Drive for a Health-Care Plan May Not Meet September Deadline

Lack of consensus in Congress could force debate into 1995

THE problem is not that Congress is not busy enough on health care.

A House subcommittee is busy marking up the first comprehensive health-care bill to march through Congress, a bill well to the left of the Clinton plan.

A Senate committee spent March 20 and 21 at a Virginia resort debating merits of mandating that employers buy insurance for workers, a tough choice facing Congress.

But for those who follow health-care reform closely, the surprise is that the issue has not made any progress toward consensus on Capitol Hill.

``Members of Congress don't want to go home in September without having done anything. On the other hand, it's March 21, and we're nowhere,'' says Joshua Wiener, a Brookings Institution senior fellow who participated in the White House task force that forged the Clinton plan.

``I am surprised,'' says Michael Bromberg, a lobbyist for the health-care industry. Three months ago, he put the odds at 90 percent that Congress would produce a health-care bill this year. ``Now it's 60 percent and moving toward 50-50.''

``There's no sign of consensus yet anywhere,'' he says.

``There's less consensus now than [last] September,'' says Mr. Wiener.

``It's murky,'' says Joseph White, another health-care expert at Brookings. ``Lots of people don't know what they're for.''

The public still has little grasp of plans proposed in Congress, including the best-known, the Clinton plan. And many members of Congress have not sorted out yet what they can support and then defend back home.

The White House is trying to penetrate the fog a bit as the president has stepped up his promotional efforts for his plan. The Clinton team has distilled his plan into five points: a guarantee of private health insurance for all, job-based health insurance, choice of doctors, a ban on insurance practices that exclude people, and the preservation of Medicare.

The House has roughly until July to send a bill to the Senate, which is giving the House the lead. That would leave Congress minimal time to turn out a conference bill in September before the entire House and a third of the Senate - except for those retiring - go home to stand for reelection.

On such an important and complex piece of legislation, that is not much time. If the issue hangs over into 1995, then the new Congress must start all over procedurally with a substantial number of new members and at least a somewhat different set of leaders. Senate majority leader George Mitchell (D) of Maine and House minority leader Robert Michel (R) of Illinois are both leaving Congress. Democrats are expected to lose a few seats.

Health care remains a big issue that commands some urgency of handling on the Hill, but it has lost much of its charge. The improving economy may have relaxed some of the insecurity that feeds concern over the health-care system, and the falloff in inflation of medical prices may ease the urgency that businesses feel for remodeling the system.

And then, of course, Harry and Louise. This is the fictional yuppie couple in a series of television ads by the Health Insurance Association of America, staunch opponents of the Clinton plan. The couple is continually discovering vast bureaucracies and limitations on their choices as they leaf through Clinton's proposed Health Security Act.

Harry and Louise are part of what appears to be a successful campaign by Clinton opponents to focus the debate over health care on the question of government, notes Wiener. The question has become whether people trust the government to run health care, he says, ``and the answer is that they don't.''

Congress could probably come to consensus easily on a number of aspects of health-care reform. Wide agreement exists that insurance companies should no longer be allowed to deny coverage to people with preexisting health problems and that insurance policies should be portable from one job to the next. Few would oppose more systematic monitoring of medical costs or perhaps even voluntary targets for holding down costs. Putting limits on malpractice fines levied for noneconomic damages is fairly popular. Setting up insurance purchasing pools for small employers is widely supported too, if the pools are not too big or mandatory for too many businesses.

The tough questions, according to Mr. Bromberg, are whether to cap the tax deductibility of health insurance premiums, to mandate that employers provide health insurance to workers, to mandate that people join large health alliances unless they work for large corporations, and how to pay for universal coverage.

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