NOW that President Clinton has formally announced his plan for a national health-care system based on ``managed competition,'' does that mean all the other plans floating around Congress have lost out?
The answer from Capitol Hill: an emphatic ``no.''
Some proponents of alternative health plans already have helped shape Mr. Clinton's proposal. And, in months ahead, all lawmakers will have a chance to bend the plan in their direction as it makes its way through the labyrinthine legislative process.
Congress's task is monumental: to take pieces of a health-care system that, in some ways, already works well for most Americans, and create a coherent whole that works well for all Americans. That will involve multiple bills traveling through several committees in each house, where the potential for turf battles is strong. The leadership in both houses will have to work hard to ensure the pieces make it through - and fit together.
Health-care activists in both houses are ready and eager for the process to begin. That will come next month, when the Clinton administration introduces its legislative package.
``Once the ball is in our hands, we'll have it for the rest of the game,'' says Rep. Jim McDermott (D) of Washington.
It has become an article of faith that sometime next year Congress will pass some sort of plan to overhaul the nation's health care. Senate majority leader George Mitchell (D) of Maine says the final plan will look similar to but not exactly like what Clinton announced last night.
On Tuesday, White House budget director Leon Panetta acknowledged the president's plan is only the beginning of the process and that the goal was to present a ``bold plan'' that left room for bargaining with Congress.
The key will be to reach 60 votes in the Senate, so that the legislation won't die with a filibuster. That means Clinton will need some Republican votes to add to his 55-45 Democratic majority in the upper house.
The House will be easier for Clinton, says Ed Howard, executive vice president of the Alliance for Health Reform, a nonpartisan clearinghouse of information. ``The House is more tightly structured,'' with a Rules Committee in Democratic hands, Mr. Howard says. ``There's a good chance the Democrats in the House can work it out among themselves, so the Republicans are less important.''
That's not good news for the 106 House Republicans who have signed onto a plan drafted by the Minority Leader's Task Force on Health - the most widely supported plan in either house thus far. This plan calls for limited restructuring of the nation's insurance system and no provision for universal coverage.
At the other end of the spectrum, liberal Democrats are pushing a Canadian-style federally run health system. The Clinton administration did not opt for the so-called ``single payer'' plan.
But liberals can already claim some victories in the crafting of the Clinton plan, including a provision to allow states to run their own single-payer systems if they choose. Liberals also got a provision for a ``national health-care budget'' that ensures that health- care costs do not rise faster than other parts of the economy.
Single-payer advocates hope to wield even more influence on the final shape of the package.
The president has outlined the principles he wants the final package to fulfill: security, simplicity, choice, savings, quality, and responsibility. Representative McDermott, a principal co-sponsor of the single-payer plan, questions whether the Clinton plan will deliver on those promises. He argues that a single-payer system will contain costs more effectively than managed competition.
``To the extent [Clinton's plan] falls short, the field is open,'' McDermott says.
But proponents of more liberal and conservative plans are likely to spend their time kibitzing from the sidelines. The real action in Congress looks as if it will take place between the Clinton plan and one announced by Sen. John Chafee (R) of Rhode Island. Senator Chafee's plan, a variant of managed competition backed by 23 Senate Republicans, calls for universal coverage by the year 2000 but only through a requirement that all individuals buy insurance.
Unlike Clinton's plan, the Chafee proposal does not rely on employer mandates. White House health care adviser Ira Magaziner suggested Tuesday this is an area in which the administration might be willing to revise its plan.
Some observers question the importance of the minutiae in Clinton's plan, which will be pulled every which way once it reaches Congress. One Senate Republican aide surmises that once Clinton's bill is introduced, the president will avoid micromanaging the outcome and will let Congress come up with its best shot at a consensus package with broad bipartisan support.
Says the aide: ``Just like he did with budget reconciliation, Clinton will just keep repeating the principles he wants fulfilled.''