National Perspective / HEALTH CARE : The Doctoring Begins

And now the real work begins on Capitol Hill. Just about every congressional committee can expect a piece of the action in crafting health care reform, but the bulk of the job will be done by five panels, the first of which will take up the task next week. President Clinton’s plan is just a starting point. Indications are that the committees will produce far different versions, from which the House and Senate Democratic leadership; must draw up legislation that not only can pass Congress but also can be signed into law by a President who has vowed to veto any bill that does not guarantee coverage for all Americans. Leaders hope to have a bill to Clinton’s desk by their August recess.

House Ways and Means

This committee is the first to begin work. And even before it started, health subcommittee Chairman Pete Stark (D-Oakland) pronounced the death of the alliances, the giant purchasing cooperatives whose clout in the marketplace would help hold down medical costs.

Original plans to begin drafting legislation on Tuesday were delayed until next week as lawmakers awaited cost estimates and financing details on Stark’s alternative. His plan would focus on covering the uninsured by offering them a version of Medicare.

Rostenkowski, whose skills at bringing disparate views in line is legendary, is guided less by his views on health care than by his desire to produce something that will pass. His signals in recent days suggest that the Administration should lower its expectations, because the ultimate legislation is likely to be far less comprehensive than Clinton had hoped.

Rostenkowski, however, could be taken out of action--an irreplaceable loss to Clinton--if his legal problems result in an indictment.

House Energy and Commerce

Dingell’s dreams of health care reform go back more than a half-century to the national health insurance legislation that his congressman father introduced in the 1940s.

However, members of the health subcommittee of Energy and Commerce are far less amenable to the idea, in no small measure because Dingell loaded the panel with moderate and conservative Democrats in the 1980s. He did so to counter the influence of subcommittee Chairman Henry A. Waxman (D-Los Angeles) during a battle over the Clean Air Act.

Now Waxman, one of Clinton’s chief allies in Congress, finds himself unable to overcome his subcommittee’s opposition to Clinton’s proposed employer mandate, which would require employers to provide health insurance to their workers, and to the President’s plan to control costs through premium caps. One member of the subcommittee, Jim Cooper (D-Tenn.), is touting an alternative that has won at least tentative support from business and is being seen as the chief rival to the Clinton plan.

As a result, it appears that he and Dingell may have to bypass the subcommittee altogether and write the bill at the full committee level.

House Education and Labor

For Ford, who is retiring this year, passage of sweeping health care reform could be the crowning achievement of a half-century political career as a champion of social legislation.

The most liberal of the major House committees to deal with major portions of the health bill, Ford’s panel is where Clinton’s plan will have the easiest time. For the same reason, the committee is somewhat out of touch with more mainstream concerns about the Clinton plan in the House, and the panel’s influence on the final result could be limited.

Nonetheless, swift and easy passage of the President’s plan through the committee, which is expected some time after Easter, could give the Administration a badly needed psychological and public relations boost at a time when it may need it most.

Senate Finance Committee

This is probably the committee to watch most closely. With only an 11-9 Democratic majority, Moynihan cannot afford to lose a single vote. The chairman himself has made no secret of his own reservations about the Clinton plan, at one point describing its financing as “fantasy.”

The Democrats on the committee include John B. Breaux (D-La.), chief sponsor of the Cooper plan in the Senate. Among the Republican members are Minority Leader Bob Dole of Kansas, Clinton’s most powerful opponent in Congress, and John H. Chafee of Rhode Island, who is sponsoring the most moderate GOP alternative.

At the same time, fighting for the Clinton plan on the committee will be some of the President’s closest health care allies, including Majority Leader George J. Mitchell (D-Me.), whose position will give him a crack at reshaping the legislation before and when it reaches the Senate floor.

Moynihan can be expected to try to bridge party lines with a compromise that could win at least a few GOP votes. However, that would certainly mean sacrificing some Clinton principles--probably the alliances, premium caps and the size of the employer mandate.

Senate Labor and Human Resources

Kennedy, who was a voice on health care reform long before it moved to the political forefront, has put aside his own preference for a more radical Canadian-style, government-financed system. Kennedy sees the President’s approach as the first real chance for significant change and does not want to let the opportunity slip away.

Kennedy’s backing is also important beyond his committee, because he is the most powerful member of the Senate’s liberal bloc. Once the bill gets to the Senate floor, Kennedy can be expected to sway about a dozen votes. That influence may be needed if the final bill proves to be less than the left had hoped.

The White House is also counting on Kennedy, with his instant name recognition, to help sell the plan to the public.

If anything, his committee may try to pull the Clinton plan further to the left, with more government involvement and richer benefits. Yet the further it goes in that direction, the less likely it is to pass when put to a vote by the Senate as a whole, which is far more conservative.