SPARKS are flying this week in a House health subcommittee that is debating one plan to reform the nation's health system.
Despite the proximity of this vote - the first one on health reform - Republican lawmakers, like Democrats, are divided over the issue. ``We're not there yet,'' said Senate minority leader Bob Dole (R) of Kansas.
Although in the minority, Republicans are flexing their political muscle. They have helped shift the entire health-reform debate by being vocal critics of some of the main tenets of President Clinton's health-reform plan. Support among Democrats for these aspects - some of which are also contained in a bill introduced by Rep. Jim Cooper (D) of Tennesee - has weakened in the last few weeks.
Falling fast is Mr. Clinton's backup plan to use price controls to bring down costs, his requirement that employers pay 80 percent of the cost of health care for workers, and the mandate that people buy health coverage as a group, based on where they live.
``Everyone recognizes the president's plan is, I won't say, dead, but certainly on life support,'' said Rep. Richard Armey (R) of Texas, chairman of the House Republican Conference.
Control vs. freedom
Mr. Armey said he hopes the Clinton plan will drop out of the center of the debate, leaving the major Republican plan to square off with the single-payer plan, in which government would raise taxes to pay for health care. ``This debate, at bottom, has really always been about bureaucratic control versus individual freedom,'' Armey said.
In the House, where Democrats dominate by a wide margin, it will, nevertheless, be virtually impossible for the Republicans to pass a plan on health reform.
The Senate, however, with 56 Democrats and 44 Republicans, is where the real fight - and possible compromise - will take place. Most are relieved that Senate committees are not expected to begin voting on health reform until at least the late spring.
While generally allied in their opposition to the Clinton bill, Republicans do not have agreement on a plan within their own ranks. They are no less solid than the Democrats, whose plans also are all over the map.
``No doubt, everybody will remain as loyal as possible to their product for as long as possible,'' Armey said.
``The middle ground exists. We've chosen to ignore it [for now],'' a Republican aide said.
In hopes of moving the party closer to consensus, Sen. John Chafee (R) of Rhode Island organized a two-day Republican retreat in Annapolis, Md., early this month. No compromise occurred. ``There was a fair amount of discussion but not a single proposal,'' a Republican aide noted.
The Republican Party is particularly challenged by the health-reform issue. Traditionally, it has opposed government intervention as a solution to economic or social problems. ``Whenever the government gets involved, costs go way beyond what you originally anticipated. You have to be terribly cautious,'' said Mr. Chafee, considered a moderate Republican.
Some of the broad issues that divide Republicans include whether people should be required to buy coverage and whether benefits should be mandated by the government and what they should include. Another concerns coverage for the poor - if it should be mandated, how it would be paid for, and when the coverage would begin.
``Abortion is likely to surface after an approach is agreed upon,'' said Chafee aide Doug Sloane.
The Chafee plan is considered the most liberal of the Republican plans because it contains an individual mandate and would eventually cover the poor; the Gramm bill is viewed as the most conservative, the Michel bill, the most moderate.
Few Republicans expect victory to emerge from the House. ``A partisan bill will emerge from the House that we will not be able to support,'' said Chafee, a member of the Senate Finance Committee, one of two Senate committees expected to vote on health reform.
Rep. Nancy Johnson (R) of Connecticut, a vocal member of the health subcommittee of the Ways and Means Committee, the panel that is marking up the first health bill, says putting the Democratic bill under the microscope will be beneficial. ``We want the debate to move forward,'' she said. Once under scrutiny, the flaws in the plan can be revealed.
Interestingly enough, the bill under consideration is not the president's bill but that of the maverick committee chairman, Rep. Fortney (Pete) Stark (D) of California. To try to appease more conservative Democrats on the subcommittee, he moved his single-payer-type plan to the right.
A Republican subcommittee member, Rep. Fred Grandy of Iowa, is ``probably going to offer a substitute to the [Stark] bill,'' a Grandy aide said. It is unclear what will emerge from the subcommittee. Bills will also be taken up by the Education and Labor Committee and the Energy and Commerce Committee.
The Senate will provide the real test of Congress's ability to compromise across party lines.
Along with the Finance Committee, the Labor and Human Resources Committee is expected to vote on health-reform bills.
The 11 Democrats and nine Republicans on Finance are expected to vote out a more conservative bill than Labor.
``Before we get to the end of April, we will sit down and talk in a bipartisan manner,'' Chafee said.
``[Finance Committee chairman Sen. Daniel Patrick Moynihan (D) of New York] has shown he wants there to be a bipartisan effort. He has no intention of shoving anything down anyone's throat,'' he added.
To pass, any Republican bill will have to enlist Democratic support, most likely found among conservative Democrats, many of whom are clustered in the South and Midwest.
Democrats, too, will attempt to woo moderate Republicans into their camp.
But efforts between Mr. Cooper, a conservative Democrat, and Chafee to do just that have so far failed. ``We haven't met recently. In the House, there is so much confusion,'' Chafee said. ``I think what will happen is we will try to develop a plan in the center, then move right,'' said Rep. Cliff Stearns (R) of Florida, who co-sponsored the Nickles bill.
With Congress ``still divided'' over health reform, Reps. Michael Bilirakis (R) of Florida and Roy Rowland (D) of Georgia have introduced a bill they say everyone can support, a bill that skirts some of the major reform decisions.
``Our bill is designed to reestablish the health-reform debate on a foundation of agreement rather than one of divisiveness,'' Mr. Bilirakis said.
Seventeen Republicans and 17 Democrats in the House support the bill. It would end discrimination in the insurance marketplace, criminalize health-care fraud, reform the malpractice system, automate the processing of insurance claims, and expand community health centers.
The bill could buy time for lawmakers of both parties who are too unwilling to enact a major social-change bill now.
According to Mr. Dole, Republicans ``will continue to meet and try to reach a compromise on individual or employer mandates.''