seeing much legislative progress, has thrust himself into the leadership void. Among Mitchell's suggestions was a compromise that would combine an employer mandate for large firms (a face- saver for the Clintons, since most large firms already provide health insurance) and an individual mandate for workers in firms with fewer than, say, 10 on the payroll. Federal subsidies would help employees pay their premiums.

Meanwhile, other Senators last week argued that a plan to foster so-called & managed competition in health care should be given a chance to work, with little or no provision for mandates. The Congressional Budget Office estimated that this proposal, sponsored by Representative Jim Cooper of Tennessee and Senator John Breaux of Louisiana, would reduce the cost of insurance, in part through $30 billion in subsidies, enough to extend coverage to 91% of Americans. The Cooper-Breaux plan got another boost last week from a new study by Lewin-VHI, a respected consulting firm, which found that the 9% who would remain uninsured would be mainly young, healthy adults and others who consume little health care.

Clinton heard support for a variation on this approach last Thursday afternoon during a 45-minute private session in the Oval Office with Senator Dave Durenberger, a Minnesota Republican on the Finance Committee. To pass health reform, Durenberger told Clinton, "you have to start in the middle, even if that doesn't get you to universal coverage" immediately. Other Senators suggested that Clinton accept something less coercive, like Cooper- Breaux, but include a "trigger" that would impose a partial employer mandate if near universal coverage is not accomplished in a year or so. Though noncommittal, Clinton said he was willing to negotiate the definition and timing of universal coverage.