Clinton Aides Take Aim at Dole in Health Care Battle : Strategy: Effort is aimed at focusing on choice between universal coverage and incremental reform. Some officials see risks.

The Clinton Administration on Thursday unveiled its strategy for the next crucial phase of the battle over health care reform--attack Senate Minority Leader Bob Dole (R-Kan.).

For months, White House officials have writhed in frustration as the “Clinton plan” became a label that a majority of Americans reject, even as polls show many continue to support key elements of what Clinton has proposed: universal coverage, requirements that companies provide insurance to workers and cost controls.

The problem, Clinton and his aides have argued, has been that their plan was being measured not against competing proposals, but against each American’s ideal of a perfect system. For White House officials, that problem was epitomized by the highly successful “Harry and Louise” television ads, which criticized Clinton’s plan but, instead of offering a specific alternative, proclaimed only that “there must be a better way.”

But while Administration officials do not believe that they can win a battle of “Bill Clinton versus Harry and Louise,” they think they may be able to win “Bill Clinton versus Bob Dole.” In talks with reporters, White House aides and Clinton advisers set about joining that battle with gusto.

“The Dole-type proposals take care of the rich because they can always buy (insurance), take care of the poor because they have governmental programs that can take care of them, and leave the middle class in great jeopardy,” White House Deputy Chief of Staff Harold M. Ickes told a group of reporters.

Democratic National Committee Chairman David Wilhelm took a similar line at a press conference called to unveil new Democratic health care ads. Dole’s plan “offers no coverage for the middle class, controls no costs, . . . slashes health benefits for older Americans. It is a disaster for the middle class,” Wilhelm said.

Dole’s plan, which has 39 other Senate Republicans as co-sponsors, would make changes in insurance rules, primarily by prohibiting certain discriminatory practices by insurance companies and ensuring coverage for those who have pre-existing medical conditions or who suddenly develop major illnesses.

The plan would also provide subsidies to help some Americans buy insurance, although the subsidies would be less generous than those provided in various Democratic plans. Dole’s plan would not include any requirement that everyone have insurance or that employers provide insurance to all workers.

Administration officials and many outside experts have argued that ending the exemption for pre-existing conditions would not work unless the move is coupled with a requirement to cover all workers. If everyone knew they could buy insurance after getting sick, healthy people would have no incentive to have insurance, officials pointed out. Over time, the result would be that healthy people would drop coverage, driving up rates for everyone else, they argued.

For his part, Dole has argued that the Administration plan to cover everyone would require too much bureaucracy and impose too much of a burden on business, forcing companies to cut back on jobs.

Focusing on Dole carries obvious risks for the Administration, as Dole, himself, made clear.

“They’re up here one day telling us they want our help with trade legislation. The next day they’re having a press conference. And we’re not going to cooperate if that’s what they want to do,” Dole said when asked about the White House attacks. “We’re not going to do another NAFTA for them,” he said, referring to the major role Republicans played in providing Clinton the votes to pass the North American Free Trade Agreement.

The threat that Republicans will refuse to cooperate with the Administration, however, carries somewhat less sting than it might because the vast majority of Republicans consistently have opposed Clinton, except on trade.

There has been little indication that Republicans, who think Clinton is in political jeopardy, have much intention of cooperating with him on issues such as crime or health care, regardless of what happens on health.

A senior Democratic congressional staff member voiced the concern about partisanship, saying that attacks on Dole are “not very helpful.”

“It could just degenerate into presidential politics,” he said, noting the possibility that Dole could seek the presidency in 1996. On the other hand, the aide acknowledged, attacking Dole’s plan could in effect “force Democrats to choose up sides, though they may not be happy about having to do it.”

Despite the risks, White House officials say they believe that focusing on Dole has the obvious advantage of placing a face--and a relatively controversial one--on the sort of incremental approach to health care reform that Clinton aides see as the biggest threat to their efforts at winning guaranteed coverage for all Americans.

The goal, officials said, is to focus public attention on the basic choice of guaranteed universal coverage versus incremental, non-universal reform.

So far, Administration officials repeatedly have failed to find a way to shift the debate away from the perceived flaws of their own plan. Now, they believe, the dynamic will change as the action moves away from the welter of health plans offered by congressional committees toward a set of comparatively simple choices on the House and Senate floors.

“We’re pleased that the committee process is over,” Ickes said. “Now we can really join the debate.”

The President, First Lady Hillary Rodham Clinton and other senior officials plan an intensive effort during the next several weeks to push universal coverage. And, officials said, Clinton’s senior economic advisers, including Treasury Secretary Lloyd Bentsen, will take a prominent role in that campaign.

That could be significant because Bentsen and other members of the economic team, who have considerable clout in the business community and among congressional moderates, have kept a low profile in the health care debate until now.