The Nation : Clinton’s Role in the Search for a Better Health-Care Plan

First there was the Clinton health-care reform plan. Then came the Cooper plan and the Chaffee plan, then the Kennedy plan, and now the Moynihan plan and the Gibbons plan--all efforts to rescue, redo or revise President Bill Clinton’s approach to health care. Which one will become law, if any? Which will the President support? Stay tuned.

No one should underestimate Clinton’s legislative prowess. Messy, last-minute and tortured though the process may seem, this is a President who has shown that he knows how to work Congress and get results. His economic plan was dead in the water a half-dozen times before it passed by one vote in the Senate, two in the House. The North American Free Trade Agreement was written off as a loser, a victim of Ross Perot and the unions, before Al Gore took to the television, and was considerably short of votes until Clinton took to the phones. The crime bill was certifiably dead four days before it passed.

So it’s possible that Clinton knows where he’s going on health care--even if most everyone else seems in the dark, and a half-dozen members of Congress think they have a better approach for dealing with the problem. But he will have to show his hand soon.

Health care represents 14% of this country’s gross domestic product. Reforming the entire system in a single legislative package is bound to be messy, in the best of circumstances. But the approach of the President’s health-care task force ensured that these would never be the best of circumstances.

One reason there are so many different plans on the table is because the original Clinton plan was such a failure politically. While the President succeeded in persuading most Americans that the health-care system needed reform, his policy advisers managed to come up with a package that almost no one could understand and that offered almost everyone something to dislike.

Its complexity made it easier to attack than defend, and it was full of juicy targets. The mandatory purchasing alliances, now long gone, were the easiest to attack--because for most Americans, government bureaucracy is the problem, not the solution. The fact that the alliances played so central a role in the initial plan was testimony to its stubborn political deafness: This was created for study in the classroom, not debate on the radio. That is not how politics works.

So Democratic Rep. Jim Cooper of Tennessee and Republican Sen. John H. Chaffee of Rhode Island saw the potential to beat the Clinton plan. Sen. Edward M. Kennedy (D-Mass.), who’s been fighting this fight longer than anyone, tried to rescue the best of the Clinton plan. And now the White House is looking to the new chairman of the House Ways and Means Committee, Rep. Sam M. Gibbons (D-Fla.), and the distinguished and sometimes prickly chairman of the Senate Finance Committee, Sen. Daniel Patrick Moynihan (D-N.Y.), to see how much of it they can salvage, and sell.

The White House strategy has been to let committees of Congress move forward on their own, to see if consensus can be built through the process, before the President steps in. The liberal-leaning Senate Labor and Human Resources Committee, chaired by Kennedy, was the first to approve an entire package. But the going has been far tougher in the more important Finance Committee--where there was no working majority for any approach as of last week. Meanwhile, in House Ways and Means, the indictment of legislative whiz Rep. Dan Rostenkowski (D-Ill.) has forced the White House to entrust its most important legislative priority to the skills of a new chairman, whose best hope is to build shifting majorities for different elements.

Meanwhile, many Republicans and even a few Democrats, who initially believed that voters would expect them to be for something, have come to the conclusion that passing nothing may be to their advantage politically. Senate Minority Leader Bob Dole (R-Kan.), his finger firmly planted in the air, is playing to the concerns, the confusion and the fear that many insured Americans have about how much they stand to lose from a new system rather than how much they might hope to gain. The system may indeed be broken, but with the plethora of plans, the talk of hard and soft triggers and big numbers flying, any consensus on how to fix it can easily evaporate.

The time for presidential leadership is here. In “The Last Tycoon,” movie mogul Monroe Stahr explains how you build a railroad through a mountain. You could spend forever deciding which of a half-dozen routes is ideal. But if you want to get it done, the challenge is to just pick one plan, even for an utterly arbitrary reason, “because the mountain’s pink or the blueprint’s a better blue” and say “let’s go.”

The President must make his choices on health care--because it’s best, or even because it’s doable--and bring the Congress and the country with him. He has to explain why his choice is the choice.

Clinton has succeeded in putting health-care reform on the national agenda. The prospect of major legislation has led many insurers finally to make needed reforms on their own, and expand affordable offerings. Those are positive steps. Other Presidents might have already declared victory.

But this President wants more. In the coming weeks, he will have to tell Congress just what he wants, and convince them that, however wary their constituents, passing his plan is better than passing nothing at all. In the end, if there is no Clinton plan, there will be no health-care reform. Congress can only do so much on its own. That’s what Presidents are for.*