Clinton May Tour to Push His Health Plan

Concerned that a health care initiative might be crippled by organized opposition before it gets off the ground, President-elect Bill Clinton’s advisers want him to embark on an aggressive campaign to sell his program directly to the people rather than push it solely through the legislative process, sources said Monday.

Assessing the resistance from special interest groups as well as competition from other plans already in Congress, many of the advisers have concluded that enacting health care reform may be much more difficult than an economic stimulus package, Clinton’s other top-drawer priority.

As a result, some are proposing a nationwide tour for themselves and selected health experts--possibly joined at points by congressional leaders and by Clinton himself--to conduct public forums and generate grass-roots support, sources said.

During the presidential race, Clinton repeatedly promised--often in fiery, populist tones--to provide universal health insurance while curbing escalating costs and to “take on” insurance companies, doctors, drug manufacturers and other health care providers. He made the health crisis a centerpiece of his campaign and cited it at length in each of the presidential debates.

But the details of a plan remain to be developed. And well-entrenched opponents, who have fended off previous health insurance initiatives, are preparing a vigorous lobbying effort to block it. Hammering out a concrete proposal and a strategy to guide it through the process will be high on Clinton’s agenda once he has finished putting together a transition team and structure, advisers said.

The advisers said Clinton is expected to send his health care reform plan to Congress in the first 100 days of his presidency. They said its outlines will not emerge soon--in part because Clinton must still blend the key elements he wants into a coherent plan.

Already, anticipation is mounting over what could be one of the most telling clashes of the new Congress.

“There’s just no time to waste,” Sen. John D. (Jay) Rockefeller IV (D-W. Va.), a leading congressional authority on health care, said Monday. A health care reform package, he added, “has to be out” within the first 100 days.

Although Clinton has been campaigning on the health insurance issue since the early days of the presidential race, his views on the best reform approach have been evolving.

Earlier this year, he more or less aligned himself with a “play or pay” proposal advanced by Senate Majority Leader George J. Mitchell (D-Me.) that would require employers to provide health insurance or pay a tax that would be used to buy insurance for those unable to get it through their employers.

Clinton now backs what is generally called “managed competition,” a catchall term essentially referring to the clustering of small groups into large purchasing entities with the economic clout to negotiate reduced fees with participating doctors and hospitals that, in turn, would emphasize preventive care and wellness programs.

Clinton now also must figure out how to cap total health care spending by, for instance, limiting hospital and physician fees--among the toughest issues he will face, experts say.

“He’s going to get lots and lots of conflicting advice--not just philosophical, but technical advice,” said Dr. Paul Ellwood, founder of the influential “Jackson Hole Group,” a private coalition of health care experts widely credited with making the managed competition idea popular.

“He will have to decide just how much excess medical care there is and can you indeed reduce volume of health care (services) without adversely affecting quality and just how much fat is there?” Ellwood added. “Some doctors will tell him: ‘None. We should be doing more.’ But I and many others say it’s 30% to 50%.”

The magnitude of the challenge facing a Clinton White House has not eluded either his advisers or the legions of health care analysts and lobbyists now gearing up for what promises to be an epic battle between a President with a new mandate and industry groups with huge resources and lobbying experience.

Said former Louisville, Ky., Mayor Harvey Sloane, a physician and reform advocate: “It’s an $800-billion gorilla that doesn’t want to change its position, and there are a lot of PAC contributions to key members of Congress. And so everybody’s going to have to compromise and nobody’s going get everything they want.”

Despite formidable odds, Rockefeller and many others said a window of opportunity is there.

Clinton will be aided in his effort by the presence of more than 100 new members of Congress, some of whom campaigned on the issue of providing broader health care protection, said Marilyn K. Yager, chief Washington lobbyist for the Massachusetts Hospital Assn.

“That’s going to be a real asset--if Clinton can pull a coalition together,” she said.

Many analysts on Monday hailed the emerging consensus among Clinton’s health care advisers that he needs to aggressively woo public support for reform.

“It’s really important to speak to the public,” said Rick Smith, a health care expert at the Washington Business Group on Health.

“You have to build a base of public understanding to make this happen,” agreed John Rother, legislative director for the American Assn. of Retired Persons.

Jeremy Rosner, a health policy analyst at the Progressive Policy Institute, a think tank here with close ties to Clinton, hailed the idea for a full-scale presidential campaign for health care reform. “It’s a good idea because I think it’ll take time for the public and Congress to digest it,” he said.

“After all, you’re talking about tackling a seventh of the gross national product,” he added, referring to the estimated $800 billion spent annually on health care. “But I think there’s a great sense out there that people want to get something done.”