Little by little, public pressure and politics are pushing Republicans and Democrats toward common ground on the divisive issue of health reform.
There's no immediate prospect of wholesale reform, which failed miserably in 1994 after President Clinton made it an early, major element of his first term. But there are signs that agreement is possible on a series of incremental measures that would fill gaps in the present system.
The outlines of agreement can be seen in the way some opponents reacted to proposals for healthcare spending in the federal budget Mr. Clinton sent to Congress this week. It bore the largest increase for healthcare since the 1960s.
While Mr. Clinton is certain to be denied much of what he wants, Republicans are showing interest in several areas, including a prescription-drug benefit for seniors, help for the 44 million uninsured, and managed-care reform.
"We're seeing some signs of convergence here, or at least we're seeing movement toward some common ground or areas where you could cut deals," says Norman Ornstein, who tracks the politics of health reform at the American Enterprise Institute here. If the election precludes action on the dealmaking this year, then expect it in the next few years, he and others say.
According to health-policy analysts, the "convergence" areas include:
*A prescription drug benefit. Mr. Clinton suggests a $160 billion program over 10 years available to all Medicare beneficiaries who want it. The premiums would cost participants $26 a month. Additionally, he would create a $35 billion "catastrophic" fund for patients with high drug bills they can't hope to pay.
Republicans like the idea of a benefit but want to target it to low-income seniors only, or to help seniors enroll in private programs that have medication benefits. "The president deserves credit for including ... prescription drugs on his canvas, but his picture needs revision," said Sen. Chuck Grassley, (R) of Iowa, chairman of the Senate Committee on Aging.
Obviously, the two sides don't agree on how to shape the benefit, but the forces pushing them toward compromise are formidable. Fifty-four percent of voters want the government to spend part of projected budget surpluses on a drug benefit for seniors, according to a Jan. 19 poll by the Kaiser Family Foundation and the Harvard School of Public Health.
Meanwhile, the drug industry, which last year launched a television offensive against the president's drug proposal, this year says it will work with him on a prescription benefit for seniors.
*Helping the uninsured. Over 44 million Americans don't have health insurance - up from nearly 40 million uninsured in 1994, when the White House tried to tackle that problem by suggesting a completely new insurance system.
In his 2001 budget, the president's taking a different tack, plugging holes here and there by expanding state-run child insurance programs and including parents as well; and providing tax credits that would help Americans buy into Medicare or buy private insurance from a previous employer.
The 10-year cost for all these measures is projected at $110 billion.
Using tax credits to help the uninsured buy coverage enjoys bipartisan support in Congress - and to varying degrees among presidential candidates. The tax credit idea is so popular the president wants to extend it to long-term care, and proposes a $3,000 credit for people with long-term needs or their caregivers. That is another idea Republicans could probably back.
The beauty of tax credits, say supporters, is that they don't throw out an insurance system that many Americans are satisfied with - it just makes that system available to those without, and gives them choice, as well. Even the Health Insurance Association of America, which helped defeat Clinton's 1994 plan with the TV-ad duo Harry and Louise, has resurrected the pair to bemoan the plight of the uninsured.
*Managed-care reform. Last year, a "patients' bill of rights" for people enrolled in health-maintenance organizations (HMOs) seemed defunct. But House majority leader Dick Armey (R) of Texas said last month he would push it to the top of the GOP agenda, promising that a bill would land on Clinton's desk by spring.
Among various "rights" would be the right to emergency care and the right to choose a specialist. But the provision holding things up is a patient's right to sue an HMO, which the president insists on.
Mr. Ornstein believes compromise will come in this and other areas because Republicans don't want to be viewed as anti-healthcare, or uncaring - an image Democrats have successfully broadcast.
"Republicans, who are not really anxious to get out there and have more federal programs or dollars, just don't want to be viewed as for HMOs against patients, against seniors and for pharmaceutical companies," Ornstein says.
With all this incremental change on the horizon, the one area most analysts say needs fundamental reform - Medicare - won't be addressed any time soon.
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