WASHINGTON — AMERICA'S great national debate over the future of its $900 billion health-care system finally began in earnest this week, and as the late Jimmy Durante used to say, ``Everybody wants to get into the act.''
The president, Congress, the 50 governors, business leaders, and an array of experts chimed in. But there was agreement on only one thing: No one can predict how this debate will end, or whether Congress will agree on a national plan.
The tug of war grew more uncertain at midweek when the Business Roundtable, an influential group of large corporations, voted to oppose President Clinton's health-reform proposal. It was a sharp setback for the White House, which already faces intense opposition from the small business sector.
Vin Weber, a former Republican congressman from Minnesota, predicts that now, despite an all-out effort by the president to pass health care, ``I think they are going to fail.''
Senate Republican leader Bob Dole of Kansas warns: ``Unless there's some bipartisan bill, there may not be any bill.''
Robert Blendon of the Harvard School of Public Health is slightly more optimistic, but cautions: ``It will be touch and go.''
In a new public opinion study, Dr. Blendon found Americans sharply divided on the many health-care proposals, and only marginally familiar with any of them. That includes the president's 1,300-page plan, the Republicans' 800-page alternative, and yet another measure drafted by a bipartisan coalition that includes Rep. Jim Cooper (D) of Tennessee and Rep. Fred Grandy (R) of Iowa.
The Cooper-Grandy bill was endorsed as a ``starting point'' for health reform by the Business Roundtable. Cooper-Grandy rejects the Clinton proposal to make employers pay 80 percent of their employees' health-insurance costs.
Yet no plan has emerged as a clear favorite, either with the public or in Congress. Blendon says the health-care debate is so ``volatile'' that the fight could quickly ``swing one way or another in a short time span.''
The week's biggest surprise was yet another set of proposals, a bipartisan compromise hammered out between Republican and Democratic governors at their annual midwinter meeting in the nation's capital.
Late last week, the governors arrived in Washington in an atmosphere of uncertainty. The usually collegial National Governors' Association (NGA) found itself badly split over health-care policy. Republicans were taking pot shots at Mr. Clinton's government-mandated plan, while Democrats complained that GOP policies would fail to provide universal coverage.
Within days, however, the governors had put aside their differences, worked out the rough patches, and cobbled together the broad outlines of what some observers say could be the ultimate health-care compromise.
Even Clinton, who had failed to win solid support from the governors for his own plan, was impressed. On the final day of their conference, he told them: ``I wish I could keep you in constant session here. You seem to have a leavening effect on the political rhetoric in the nation's capital.''
The incoming chairman of the association, Gov. Howard Dean (D) of Vermont, a Clinton ally, says if all sides could accept the governors' outline, a national health-care plan could be worked out within months.
AMONG the ``minimum'' standards the NGA program urged Congress to adopt:
* A core package of health benefits comparable to those now available from the most cost-efficient health-maintenance organizations. Insurance would be available through employers (but not necessarily paid for by them), with subsidies for persons who cannot afford the premiums.
* Portability of health insurance, with guaranteed renewal.
* Tax deductibility of health-care premiums for the core package, but new taxes on above-average policies with costly benefits.
* Equalization of tax deductibility between corporations (which can deduct the full cost of insurance) and self-employed individuals (who can currently deduct only one-quarter of their premiums).
* Medical malpractice and liability reform aimed at reducing the amount of litigation.
* Medicaid changes which, among other things, would permit states to move recipients into managed-care settings.
The flurry of activity involving the governors' plan and the Cooper-Grandy bill has taken some of the steam out of the president's proposal.
Blendon says the latest polling shows 79 percent of Americans like one major aspect of the Clinton plan: its guarantee of universal coverage that cannot be taken away.
Yet only 52 percent like the Clinton plan itself. They worry that the cost is too high, that it could mean bigger government, and that it could lower the choice and quality of their own care.
House and Senate hearings on health care now are under way. The House could vote first, perhaps in July. A Senate vote is not expected until at least August or September.