Mitchell Declares Health Reform Dead for Session

Senate Majority Leader George J. Mitchell (D-Me.) formally pronounced health care reform dead for the year Monday, rendering a final, if somewhat anticlimactic, verdict on what has been apparent for weeks.

Yet there was an undeniable poignancy to the moment as the retiring majority leader, having forfeited a chance to be on the Supreme Court so he could fight for a bill he saw as the crowning achievement of his legislative career, conceded: “The combination of the insurance industry on the outside and a majority of Republicans on the inside proved to be too much to overcome.”

Though some of his allies had urged him to continue to push for health care legislation, Mitchell said he feared that the effort would jeopardize the remaining business before Congress, most notably an international trade agreement that GOP leaders had put “in the position of being hostage to health care legislation.”

President Clinton vowed to renew his drive next year, even though expected Republican gains in November’s congressional elections could make it even more difficult. “This journey is far, far from over,” he said in a statement.

Mitchell’s decision, announced at a news conference, effectively dooms House efforts as well, since no legislation can be passed without both houses.

Clinton handed off the issue to Congress a little more than a year ago, offering as a starting point a 1,342-page bill produced by a task force that had been headed by First Lady Hillary Rodham Clinton. It has preoccupied Capitol Hill ever since--to the exclusion, many Democrats and Republicans concede, of most other meaningful accomplishments in the latter half of the term, scheduled to end in two weeks.

It began as an effort to produce the most important piece of legislation since the Great Depression--one that would revamp one-seventh of the U.S. economy and provide health coverage to the almost 40 million Americans who now lack it. In the end, warring factions were unable to agree even on modest changes in unpopular insurance practices, such as exclusions on covering pre-existing conditions.

Along the way, interest groups poured at least $100 million into the battle. Advertising expenditures alone accounted for more than Clinton and George Bush together spent on their 1992 presidential campaigns.

Mitchell tried to put the blame squarely on GOP opposition, in obvious hope that the issue will haunt Republicans on Election Day. Though the Democrats hold a majority of Senate votes, they do not have the 60 needed to block a filibuster.

However, even the Democrats themselves were sharply divided on the issue, and it was far from certain whether Mitchell could have garnered even the 50 votes needed to pass any of the alternatives considered in recent days.

Senate Minority Leader Bob Dole (R-Kan.) proclaimed that the reform effort died because the American people rejected it--understanding correctly, he said, that President Clinton’s vision of health care reform was one of dizzying complexity, strangling bureaucracy and wanton spending.

“We saw democracy in action,” Dole said.

Indeed, lawmakers of both parties are finding little public outrage over the demise of the health care reform effort. If anything, they say, people seem relieved.

Mitchell noted that there are “several good starting points” for health legislation next year. Proposals on the table include a package of insurance reforms and subsidies aimed at expanding coverage to about half the uninsured, as well as a plan to increase coverage for children and pregnant women.

In addition, Senate Finance Committee Chairman Daniel Patrick Moynihan (D-N.Y.) said on Monday night that he had yet another alternative: a package of “modest and sensible changes” he will lay before his committee today. It focuses on increasing the tobacco tax, making health insurance costs for the self-employed fully tax deductible, expanding Medicaid for children and pregnant women, and several health insurance reforms.

Meanwhile, health reform advocates are grappling with dejection, anger, bitterness and disbelief. But they are also searching for lessons as they contemplate a political resurrection.

If they do, the campaign will bear little resemblance to this year’s effort. Speaking on the condition of anonymity, several top White House advisers said the President is likely to advance a more modest agenda that seeks step-by-step reforms.

They also said the White House is likely to adopt a far more open process in developing that agenda--in sharp contrast to the highly secretive meetings used to hammer out the President’s massive plan, which the public, and Congress, found far too complex to digest.

At the White House, advisers also are vigorously debating what role, if any, the First Lady should play when--not if--the President seeks to rejuvenate his health reform agenda in 1995.

When Clinton put his wife in charge of his biggest domestic policy initiative, the move was hailed as breathtakingly bold. But many now wonder whether her presence at the head of the task force insulated it from valid criticism that would have more readily exposed the flaws in its plan.

“Frankly, there will be a lot of pressure for her not to do it,” said one top White House adviser.

As for the President, having proposed an ambitious government-dominated agenda only to make compromise after compromise in the face of public and congressional skepticism, his credibility may well be suspect no matter where he stakes out a new starting position, Administration officials conceded.

The major interest groups also are already girding for the next round. Many of them endorsed the concept of universal coverage but disagreed with the Administration’s method of achieving it, or they strenuously objected to portions of the Clinton plan.

At the Health Insurance Assn. of America, whose “Harry and Louise” television ads opposing the Clinton plan are widely credited with delivering a crippling blow, its president, Willis D. Gradison said: “We’re not breaking out the champagne around here. We wanted national reform action.”

The group is already at work on an agenda to unveil before the new Congress convenes in January.

“Our concern is that this impasse may continue for two more years. So we’re going back to the drawing boards and thinking this over. The quickest way to universal coverage may be one step at a time,” Gradison said.

While there is plenty of blame to go around for the failure of comprehensive health care reform, said Dick Davidson, head of the American Hospital Assn., the key now is for all parties to pick up the pieces and move on. The AHA opposed the Clinton plan’s Medicare cuts and price controls.

“We can go to sleep today and wake up on Jan. 15, and all the problems will still be there. What we need to do is see what we’ve learned from the whole debate and roll (it) into a new approach to getting to the President’s objective of universal coverage,” Davidson said.

For some, the biggest enemy now is simple weariness.

“Nobody is going to have much stomach next year” to wage the same war, said Dr. James Todd, executive vice president of the American Medical Assn., which was worried about government bureaucracy encroaching on doctors’ decisions. “It’s really disappointing after 21 months of the most intense debate . . . to come away empty-handed.”

Yet some consumer advocacy groups in Washington already were gearing up for next year.

“This was the farthest that a universal coverage bill has gone in Congress,” insisted Arnold Bennett of Families USA, a tireless supporter of the White House plan. His group is designing a new long-term public information campaign aimed at building support for a comprehensive measure.

“Health care reform should have been done by now,” Bennett said Monday. “But the fight is not over. It’s just beginning.”

* TAX BLOW: The self-employed are expected to lose a tax deduction for health insurance. D1