One of the administration’s first spokespeople to testify for the plan inadvertently revealed just how difficult. Before the Senate Finance Committee, Health and Human Services Secretary Donna Shalala let slip that “a few people” might see their health bills go up under the plan. The committee chairman, Democrat Daniel Patrick Moynihan, pounced. “How few of them are there?” he demanded. The secretary turned to her top health economist, who began, “Among those who would pay slightly more…” Moynihan interrupted: “Just facts. No “slighty.’” He went on to estimate that 120 million Americans, about 40 percent of all those who are now insured, would pay more. Shalala did not dispute him.
Administration spinners quickly argued that healthy young people would be the hardest hit and that the “peace of mind” provided by universal health care was priceless. But the dodging and weaving could not obscure an uncomfortable reality: most Americans already have health plans, and they fear that under Clinton’s plan they will pay more for less care.
The administration knows it will be hard to get people to put aside their own interests for ideals like “universal coverage” and deficit reduction. To sell the plan, the Clintons are returning to the model that got them into office, a campaign “war room” to attack critics and stir grass-roots support. With the help of former Peace Corps director Richard Celeste, they will start bombarding the country this week with books, videos and an 800 number to sign up volunteers. Amazingly enough, a 136-page draft version of the plan has already made The New York Times best-seller list, and two publishers are competing to rush into print the latest version of “Health Security: The President’s Report to the American People,” with a foreword by Hillary Rodham Clinton.
But not many Americans are likely to rush to their local community center to watch a 15-minute video of the president earnestly explaining regional health alliances and mandated benefits. The “war room” has already had to scrap one consumer-friendly gimmick designed to calm small business owners who worry that the Clinton plan will be too costly and complex. When aides tried to create computer software to calculate how much it would cost them to cover their employees, they found there were so many variables that it couldn’t be done. “It was a great idea that turned out to be harder than we thought,” said White House spokesman Jeff Eller.
The White House has orchestrated a series of purportedly spontaneous grass-roots movements. Clinton’s team, “the National Health Care Campaign,” is housed in the Democratic National Committee headquarters. There are political directors for every region of the country and “liaisons” for every interest group from ethnics to seniors. Celeste says his goal is to generate enough grass-roots pressure on members of Congress that, by next spring, they will hear “the whisper of the guillotine” if they fail to act. The Clinton campaign may be outdone, however, by interest groups with deeper pockets. The insurance lobby has already spent millions of dollars on television advertising, and Celeste concedes that he has yet to raise his goal of $1 million to $3 million. “I have to do much more asking,” he told NEWSWEEK.
In some ways, the president and First Lady want to be seen as besieged by interest groups. It allows them to claim they are on the side of the ordinary voter. The insurance and pharmaceutical companies in particular are being set up as the villains. Yet behind the scenes the Clintons have been working hard for months to buy off some of the biggest interest groups, like the elderly and organized labor. And more compromises are sure to come.
As it winds its way through Congress, Clinton’s plan will be picked apart, watered down and, in many important ways, radically changed. The final product very likely will be less grandiose, though the Clintons seem determined to hang on to their goal of universal coverage. Publicly, they say they are ready to deal. Privately, they really believe theirs is the best plan and none else compares. But whatever health-care plan passes, it will be sold, at least around the 1996 campaign, as “the Clinton plan.”
The early leak of Clinton’s plan enabled the White House to gauge reaction from Congress, lobbyists and voters–and scramble to soothe sore points. Examples:
Conservatives complained Clinton was creating a huge new entitlement that would prompt runaway spending and endless government regulation.
Federal subsidies to low-income workers, small businesses and retirees will be capped. The National Health Board, which would control health-care costs in each state, would lose its independence and be accountable to the president.
Consumer advocates claimed the plan asked the working poor to pay too big a portion of their income for health insurance. Women’s and children’s groups said the plan skimped on mammography, family planning, Pap smears and kids’ dentist visits.
Individuals’ contributions to premiums would be capped at 8.9 percent of income. The government would pay the rest. Copayment at the doctor’s office would be reduced to $2 from $10 for the poor. Gynecological services and children’s dental benefits have been expanded.
Even pro-choice members of Congress fretted about covering abortions, saying the bill could founder on this single provision.
A “conscience clause” that has been inserted would exempt doctors from performing procedures that violated their beliefs.
Doctors and some consumer groups said the plan restricted the right to choose one’s doctor. Physicians also complained that the health alliances would wield too much power in negotiating fees.
All health plans, even HMOs, must offer patients the option to seek care from any physician, even if at a higher cost. Doctors won a waiver of antitrust laws to allow them to bargain collectively with the health alliances.
Small businessmen said that paying 80 percent of employees premiums would bankrupt them.
The small-business subsidy will include companies with 75 or fewer employees, up from 50.
