Clinton Team Launches Battle For Health Care

President wants to avoid party-line conflict, capitalize on public's eagerness to see change

WITH his mid-vacation speech to the National Governors' Association on Aug. 17, President Clinton began the selling of his health-care reform plan.

The White House "war room" for coordinating the drive to pass the budget has gone silent. Within days, the same digs in the Old Executive Office Building, across a driveway from the White House West Wing, will be the center of the health-care drive.

While Mr. Clinton's first presidential speech on the subject, given in Tulsa, Okla., to the National Governors' Association, laid out some broad principles, he also made apparent one key point of opposition he will encounter - he went beyond his script to defend his plan to require businesses to insure their employees.

Like the debate over taxes in his budget plan, the employer-mandate debate turns on the threat to small businesses and the jobs they produce.

The president clearly wants to avoid another round of party-line debate in which he fails to win a single Republican vote and the Democrats do not grant a one more vote in either house than is absolutely necessary to win.

He also does not want to lose in the court of public opinion, the way he did in the budget battle. The White House never shook off the public perception, formed early, that the middle class would carry the chief burden of the tax hikes.

The health-care plan is the most far-reaching initiative yet advocated by the Clinton White House. Over the long haul, it has larger implications for the economy and the federal budget than the budget debate.

The budget battle was a conventional one, fought along the traditional fault lines of how to balance spending versus taxes, the size of government, and shifting burdens and benefits between richer and poorer.

The health-care debate will have those elements, too. But it breaks new ground and presents more opportunities for different alliances and divisions.

The health-care problem is a financial problem, not only for the government and business, but for families as well. It is far more personal than the budget deficit, so the public may view it in more practical and less symbolic terms than the budget battle, according to some lobbyists and strategists.

The upshot is that Americans may have a stronger appetite for action on health care than on the budget.

So far, the Republicans have not shown much unity in opposition, although 41 GOP senators signed a letter opposing mandates on employers to provide insurance.

"As a party, we have a long haul on this issue," says Republican pollster Bill McInturff. Clinton and the Democrats have a 30- to 40-percent advantage over Republicans in public opinion as the party best able to deal with the health-care issue, he says.

But Clinton's proposals have some vulnerabilities as well. Mr. McInturff surmises that, while the public wants action on health care, the Clinton plan is "badly overreaching" public opinion. He predicts that when people see that their choice of health plans will be limited to those offered by a single health alliance, or purchasing cooperative, and that prices will be controlled by government-appointed boards, they will rebel at too-intrusive government control.

The Clinton team is aware of these vulnerabilities, too, and is likely to heavily promote the choices available within their "managed competition" model.

The toughest question confronting the health-care plan is how to fund insurance coverage for the roughly 37 million Americans not now insured. Clinton has not yet addressed this point in public, and may not have decided on an approach.

A cigarette tax is likely to fund part of the cost, estimated at between $30 billion and $150 billion a year. Some of it may be shifted from Medicare and Medicaid. But some of it is likely to have to come from raising the cost of insurance premiums, an increase that opponents will not hesitate to identify as a tax.

Other major points of controversy are the employer mandates and the government limits on premium costs. Clinton argues that employer mandates are the least disruptive and most fair way of funding health care, since nearly 85 percent of Americans are now covered through employers.

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