Key Health Reform Committee Fires Up : Legislation: President delivers a spirited sales pitch for his proposals as bill-drafting process begins. Special interests escalate lobbying efforts.

More than five months after President Clinton unveiled his controversial health reform agenda, the legislative machinery ground into action Tuesday as a key congressional panel began considering an approach that preserves Clinton’s goal of universal coverage but rejects some of the means he had proposed for getting there.

As the House Ways and Means health subcommittee went to work, the President delivered a spirited sales pitch for his proposals, urging “naysayers and pessimists” not to be “quite so fast” in dismissing the chances of comprehensive health reform.

“I have seen a lot of endeavors in which I was involved over the last 15 years given up for dead, including my own political endeavor,” Clinton told a group of executives.

With the drafting of health reform legislation finally under way, a dizzying array of special interests have escalated their lobbying efforts on Capitol Hill, jockeying for attention. Among them are doctors, dentists, hospitals, women, tobacco workers and consumer advocates.

Clinton, in a speech to the American Society of Assn. Executives, described how the many key elements of his plan mesh to form a comprehensive agenda that he said would lower aggregate medical spending, increase consumer choice, enhance the quality of care, relieve providers of burdensome paperwork and ensure universal coverage.

The President also defended several specific pillars of his plan that many in Congress say have little or no chance of passage: a cap on insurance premiums, a requirement that employers pay at least 80% of a worker’s premiums and the creation of mandatory health insurance-purchasing alliances.

Clinton said that the employer mandate builds on the current system “because that’s where nine of 10 Americans who have insurance already get it.”

And by pooling consumers into large purchasing cooperatives, members will be able to buy less expensive insurance and have a choice of plans, he said.

Unless every American is covered, Clinton added, providers will continue to shift the uncompensated cost of treating the uninsured onto those who have insurance--through higher, hidden charges.

“That is why I have said that I cannot sign--and indeed would have to veto--a bill that pretended to reform the health care system without providing a system by which everyone is covered. Because--unless everyone is covered--there is no cost control, there is no end to cost shifting, there is no real security and there is no balance in the system,” Clinton said.

Although at least three separate committees will be considering health reform legislation, it is the Ways and Means Committee that House Democratic leaders regard as the critical bellwether of how health care reform will fare in the House at large.

Health subcommittee chairman Pete Stark (D-Oakland) wants to achieve Clinton’s primary goal--health coverage for all Americans--through different means. Rather than requiring most Americans to get their insurance through government-organized purchasing cooperatives, Stark would achieve universal coverage by expanding the Medicare program to cover the uninsured.

Like Clinton, Stark would require employers to contribute toward their workers’ coverage. But Stark’s plan offers a less comprehensive package of benefits. While precise cost estimates are not yet available, he said that the annual cost of insuring an individual would be about $1,800--or $300 less than Clinton’s plan is projected to cost.

Stark said that his proposal “builds upon the best features of the President’s plan, as well as the current system.” But he conceded that his plan, like Clinton’s, lacks the votes it needs to pass his subcommittee.

The panel could take up to two weeks to draft the legislation. And actual voting may not begin until next week. In the meantime, health care lobbying is quickly picking up steam. The American Hospital Assn. has launched an ambitious grass-roots advocacy campaign, designed to mobilize 5,000 member hospitals--and their 4 million employees--to promote the association’s health care reform principles at the local level.

The group generally supports the employer mandate but opposes mandatory health alliances, premium caps and Medicare cuts.

More than 1,000 dentists and physicians also are here this week. Members of the American Dental Assn. are specifically pushing for federal funding to cover dental treatment for low-income residents and for elderly Americans.

The most noticeable presence are the 800 doctors attending the annual American Medical Assn. lobbying conference. Among the AMA’s health reform goals are antitrust relief and malpractice reform, namely a $250,000 cap on non-economic damages in malpractice suits.

But even as the doctors were convening, consumer advocate Ralph Nader called a press conference to denounce such a cap, calling it “a hidden time bomb that will drastically restrict the legal rights of health care consumers.”

The AMA, the nation’s largest doctors organization, also supports universal coverage, consumer choice of providers and a lessening of government regulations, particularly in the physician-patient relationship, said James S. Todd, executive vice president.

In a sign of the AMA’s clout, a steady stream of key members of Congress spoke at its session. They included Sen. John H. Chafee (R-R.I.), an influential GOP figure on the issue; Rep. Jim McDermott (D-Wash.), sponsor of the Canadian-styled, single-payer plan; Rep. Jim Cooper (D-Tenn.), sponsor of a leading rival plan to Clinton’s; Sen. Edward M. Kennedy (D-Mass.), and Senate Minority Leader Bob Dole (R-Kan.).

Speaker after speaker said that Clinton’s plan needs major revisions. Among them was Rep. John D. Dingell (D-Mich.), the designated White House representative to the doctors. “The legislation submitted by the President is going to be rewritten” because of its “many flaws,” declared Dingell, chairman of the House Energy and Commerce Committee.

First Lady Hillary Rodham Clinton was invited, as were many Administration officials, but none accepted, AMA officials said.

Separately, the Congressional Women’s Caucus said that coverage for mammograms must be broader than currently proposed in most of the pending plans.