Clinton Holds Tutorial in Thanks for Key Vote : Politics: He brings charts, aides and a hidden agenda to district of a congresswoman who put his economic plan over the top. She is now in trouble.

In an appearance designed both to pay off a political debt and to derail congressional momentum for ever deeper budget cuts that could imperil his health care reform proposal, President Clinton on Monday attended a conference on federal spending hosted by the first-year member of Congress who cast last summer’s deciding vote on his economic plan.

Democratic Rep. Marjorie Margolies-Mezvinsky represents a largely wealthy, suburban district outside Philadelphia--one of only three in the nation where more people had their taxes raised by Clinton’s economic plan than saw them cut. She asked Clinton not for new federal building projects, grants or contracts in exchange for her 218th vote in favor of the budget, but for something proverbially cheaper--talk.

And talk Clinton did, leading an hour-long round table discussion on health care spending after a 35-minute opening statement during which he displayed some of his favorite multicolored charts and graphs. Clinton was joined by some of his most senior Administration officials--including Leon A. Panetta, director of the White House Office of Management and Budget; OMB deputy director Alice Rivlin; Health and Human Services Secretary Donna Shalala and Laura D’Andrea Tyson, who chairs the Council of Economic Advisers.

In the midst of the talkathon, the White House had a serious message to deliver: Health care reform must take precedence over further efforts to reduce the deficit.

The White House is increasingly worried that budget deficit hawks will stampede Congress early next year into voting for deep cuts in the growth of entitlement programs--such as Medicare and Medicaid--going far beyond the scope of Clinton’s deficit-reduction plan passed last summer. Many moderate Democrats, especially freshman lawmakers like Margolies-Mezvinsky, voted for Clinton’s budget only reluctantly and were frustrated that it did not include more spending cuts.

Thus, the focus of Margolies-Mezvinsky’s conference Monday was entitlement reform. The event was attended by many of the nation’s leading deficit hawks, including two former senators, Democrat Paul E. Tsongas and Republican Warren B. Rudman. The ex-lawmakers are co-chairmen of the Concord Coalition, which hopes to increase grass-roots support for budget cutting. Tsongas, Rudman and most other deficit hawks agree that the uncontrolled growth of entitlements like Social Security, Medicare and Medicaid is the leading cause of the budget deficit.

“This is about jobs,” observed Sen. Bob Kerry (D-Neb.), chairman of a bipartisan commission on entitlement reform and the final vote for Clinton’s budget in the Senate. “Unless we control the deficit, we won’t make the economy productive again and we won’t control the deficit unless we do something about entitlements.”

Indeed, the surging growth of entitlement spending over the last decade has frustrated every previous effort at deficit reduction in Washington. Entitlements were left unchecked by the 1990 budget agreement--which failed in its goal to reduce the deficit. Many critics warn that the same fate awaits Clinton’s deficit plan, which also did not cap entitlement spending. Such mandatory spending now accounts for 62% of the budget. Medicare alone eats up $1 of every $10 spent by the federal government.

But the Clinton Administration wants to hold off further cuts in entitlement programs now so that it can use those savings later to help pay for its health care reform plan. So while Clinton and his aides politely paid off their debt to Margolies-Mezvinsky--whose reelection is considered in doubt because of her budget vote--their real agenda was to derail any efforts at entitlement reform before Congress gives the President a chance to get his health care reform plan off the ground.

Clinton argued during the session that slashing Medicare and Medicaid without providing universal health insurance would fail to solve the real problem of spiraling health costs. Only by slowing the growth of health entitlements within the context of a broader reform effort can Washington avoid a massive shift in health costs from the government onto the private health care system, he insisted.

“We could bring this deficit down. . . . We could just cut how much we’re going to spend on Medicare and Medicaid, even though it’s an entitlement,” Clinton said. “We can just take ‘er down. But if we do that, those costs will be shifted by the health care providers to the people who already are providing insurance--with the impact that it will be a hidden tax increase on businesses and on employees. . . . That is why our Administration has argued that if you really want to solve this problem, you have to go back and have comprehensive health care reform.”

Yet White House officials conceded they have their work cut out for them if they are to head off further efforts at deficit reduction in 1994.

Kerry and Sen. John C. Danforth (R-Mo.) are committed to developing a bipartisan entitlement reform plan that Congress can vote on next spring. Meanwhile, Congress seems certain to vote on a balanced-budget amendment to the Constitution early next year. And Rep. Timothy J. Penny (D-Minn.), who also attended Monday’s conference, plans to revive his efforts to slash as much as $90 billion more from entitlements and other programs over the next five years; Penny’s budget package fell just five votes short of passage in the House in November.

The White House, however, is counting on the fact that when lawmakers see just what entitlement cuts would do, many will back away. For instance, Kerry and Danforth, as well as Tsongas and Rudman, have endorsed a proposal to make the affluent pay more for Medicare and other entitlement benefits, but such “means-testing” of broad-based programs always has been extraordinarily controversial in Congress.

“I think there is a lot of support for entitlement reform but there is not much support for what is required to get there,” noted one White House official.