VIEW FROM WASHINGTON / JAMES RISEN : Insight : With Clinton Health Plan on the Outs, Congress Plays 52 Pickup

That dull thud you just heard coming from Washington was the sound of the Clinton health care plan being dropped into the congressional dustbin.

The end came quietly for the most ambitious and detailed piece of social legislation to emerge from the White House in at least a generation. In a private White House meeting in mid-June, Sen. Daniel Patrick Moynihan (D-N.Y.), chairman of the Senate Finance Committee, and his sidekick, ranking committee Republican Sen. Bob Packwood (R-Ore.), told the President that Clinton-style reform couldn’t pass either their committee or the full Senate.

Progress in other congressional panels, notably in the more liberal House, was only masking the trouble that awaited down the road in the Senate, the senators warned. The intricate plan crafted by White House health care guru Ira Magaziner and his team simply wouldn’t fly. It was time, they said, for compromise.

But don’t mourn health care reform. Rather, think of the death of the Clinton plan as just the end of the beginning for reform.

Now, a fresh political and legislative process is under way, one over which the White House has far less control. That process may prove so slow that President Clinton is disappointed in his bid to win passage of a broad health care plan this year. But the momentum for some kind of change is strong, and so Clinton still may get a chance to declare some kind of victory.

Next comes the really hard and ugly part--the jockeying, wheeling and dealing, in which the Clinton Administration and Congress have to sort through the morass of competing health care proposals floating around Washington in order to strike a deal. In all likelihood, that deal will acknowledge Republican and business opposition to a mandate that corporations provide their workers with health coverage while still trying to accommodate--in some form--Clinton’s demand that reform include universal health care coverage.

In the meantime, the health care news from Capitol Hill is maddeningly incremental, terribly confusing and can be easily misleading. (Don’t tell my editors, but here is a bit of heretical advice: You can skip the daily health care stories for several weeks until the smoke clears.)

A recent Washington Post editorial had it about right: “On alternate days for the next few weeks--sometimes the same day--you’re going to read that health care reform is hopelessly bogged down or finally making some progress; that the Democrats--or was it the Republicans?--are newly united/in disarray; that the President or chairman of the Senate Finance Committee or Bob Dole, or someone, is getting either good or bad marks. . . . It will all be true. . . . You need to preserve a sense of detachment for awhile.”

So what will the health care plan that emerges look like? That, of course, is the $64 question in Washington these days; even the outlines of a possible compromise are only dimly visible. Still, it seems timely to speculate on where this summer’s grind-it-out congressional action ultimately may lead.

If agreement does come, look for it first in the arena of insurance industry reforms. Generally, both Republicans and Democrats are willing to demand more of the nation’s health insurers. A bipartisan agreement might be reached to impose such new rules as requiring that insurers not turn away people with pre-existing conditions or that the industry accept so-called “community rating,” under which insurance premiums are evened out across an entire community, reducing or eliminating disparities between premiums paid by the healthy and those paid by the seriously ill.

Such reforms could address at least some of the most serious and heart-rending problems faced by American families today--without requiring a big new federal presence in the health care industry.

Some new compromise that could give Clinton at least the appearance of having achieved universal coverage also may be possible. Clearly, an immediate move to an employer mandate for health care coverage--which the Administration initially saw as critical to achieving universal coverage--seems unlikely. Clinton simply never won over enough business support for the mandate to have a good shot in the Senate.

One helpful move might be for Clinton to back away from his insistence on universal coverage. Would coverage for 90% to 95% of Americans--up from today’s 85%--be good enough? That is not a trivial question. If the President shows flexibility on this score, he may be able to achieve his goal of enacting meaningful health care reform.

And what of the latest compromise idea now on Capitol Hill--the so-called employer-mandate “triggers?” With a trigger, an employer mandate would kick in at some future date only if more modest insurance industry reforms failed to achieve universal access.

Republicans and business groups remain solidly opposed to a trigger. But a very “soft trigger” that went into effect only under very tightly controlled conditions might be negotiable. Another alternative--a modified form of mandate on individuals rather than businesses--also might be acceptable.

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Indeed, a bipartisan group led by Sen. John Chafee (R-R.I.) in the Senate Finance Committee--the most critical congressional choke point for health care reform--has worked hard in recent days to forge a plan that would meld several strains of compromise. The notion: A mechanism that would trigger individual mandates if coverage for 95% of Americans is not achieved soon after the turn of the century.

The Chafee compromise failed in its first go-round in the Finance Committee in late June, but it nonetheless seemed to offer the elements that a future compromise might build upon.

Significantly, Sen. David Boren (D-Okla.), one of the thorns in Clinton’s side on health care and a key member of the panel, seemed to like the Chafee approach. His support signaled, perhaps, that gridlock might be avoided. Boren noted that he liked the idea that the compromise involved “minimal amount of government intrusion,” adding that phased-in reforms were the way to go.

“I don’t think any of us has the confidence. . . . that the government has all the answers to move now in a way that would lock us into only one possible course of action,” Boren declared.

If Boren’s gradualist vision becomes reality, the grand irony of health care reform will be this:

Bill Clinton will have to decide whether to take credit for the kind of incremental change George Bush proposed--and candidate Clinton ran against in 1992.