The lights are on, the camera running. This week, finally, Congress begins action on health-care reform.
Unfortunately for President Clinton, the director's chair is vacant, bit players have taken center stage, the budget is running in the red, critics have turned thumbs down and the audience can't follow the plot.
As a result, what could eventually be the biggest and boldest social program since the Great Society faces an array of political and procedural hurdles that make Capitol Hill look more like Mount Everest.
"This is a complicated bill," says Rep. Henry Waxman, D-Calif., one of two House subcommittee chairmen who will begin writing new versions this week. "It's an extraordinary legislative undertaking."
Between proposal and passage are obstacles that make Clinton's task tougher than those faced by Franklin D. Roosevelt in the 1930s or Lyndon B. Johnson in the 1960s:
-- The director's chair. Clinton was elected with just 43% of the vote; he can't control Congress the way Johnson did when his 1964 landslide paved the way for Medicare.
"We had a very different political situation," recalls House Energy and Commerce Committee Chairman John Dingell, D-Mich., a 40-year veteran of Congress. "We passed it . . . with a whoop and a holler."
Clinton's team on the Hill - House Speaker Thomas Foley, D-Wash.; Senate Majority Leader George Mitchell, D-Maine; and House Majority Leader Richard Gephardt, D-Mo. - enjoy at best marginal sway over 532 other members.
"It's not the kind of discipline that you once had," says House Minority Leader Bob Michel, R-Ill., who has served with nine presidents.
-- The bit players. The congressional calendar gives first dibs to subcommittee chairmen such as Waxman and Rep. Fortney "Pete" Stark, D-Calif., whose panels are so fractured they cannot pass Clinton's bill.
A star player is Senate Finance Committee Chairman Daniel Patrick Moynihan, D-N.Y. There's doubt about his commitment to health-care reform and his ability to steer a bill through a panel with a tight 11-9 margin of Democrats.
Meanwhile, sponsors of alternatives - from incrementalists to utopians - are fighting to defeat the Clinton plan.
Says Stark: "I can't get it out of my subcommittee. I can't get six Democrats to agree."
-- The budget. To cover the uninsured, expand benefits and subsidize those who cannot pay, billions of dollars are required. That means taxes or government mandates - all of them political dynamite.
Complicating the picture are deficit-reduction laws passed in 1990 and 1993 that make new programs more difficult by demanding they be paid for. "We have to educate the American people," says House Ways and Means Committee Chairman Dan Rostenkowski, D-Ill. "We have to tell them, you're going to get what you're willing to pay for."
-- The critics. While Clinton battles the budget and Congress, private interests with millions to spend on 30-second TV ads have spread doubts. Groups representing the insurance industry, small businesses, doctors and the elderly have taken their case directly into congressional districts, forcing lawmakers to listen.
"It also makes them a much more cautious institution, which is why the Clinton plan will not pass," says John Motley, a National Federation of Independent Business lobbyist. "Social Security may not have passed in this atmosphere."
-- The audience. At a time when the powers of presidents, political parties and legislative leaders have waned, lawmakers listen to their constituents.
And faced with a cacophony of charges and countercharges, the American people are confused. The 1,342-page Clinton bill is far too complex for simple explanation.
"Many members report that the public is not clear yet," says Foley. "They're reserving judgment."
"It clearly helps the opponents," says Mitchell. "They're able to create doubt and fear."
Neither Mitchell nor Gephardtsays the roadblocks will prevent passage of health-care legislation this year. "It will dominate the agenda, dominate my time. It's a very hard bill to put together," Gephardt says. "I've seen a lot of things get done when nobody thought it could get done."
"Everybody in here thinks we're jumping off a cliff, because this has never been done before," laments Rep. Louise Slaughter, D-N.Y., who heads a House task force on women's health. In truth, several states and communities, including her hometown of Rochester, have experimented with "managed competition" among health plans.
Part of the problem, current and former lawmakers say, is a lack of knowledge about the private health system even among lawmakers and staff.
"There's very little solid know-how within this beltway on health insurance regulation," says Bill Gradison, a former House member now president of the Health Insurance Association of America, sponsor of the "Harry and Louise" ads attacking the Clinton plan.
Add the jumble of committees and subcommittees that will have their hands in the health-care cookie jar between now and November, when all House members and one-third of the Senate face re-election. "It could create a real logjam," says Rep. David Dreier, R-Calif., a member of the House Rules panel that will piece together a final bill this summer.
In the meantime, interest groups and the public will be making their feelings known.
"All of a sudden, the members begin getting phone calls and letters in volumes that they never did before," says James Todd, executive vice president of the American Medical Association - sending thousands of members to Washington next week to lobby.
Even the most loyal Democrats have begun to hear from nervous constituents who don't trust the federal bureaucracy.
"Anti-government feeling is really making this tougher," says Rep. Vic Fazio, D-Calif., who chairs the House Democrats' re-election effort.
Many lawmakers say the size and the complexity of the task will overwhelm Congress, which can take years to pass measures of less magnitude. They expect something less than Clinton's package to pass. "Congress doesn't make dramatic changes that affect individuals' lives dramatically and substantially with a program that's untried," says Rep. Rick Santorum, R-Pa., one of many young lawmakers who went to Washington to get government out of the way.
Says Michel, who is retiring after 38 years in Congress: "This thing's going to stretch over several Congresses before it's finally resolved."
People and panels facing health-care reform in Congress
HOUSE -- SPEAKER THOMAS FOLEY, D-WASH.: Must coordinate the work of key committees and supervise crafting of final House product. -- MAJORITY LEADER RICHARD GEPHARDT, D-MO.: Lead sponsor of Clinton bill and top political strategist for the reform effort. -- MINORITY LEADER BOB MICHEL, R-ILL.: Head of House Republicans and sponsor of their incremental approach to reform. SENATE -- MAJORITY LEADER GEORGE MITCHELL, D-MAINE.: Coordinates, supervises in Senate, where he's lead sponsor of Clinton bill. -- MINORITY LEADER ROBERT DOLE, R-KAN.: The pivotal Republican in Congress, where his support may be crucial for passage of a plan.
ALTERNATIVE PLANS
-- COOPER PLAN: Rep. Jim Cooper, D-Tenn., and Sen. John Breaux, D-La. Lead sponsors of a less regulatory approach to reform that covers fewer people, costs less - and is gaining momentum. -- SINGLE PAYER: Rep. Jim McDermott, D-Wash., and Sen. Paul Wellstone, D-Minn. Lead sponsors of a tax-financed,
government-supervised plan similar to Canada's that enjoys broad support among liberals. -- GOP PLANS: Sens. John Chafee, R-R.I., Don Nickles, R-Okla., and Phil Gramm, R-Texas. Sponsors of three separate Republican plans that gradually expand coverage without as much government bureaucracy.
KEY COMMITTEES WITH JURISDICTION
HOUSE
-- Ways and Means: 24 Democrats, 14 Republicans. Rep. Dan Rostenkowski, D-Ill.,
