THE effort to renovate the health-care system entered a new stage this week as debate began for the first time in full committees of each chamber of Congress.
But the shape of reform is still a long way from jelling - further away than many thought Congress would be by now. The House of Representatives in particular has bogged down in recent weeks, while earlier in the spring it was expected to act before the Senate did.
Some aides on Capitol Hill believe that House members are recalling their politically damaging votes for an energy tax last summer - a tax that the Senate quashed and the White House abandoned. Before making a vote on a sensitive, treacherous issue, members seek confidence that it will not be futile.
``What we're talking about now is members of these committees who have to cast the first votes going line by line,'' says Martin Corry, director of federal relations for the American Association of Retired Persons. ``We're now talking about people jeopardizing their political lives as well as [potentially] mucking up a seventh of the economy.''
Mr. Corry suspects that Congress is not even halfway through the forging of a bill.
``For the first time, I think it's possible that we might not get a bill,'' says Michael Bromberg, a prominent lobbyist with the Federation of American Health Systems. He rates the chances that Congress will produce a bill that President Clinton will sign at a little better than 50 percent.
The jockeying under way on Capitol Hill offers few clues about what direction compromise will take. Very different forms of health-care reform are following different tracks. But perhaps significantly, separate versions proposed by leading party regulars in each house - Sen. Ted Kennedy (D) of Massachusetts, chairman of the Labor and Human Resources Committee, and House Energy Committee chairman John Dingell (D) of Michigan - each soften the Clinton plan's mandate that all employers pay most of their workers' health-insurance premiums.
Each plan allows very small businesses to opt out of the mandate and pay a 1 to 2 percent payroll tax instead. The Kennedy proposal would let businesses with five or fewer employees off the hook. A key moderate Democrat, Sen. John Breaux of Louisiana, indicated this week that he might support Mr. Kennedy's plan if it would exempt firms with up to 10 employees.
The problem that many committees wrestling with health care are up against is that for every business exempted, or any other softening of the employer mandate, the cost of subsidies goes up.
One possibility for paying those costs is to start taxing health benefits above a certain level of coverage. Currently, all employer-paid health benefits are tax-deductible.
Organized labor stands emphatically against any cap on tax deductibility, since union members generally have won very high health benefits in lieu of wage increases in the past decade or so.
But Sen. Dave Durenberger (R) of Minnesota, a moderate who sits on two key committees shaping health reform and who is likely to be part of any eventual compromise, believes that a cap on tax deductibility is ``inevitable.''
THE main tracks that health care is moving on are the House Ways and Means Committee and the Senate Labor Committee and Finance Committee. Ways and Means chairman Dan Rostenkowski (D) of Illinois is viewed as a nonideological player who is past-master of putting together bills that can win the votes to pass on the House floor. He has been stymied so far in his own committee, however. He often likes to have a majority of votes in hand before his full committee meets, but it began meeting this week without a consensus.
Mr. Rostenkowski also faces the possibility of indictment soon for alleged financial improprieties. His lawyers are reportedly negotiating for a plea bargain, but if he is indicted on felony charges, he must step down from his chairmanship immediately.
The House leadership is preparing to take up the slack. In any case, the leaders will use the rules process to piece together the different bills that come out of committees and put them to a floor vote, probably allowing votes on alternative packages as amendments but barring rifle-shot amendments that alter details.
The health-care bill that passes the House may be a little to the right of the Clinton plan, but it is expected to be well to the left - that is toward a stronger government role - of the Senate bill. The Senate Finance Committee has been meeting privately, without staff, to begin putting together a market-based plan.
``I believe whatever passes is what can get through Senate Finance,'' says lobbyist Thomas Scully of Patton, Boggs, and Blow. But he adds: ``I just don't see the confidence level among members that they can go home and defend a vote on any of these bills yet.''