Already the critics are starting to shoot at the Clinton proposal, titled the Health Security Act, as big government run amok. The special-interest lobbyists have coined a new nickname for Hillary Clinton, the plan’s chief promoter: “Big Sister.” The Clintons would create a whole new entitlement program for Americans and establish a new government bureaucracy to carry it out. Many members of Congress are persistently questioning whether the Clintons’ plan is too expensive and unwieldy–and are considering less ambitious alternatives.
President Clinton is widely perceived as ready to barter some provisions away as long as the final bill makes health care available to all Americans. Hillary, however. is a true believer. She thinks the plan proposed by the health-reform task force she chaired through the winter, spring and summer is the right solution, and she is not eager to compromise. Some colleagues believe the First Lady is more liberal than her husband. more sympathetic to government solutions to social problems. She is certainly more adamant. Many lawmakers regard her as not only tough-minded but, at least on health reform, somewhat inflexible.
But they are afraid to say so publicly. Throughout Mrs. Clinton’s much-publicized testimony on Capitol Hill last month, gruff barons like Ways and Means chairman Dan Rostenkowski and House Energy and Commerce Committee chairman John Dingell fawned over her. Few lawmakers asked confrontational questions. When a Republican senator began quizzing the First Lady about abortion rights under the plan, he was told privately by Senate Finance Committee chairman Daniel Patrick Movnihan to “back off.”
Lawmakers and lobbyists describe Mrs. Clinton as relentless in trying to win converts. One lobbyist recalls her dismissing concerns about lost jobs in the insurance industry by declaring that the newly unemployed could become “caregivers.” He said, “I had this image of insurance agents and accountants giving me my flu shot.” Like most First Ladies, Mrs. Clinton is regarded by staffers with a mixture of fear and adulation. A Democratic Senate aide says that phone calls delivering bad news to the First Lady are received with “urgency and desperation.” Some staffers proposed that the delivery of the bill this week be turned into a birthday celebration for the First Lady, who turns 46 on Oct. 26. The idea was wisely rejected as “too cute.”
Operating out of a White House “war room” set up to push health reform, Hillary has adopted the Clinton campaign strategy of hitting back hard. (A staffer listening to one Hillary pep talk described her as “James Carville in a skirt.”) When conservative Democrat Jim Cooper of Tennessee announced his rival plan earlier this month (chart), Hillary’s minions phoned in to blast the proposal on radio talk shows and in the local press. As part of the White House PR machine, Senators Harris Wofford of Pennsylvania and Tom Daschle of South Dakota decried Cooper’s plan as “rock-bottom WalMart.” (Cooper joked that, in his part of the country, that’s a compliment. When Al Gore, then a senator, first introduced Clinton to Tennessee voters in 1992, he bragged that the two got the biggest crowd since the local Wal-Mart store opened.)
Some of the sniping at Mrs. Clinton reflects the resentment of other Clinton administration officials who were cut out of health reform by the First Lady and her chief adviser, Ira Magaziner. “Ira has mesmerized Hillary,” complained Health and Human Services Secretary Donna Shalala to her colleagues. At one point Robert Rubin, the chairman of the National Economic Council, privately griped: “How can I advise the president on a plan Ira Magaziner won’t let me see?”
Mrs. Clinton may be playing bad cop to Clinton’s good. “Hillary doesn’t want to be seen as ‘Miss Grazing Fees’,” says a Senate staffer, referring to the president’s cave-in last spring over a plan to raise the fees for Western cattle ranchers using federal lands. Picturing the First Lady as Big Sister is also convenient demonology for her opponents, who remember that Hillary was forced by similar attacks to lower her profile during the 1992 campaign.
In any case, senior White House advisers recognize that they will have to compromise if a bill is going to pass. The model may be Congressman Cooper’s plan, which he half jokingly dubs “Clinton Lite–Tastes Great, Less Filling.” The Cooper plan is less bureaucratically cumbersome. it is also fiscally more realistic and, in political terms, probably closer to the congressional center than the Clinton plan.
Under the Cooper proposal, the poor and low-income families earning up to about $26,000 a year would get free or subsidized health care. Cooper would pay for the cost–$25 billion a year–by taxing “gold-plated” corporate plans, requiring rich retirees to pay for most or all of their doctors’ bills and slowing the rate of increase in doctors’ and hospital fees paid for by Medicare. The Medicare cuts–about $32 billion over five years–are one quarter the amount proposed by Clinton, whose estimates have been derided as political “fantasy” by top lawmakers.
Cooper would not provide universal health coverage. But he would make health insurance more accessible and affordable. Insurers could no longer refuse to take high-risk customers. And small businesses and individuals would pool together to get lower rates. Individuals could deduct the entire cost of health insurance before paying taxes. Cooper’s plan would be more affordable to taxpayers because it would not offer many of the bribes the Clinton plan proposes to win over various interest groups. There are no new benefits for the elderly or special breaks for early retirees. Cooper also includes one tough cost control that Clinton left out to appease the politically powerful trial lawyers’ lobby: malpractice-lawsuit reform. Cooper would limit damages for “pain and suffering” to $250,000. His plan is hardly foolproof, and it too may make some optimistic assumptions on costs and savings. Some parts would anger powerful interest groups, like lawyers and the affluent elderly. But it is a more cautious first step. “If it doesn’t work,” says Cooper, “we can come back and do something bigger.”
Privately some top White House aides predict that the Cooper plan is about where health reform will end up, if Cooper will move toward universal coverage. It is close to a plan produced by Republican Sen. John Chafee of Rhode Island–who, with 27 cosponsors, has more committed votes for his proposal in the Senate right now than Clinton does for his. White House aides also predict that Magaziner will be eased out as health-reform straw boss. “He is an architect, not a manager,” says one senior official. “His job is done.” Clinton’s top aides are looking for an operator along the lines of Deputy Treasury Secretary Roger Altman, who is both substantive and politically canny. The president is said to be ready to go to Capitol Hill and bargain for votes. The question is whether he can win over his wife.
