Clinton Says He’s Open to Change in Health Bill

President Clinton, on the eve of unveiling a health care reform plan that could rank with Social Security in its sweep, expressed confidence Tuesday that Congress will rise to the challenge but emphasized his willingness to negotiate on the details.

“I believe very strongly that this is a moment when it is likely to occur,” Clinton said of health care reform, “because I think there is a clear consensus that the problems that exist--in the escalating costs and the escalating dysfunctions, with more and more losing their health insurance every month--are greater than the cost of change.”

The President and Hillary Rodham Clinton, who headed the White House Task Force on National Health Care Reform, spoke optimistically about the program’s chances of congressional passage at a White House luncheon for a small group of journalists.

“This plan is designed, first and foremost, to provide health care security,” the President declared, sounding a theme he is likely to repeat again and again in the long battle over his plan. Clinton noted that the nation has debated the health care issue since President Franklin D. Roosevelt introduced the first bill to provide both Social Security and health care 60 years ago.

Mrs. Clinton said “universal health care as soon as possible” is the one non-negotiable proposal in the agenda.

The First Lady also revealed that she and the President intend to publicly sign “living wills,” which direct doctors not to go to extreme lengths to prolong life in patients who are terminally ill, as a way of encouraging “better informed decision-making in the last years and moments of life” by all Americans.

Clinton, who also spent a good part of the day briefing many broadcast journalists, including radio talk show hosts from around the country, reiterated in an interview with MTV that the standard benefits package contained in his plan “will guarantee that most plans will cover abortion.”

With the issue of abortion coverage looming as one of the major controversies surrounding health reform, Administration officials and members of Congress already have begun a behind-the-scenes search for a compromise to defuse the volatile question.

Under discussion is a proposal to require, as the President’s plan now does, all health plans to offer abortions under the heading of “pregnancy-related services.” But the premium for abortion coverage would be isolated--as an option that would be paid for directly by those desiring such coverage--sidestepping the explosive issue of spending tax dollars directly on abortion, sources said.

Administration analysts have calculated that insurance coverage for abortions would come to roughly $5 per year for an individual.

No such provision will be included in Clinton’s presentation tonight. But if the plan that finally emerges from Congress were to work that way, abortion opponents would not be able to claim that their money was going to pay for a procedure they regard as immoral. On the other hand, “at $5 per year, you would not be in the position of denying access to anyone,” one White House official said.

During their lunch with reporters, Mrs. Clinton, who earlier had told reporters she expects Congress to pass health care reform before next year’s congressional elections, suggested there may be room for negotiations over the actual speed of phasing in coverage for the 37 million Americans who are currently uninsured.

The President’s plan calls for universal coverage by no later than Jan. 1, 1998. But Mrs. Clinton said Tuesday: “These are all things we are open to talk about.”

At that point, the President quickly chimed in: “You will never get the maximum savings envisioned by this plan until you have universal coverage. Until you have universal coverage, you won’t have the benefit of everybody being in, bulk buying. And until you have universal coverage you will not have an end to cost shifting.”

The First Lady also seemed to leave some room for compromise on the Administration’s proposal to require employers to pay at least 80% of their employees’ insurance premiums, with the workers picking up the rest.

“I think what is non-negotiable is a fair and responsible way of funding the system,” Mrs. Clinton said. “We think the employer/employee contribution is the best way of doing that. But if there is a better way out there to get it done . . . .”

This evening, before a joint session of Congress and a nationwide television audience, the President will formally unveil his plan, which, if it is passed, would likely change the way virtually every American receives and pays for health care from what is now a $900-billion industry.

The Clintons, who discussed their reform agenda during an interview that lasted well over an hour, vigorously defended the budgetary figures behind their proposals, which project $700 billion in savings after seven years--estimates that have aroused considerable skepticism among health analysts, economists and some members of Congress.

“There have never been any numbers produced that are grounded in more analysis than these,” Mrs. Clinton said.

Calling the financial projections “honest,” the President added: “We decided from the get-go when we began this process that we had to have integrity of numbers.”

Nevertheless, Clinton conceded without elaboration: “There is still some uncertainty in there.”

The White House Tuesday also trotted out its top economic team members to defend the projected costs and savings.

Deputy Treasury Secretary Roger Altman said that if the numbers don’t work out, the Administration will cut back on the costs of the health plan--and restrict benefits--rather than propose more taxes to make up the difference.

Budget Director Leon E. Panetta said that under the Clinton plan, the federal government will be responsible for roughly $350 billion in spending between 1995 and 2000 to cover a range of new benefits: $80 billion for long-term care for the elderly and the disabled; $72 billion for prescription drug benefits for Medicare recipients; $29 billion in public health “investments,” such as new spending on community clinics; $9 billion to pay for 100% tax deductions for insurance coverage for the self-employed; and roughly $160 billion for subsidies for small business and low-wage workers.

Panetta conceded that estimates for the subsidies still need to undergo further scrutiny by the Office of Management and Budget.

Although some White House officials have hinted that Clinton plans to propose taxing both cigarettes and alcohol to generate $105 billion over five years to help finance health reform, the President mentioned only a cigarette tax.

“I’ve always thought there ought to be a cigarette tax and I’ll propose one, but it won’t be a big part of it. We don’t need a lot of money . . . “ he said.

Asked about a tax on alcoholic beverages, Clinton said, “There might not be one. I never said there would be.”

Administration officials said the President’s delay in making a final decision on so-called sin taxes largely has to do with the uncertainty over how many of the nation’s large businesses might opt to set up their own health insurance purchasing alliances. Such “corporate alliances” likely would be assessed a fee of as much as 1% of payroll, and those funds are expected to contribute to the $105 billion in new revenue the Administration needs in order to finance health reform.

Under Clinton’s agenda, the federal government would supervise the creation of large, regional alliances of health care consumers. These cooperatives would shop among provider networks for the best insurance plans on behalf of members.

On the politically charged question of whether his plan will lead to job creation or job loss, Clinton demurred.

“We believe very strongly that rationally it is a net job gainer, because we believe that instead of paying more money for the same health care, if people have the same amount of money to invest in something new, then it only stands to reason that in the aggregate you’ll have more jobs created. But there is no, frankly, no available modeling for this sort of stuff,” Clinton added.

For example, Clinton asked, “What happens if you lower the insurance premiums to the self-employed couple who have a flower shop? Do they hire somebody else, do they buy more flowers? There just aren’t any economic models that we know of that answer all these questions.”

Times staff writers David Lauter, James Risen and Karen Tumulty contributed to this story.

* PRESIDENT ON TV: Clinton’s health care address will be broadcast live at 6 p.m. on ABC, CBS, NBC, CNN, C-SPAN, C-SPAN II and PBS.

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