TIME: Almanac 1995

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<text id=93TT0285> <title> Sep. 27, 1993: Lots Of Second Opinions </title> <history> TIME--The Weekly Newsmagazine--1993 Sep. 27, 1993 Attack Of The Video Games </history> <article> <source>Time Magazine</source> <hdr> HEALTH CARE, Page 34 Lots Of Second Opinions </hdr><body> Clinton's plan is heading for an operating room full of lobbyists By GEORGE J. CHURCH--Reported by Laurence I. Barrett, Michael Duffy and Dick Thompson/Washington In one sense, the publicity buildup has been overhyped. Yes, the televised speech Bill Clinton makes to a joint session of Congress this week will be the most important of his still young presidency. And yes, the health-care program he will finally officially unveil (more or less -- it is still changing) would mark the biggest upheaval in social policy in decades. But the speech will not quite kick off the widely advertised Battle of the Century. More like the Policy Seminar of the Century. The maneuvering has already begun. Republican Representatives and Senators tried to steal a march on the White House last week by outlining alternative plans. And the early talk gives promise of a serious debate over substance, conducted in civil tones rather than by an exchange of raucous invective. Such normally fierce partisans as Senators Bob Dole and Ted Kennedy went out of their way to compliment their opponents. Clinton, in an interview with TIME, commended "the sort of spirit that seems to have enveloped the debate. There's a real openness to discussion . . . a sense that we're now on a journey together." Moreover, the competing ideas have such wide areas in common, with one another and with the Clinton plan, as to make some eventual broad overhaul of health care seem inevitable. Congress is hearing a loud message from back home: the public may not yet know exactly what it wants, but it is clear on what it does not want -- the present system. Pollster Bill McInturff, who conducted focus groups for Republicans in June, terms flat opposition to reform "a loser. You have to say, We're serious about making changes but at a pace that is a lot more compatible with a private market." So is it all over except for some squabbling about details? Not at all: the details are all-important, and the struggle over them will be prolonged and sharp. Confused too -- the Clinton plan is so sweeping that almost anyone can find in it provisions both to applaud and to decry. Some of the more intriguing objections: cigarette makers, targeted for a tax of around 75 cents a pack to help pay for the plan, have been howling "No fair." They insist that any "sin" taxes should fall on liquor as well as smokes. Some feminists, while enthusiastically pro-reform, gripe that Clinton's plan does not pay enough attention to women's special health problems. For example, they say, it would be too stingy in paying for mammograms. The Administration is still trying to mollify the dubious and the displeased. Over the weekend White House health adviser Ira Magaziner sat down to write 150-odd changes into the 239-page draft that was widely leaked two weeks ago. One sample: to reassure women's groups, the Administration put obstetricians and gynecologists with the "primary-care physicians" whose numbers it wants to swell, rather than with the "specialists" whose ranks it intends to thin. Magaziner expects to make about as many more changes in each of the three or four remaining weeks between Clinton's speech and the submission of a "last and final" draft bill to Congress. If nothing else, that malleability has confused some doubters into temporary silence. Asks a business lobbyist: "Which Clinton plan are we supposed to take a position on? The one today? The one tomorrow? Which?" Besides, it makes sense for probable opponents to hold their fire as long as they retain a chance of negotiating further changes in the plan. But while Clinton is being highly flexible on details, he is adamant on some basic principles. Several are echoed by the most thorough alternative plans, including one proposed last week by 22 Republican Senators and nearly identical bills likely to be introduced this week by two Democrats, Tennessee Representative Jim Cooper and Louisiana Senator John Breaux. Some amalgam of these proposals could become the principal bipartisan alternative to Clinton's plan. Clinton and leading competitors would eventually extend health insurance to everybody. They would have the government define a basic package of benefits. They would enable a person to keep the same policy after changing jobs or becoming unemployed, and to buy insurance even if he or she were already sick. And they would aim at simplifying insurance procedures -- by reducing the bewildering multiplicity of claim forms, for example. But the differences are hardly trivial. Clinton's plan is far more complex, largely because it aims at a more thorough overhaul of the whole system. For instance, it would even contain a mechanism enabling the government to determine how many general practitioners and how many specialists medical schools train. Though Clinton and Magaziner insist they rely on carrots far more than sticks, critics still maintain the plan is too regulatory. Though all the leading plans aim to set up large risk pools of insurers and insured, the Clinton scheme would make these "alliances" mandatory. And though all are supposed to hold down the zooming increase in medical costs, the competing plans would rely on market mechanisms while Clinton would try tight, mandatory limits on increases in insurance premiums. To opponents, these add up to a form of price control that might lead to a rationing of medical care. While there is room for compromise, and both sides are pledging a genuine effort to negotiate, there is also a possibility of deadlock. But the battle lines are more fluid than usual: the Administration has artfully put together various ideas into a plan with enough of a something-for-everybody approach to splinter some normally united interest groups: