Clinton Unyielding on Health Benefits for All : Insurance: He says full coverage is his ‘bottom line’ requirement. Issue puts him at odds with rival plans.

President Clinton presented his health care legislation to Congress Wednesday, inviting compromise but setting out a clear “bottom line” for the coming debate--”a comprehensive package of health care benefits that are always there and that can never be taken away.”

“That is the bill I want to sign, that is my bottom line,” Clinton said. “I will not support or sign a bill that does not meet that criteria.”

In setting those two principles--comprehensive benefits and universal coverage--as his requirements, Clinton put himself in firm opposition to several alternative plans that have been introduced on Capitol Hill by conservative Republicans and some moderate Democrats. Some of those plans would provide coverage against only catastrophic illnesses, rather than the comprehensive benefit package Clinton seeks. Other alternatives aim at changing the insurance market to make coverage more affordable but would not guarantee coverage for all.

Appearing animated and energized, Clinton pounded the lectern in front of him as he reminded the audience gathered in the Capitol’s Statuary Hall of the huge toll that rising health care costs have taken on the federal budget and on the health of the U.S. economy. His plan, he insisted, should be judged not against an ideal standard but against the problems of the current system.

“None of us could devise a system more complex, more burdensome, more administratively costly than the one we have now,” Clinton said. “Let us all judge ourselves against, after all, what it is we are attempting to change.”

As he spoke, Clinton displayed a book the White House has prepared to explain the plan to Americans. In an apparent first, White House officials made the text available both as a 136-page paperback and on a computer disk. Clinton strategists hope to distribute the book widely.

As Administration officials made clear, the scope of their proposal is vast. Next year, the government estimates, the nation as a whole--families, companies and government at all levels--will spend roughly $998 billion on health care.

“Without reform, in the year 2000, we’ll spend $1.613 trillion,” Deputy Treasury Secretary Roger Altman said.

Clinton hopes to avoid that jump in expenditures by holding down costs through “managed competition,” a system designed to reduce administrative expenses and channel more Americans into health maintenance organizations and other managed systems subject to budgetary controls. Administration number-crunchers project that by the end of the decade, health care reform will begin to reduce the nation’s total spending.

“Over the long term business will spend less with reform than it would without,” Altman insisted. “The biggest business winners in this plan are going to be small businesses that already provide coverage.”

But the Administration is expecting a lot from its managed competition model and even top White House officials admit that they cannot be sure the plans would work as designed. “We think we have a good case,” said Alice Rivlin, deputy director of the White House Office of Management and Budget. “But one can’t be sure of that.”

Under the Administration’s plan, managed competition must work well enough not only to restrain existing spending but also to make room to cover those who do not now have adequate insurance. If the government ordered universal coverage immediately, which Clinton does not plan to do, covering the 37 million people who have no insurance and the millions more who have inadequate insurance would raise that spending initially by between $60 billion and $65 billion, Altman said.

The actual expenses of universal coverage would be different because the plan would be phased in. But Administration officials estimate that whatever the total bill, about 35% of the new costs would be born by businesses--primarily through providing insurance to workers who do not have it now.

About 55% would be covered by the federal government--primarily to subsidize small businesses and low-income families. Individual families would pick up the rest.

State and local governments would see their spending go down by billions of dollars a year, largely because universal insurance would mean that local governments no longer would have to pay hospitals to care for people who lack insurance.

Clinton’s plan and the various alternatives to it now face months of legislative debate before final congressional votes, which could come as early as next summer. The deliberations, said Senate Minority Leader Bob Dole (R-Kan.), will be “one of the most important debates of the 20th Century.”

The debate, Dole said, would not be over “the diagnosis” because a large majority of both Democrats and Republicans agree that the nation’s current health care system is seriously ill. Instead, he said, the argument will be over “the prescription.”

As Clinton and his top advisers seek to convince Americans that their prescription is best, they have chosen to make a virtue of the length--1,342 pages--and detail of their legislative proposal, insisting that other plans should be held to the same standard of leaving no question unanswered.

So far, the competing alternatives to Clinton’s plan fall far short of that standard. In general, sponsors of the alternative plans have not clearly spelled out the new revenues or spending cuts that would be needed to pay for their proposals--something Clinton has done. Nor have the alternatives answered some basic questions, including how their proposals would work in the real world.

Administration officials, by contrast, have become increasingly confident that they have explored the complex issue to a far greater extent and have arguments that could sink most alternative proposals.

“We have gone down a whole lot of option trails,” White House health policy adviser Ira Magaziner said during a recent interview. “And as people raise ideas, in Congress and elsewhere, the chances are that we’ve thought about it and we can say: ‘Well, we looked at that and here’s why we didn’t go that way.’ ”

The Administration plans to offer the services of its experts “to analyze other bills and alternatives with the same level of analytical dimension and economic analysis as has been brought to this bill,” First Lady Hillary Rodham Clinton said. It’s a proposal that sponsors of alternative plans may see more as a threat than an offer.

“If we are to have the kind of honest and open debate that we know we need, we have to hold every possible proposal and plan to the highest level of scrutiny to determine what it would really mean and how it would really work in the lives of Americans,” Mrs. Clinton said while introducing her husband at the Capitol Wednesday.

Behind the Clintons as they spoke were dozens of members of Congress who had agreed to be co-sponsors of the Administration’s legislation. Notable among them--strategically placed in the middle like the cherry on a sundae--was Sen. James M. Jeffords of Vermont, the only Republican co-sponsor and their only claim so far to bipartisan support for the proposal.

Both Clintons spoke of the need for the health care debate to be bipartisan and Republican leaders present at the ceremony promised to work with them. But the Republicans also made clear that the debate will be neither short nor easy.

“The long-awaited presentation of your health reform bill today is just the beginning of a long, tortuous process that must wend its way through the Congress,” House Minority Leader Robert H. Michel (R-Ill.) told Clinton.

“As the process begins, we should be clear as to what the debate will be all about. There are substantive and profound policy differences between those who support the concepts at the heart of your bill and those of us like myself who see another possibly different road to health care reform,” Michel said. “The real differences cannot be glossed over.”

Liberal Democrats, for their part, greeted the plan with complaints that Clinton had already done too much to placate conservative opponents.

As has been the case in other congressional appearances in recent weeks, the ceremony on Capitol Hill became something of a personal triumph for the First Lady as members of Congress, lobbyists and visitors pressed toward her.

“When President Clinton decided to entrust to Mrs. Clinton, the First Lady, the responsibility of preparing this legislation, some criticized his judgment in taking so central an issue to his Administration and to the country’s future and giving it in the charge of the First Lady of the United States,” said House Speaker Thomas S. Foley (D-Wash.). “Nobody questions that judgment today.”

As Mrs. Clinton praised her husband for being willing to come to grips with the health care problem, he could clearly be seen mouthing the words “I love you” to her back. Later, on returning to the White House, the couple stood together talking intently at the door to the Oval Office before heading off, separately, to their next appointments.

Times staff writer Karen Tumulty contributed to this story.

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