BUSINESS. Big companies favor Clinton's plan because it would save them money. It would cap employers' contributions to workers' health insurance at a level below what many corporate giants now pay. Further, the plan would enable such companies as Ford, Chrysler and U S West to shed much of the cost of insuring their armies of retired workers. Clinton would entice many of these oldsters to switch from company plans into health-care alliances, and would cap at only 20% the share of premiums that companies would continue to pay for retirees; the government would pay the rest. Small-business operators are the most frightened opponents of Clinton's: their National Federation of Independent Business is gearing up a campaign to kill his plan. The entrepreneurs fear that being forced to offer health insurance to their employees and pay 80% of its cost would either bankrupt them or force them to lop workers off their payrolls (even though some employers would get federal subsidies to help out). On a televised visit to a Washington hardware store last week, the President pledged to take another look at his plan to see "if there is something we can do for people who have between 50 and 100 employees." The small-business owners he met were not reassured. THE ELDERLY. Although the American Association of Retired Persons will probably not take an official stand until mid-November, it is leaning heavily toward the plan. A.A.R.P. especially likes the idea of government-mandated insurance coverage for prescription medications and for home-care visits by nurses or aides -- two major needs for many sick seniors. But the elderly and allies in the National Committee to Preserve Social Security and Medicare are aghast at Clinton's intention to whack $238 billion out of Medicare and Medicaid spending between 1996 and 2000, mostly by limiting payments to doctors and hospitals. They do not trust Administration promises to return much of the money to the old and poor through other portions of the plan. THE MEDICAL PROFESSION. The American Medical Association is officially neutral now but preparing to go into opposition. Like some nonmedical allies, the doctors are worried about being pushed into rationing care. Specifically, they fear that government-enforced caps on insurance-premium increases will prompt insurers to cut costs by dictating in niggling detail to doctors whom they can treat and how. Nurses, however, take a different view: they happily anticipate playing a more important -- and better-paid -- role in patient care. INSURERS. Big insurance companies that would be able to set up the health-care networks so central to Clinton's plan are, not surprisingly, for it. But the nonprofit Blue Cross and Blue Shield Association last week came out in favor not of the Clinton plan but of the much less mandatory alternative outlined by Rhode Island Republican John Chafee, Dole and 20 other G.O.P. Senators. That plan would require employers to offer insurance to workers but not necessarily to pay for it. It would force consumers to buy insurance, as automobile drivers must, but give them tax deductions and, if they are poor, government vouchers to help them pay. The Blue plans are concerned about how they will fare in Clinton's new world of giant health-care alliances and premium limitations. Smaller, for-profit insurers have no doubts: they think they will be wiped out. Their organization, the Health Insurance Association of America, has opened fire with a series of TV ads picturing a future married couple bemoaning its loss of choice -- of doctors and insurance plans -- under a Clinton-style reform. The Democratic National Committee shot back on Saturday with a TV ad implying that the insurers are "scared" they can no longer get away with "denying people coverage and jacking up prices." Though the divisions among its opponents give the Administration a great selling opportunity, the complexity of its plan makes it less than ideal to explain to a skeptical public. Undaunted, the White House is kicking off an all-out campaign stressing broad themes: universal coverage and portability and security of coverage -- or, in bumper-sticker language, HEALTH CARE THAT'S ALWAYS THERE. Clinton last week was host to a Rose Garden ceremony, filmed for local TV stations, at which people who had written letters to the White House detailing their health-care troubles read their horror stories aloud. For this week, the Administration scheduled a "health-care university" on Capitol Hill for 400 lawmakers of both parties, at which Hillary Rodham Clinton and other luminaries were to teach "courses" in how the plan would work. (Though she headed the task force that put the plan together and will be a major witness at the first congressional hearings late this month, Mrs. Clinton is being cast as a "supporting actress," in the words of White House press secretary Dee Dee Myers, while the President plays the lead sales role.) Other Administration officers will hit the road to whoop up the plan; the White House has brought in a TV coach to prep them to make the most effective possible appearances on national talk shows and local programs. Among other things, they are being told to avoid jargon: to talk of alliances, for example, instead of Health Insurance Purchasing Cooperatives -- and for heaven's sake not HIPCs (pronounced Hippicks). Amid all this hoopla, so far at least, the Administration is talking in tones of conciliation and cooperation. Magaziner and others have made a sort of mantra out of the contention that their plan is "not graven in stone." On the opposite side, the great majority of critics are taking an approach of "We know fundamental reform is necessary, but . . ." After the venomous partisanship of the budget fight, and the bipartisan venom of the battle now being joined over the North American Free Trade Agreement, the nation just might be in for a rare treat: a statesmanlike debate on a weighty problem, focusing on substance and conducted in tones of gravity and civility. Well, at least one can hope. </body></article> </text>