by Steven V. Roberts, Kenneth T. Walsh, Katia Hetter
In his State of the Union address, President Bill Clinton tried to be two things at once: a cheerleader for economic recovery and a fearmonger about the lack of guaranteed health insurance for American families. It is understandable that his speech was laced with such contradictions because the electorate is gripped by a massive ambivalence complex -- particularly regarding health care. Citizens feel good about their own doctors but think the system is rotten. They welcome change, but nothing too dicey or disruptive. If anything, this divided opinion is growing as the public focuses on the details of the health care debate. "The euphoria is over," argues U.S. News pollster Celinda Lake. "And as people think they might actually get a new plan, it elevates the contradictions."
Few issues will have a greater impact on the mid-term congressional elections this November and the president's re- election bid in 1996. And both parties want to have it both ways. For the Democrats, it is their best chance to show that they can use government effectively -- but not exclusively -- to solve social problems. For the Republicans, the challenge is to provide a distinct alternative, while not appearing too obstructionist. But Rep. Henry Waxman, an influential California Democrat, says the situation remains fluid: "There isn't a majority in the House for anything at the moment."
The main source of the "weird mixed signals" GOP pollster Bill McInturff finds flowing into Washington is the public's love-hate relationship with government. In a recent U.S. News poll, 2 out of 3 respondents say the government should have a large role in solving the nation's major problems, about the same number who consider universal coverage a very important goal of health care reform. "There is an enormous suspicion of government," says pollster McInturff. "But people also understand it is the only institution out there with the power to make fundamental changes."
"Peace of mind." Democrats have seized on this side of the public's ambivalence, stressing the role of government protection in providing "peace of mind" to workers who don't have health insurance now or fear they may lose it in the future. "Health security," a conscious imitation of Social Security, will be the party's watchword in the months ahead.
At the same time, the public believes Washington is full of pushy, inept scoundrels. Only 1 in 4 Americans is willing to pay higher taxes or premiums to upgrade the health system, and 4 out of 5 believe any new revenues will be squandered. Republican pollster Ed Goeas, who does surveys with Democrat Lake for U.S. News, says that by a margin of 3 to 1, Americans fear government is getting "too intrusive" in their lives. Republicans are trying to exploit this side of the public's ambivalence, charging the White House and its allies with mounting a "hostile takeover" of the health care system and playing on anxieties about government bureaucracy and rising taxes. That was the theme of the humongous chart Sen. Bob Dole displayed in his response to Clinton's address, and it clearly struck a chord with viewers: Callers besieged Congress requesting copies.
Yet Clinton himself enjoys some significant political advantages as the battle begins. As he demonstrated last week, the president can command public attention in ways that no opponent can begin to match. And his sympathy for the fears of ordinary Americans connects with voters and echoes their own concerns. For that reason, many Republican strategists are aghast at the new line of some GOP leaders that there is "no crisis" in the health care system. That argument, says Vin Weber, a former GOP congressman, "just reinforces the image of flint-hearted Republicans," the same image that helped cost George Bush the 1992 election. Celinda Lake agrees: "I hope we get every Republican candidate saying there is no crisis -- on tape."
Pink slips and medicine. Republicans hold more solid ground on other fronts. One of them is the very economic success Clinton crowed about last week when he hailed robust growth, business investment and housing construction. To a significant extent, anxiety over health care is tied to the country's economic outlook. As consumer confidence rises, worries about getting fired and losing benefits begin to fade. In most recent polls, crime has edged ahead of health as the public's No. 1 concern, and lawmakers returning to the capital last week report a distinct downturn in public enthusiasm for massive overhaul of the health system. Says Rep. Norman Mineta, a California Democrat: "The mood here is now slowing down rather than speeding up."
As the needle gauging public opinion swings back and forth, strategists on all sides are trying to calculate where it will stop. Clinton's risky decision to threaten a veto unless Congress guarantees coverage to all Americans was clearly an effort to shift the consensus leftward. And it was cheered by party liberals like Senate Majority Leader George Mitchell, who said the vow "changes the whole nature of the debate" and stymies momentum toward a more moderate compromise.
But the cheers for Clinton's strategy were hardly unanimous. Inside the White House, counselor David Gergen argued that a veto threat would irritate Congress and limit the president's options, and many advisers did not learn of the final decision until they saw the speech. Several congressional Democrats also noted that the veto ploy injected new tension into the issue and compared the threat with previous administration vows to bomb the Bosnian Serbs: If your bluff is called, you have two unpalatable choices - - backing down or escalating the conflict. "The perception is that this stuff [like Clinton's stagy veto threat] is planned down to the last detail," says a White House official. "Well, it isn't. We were never sure the president would actually hold up the pen."
The coming debate will revolve around a series of conflicting attitudes that continue to dominate the public's view of the health care problem:
Government role. Strategists in both parties say the answer could lie in a formula that has Washington "police" or regulate the system, but not run it. "People reject the role of government as manager," says Celinda Lake -- a prime reason why Clinton stressed his preference for a "private" over a public system.
Coverage versus cost. While voters say they favor universal coverage, that abstract preference could wane as the cost to the taxpayers becomes more visible. "They are struggling to balance the politically correct answer against self-preservation," says Goeas.
I'm OK, you're not. Three quarters of voters say they're satisfied with their own coverage; but they favor an overhaul of the system by the same margin. This ambivalence reflects two factors: a generalized fear that the future will be worse than the present and a resentment against big institutions of all kinds.
Controlling the controls. Voters stress the importance of holding down health care costs. But they don't want a global medical budget that could degrade the quality of care or deprive them of options. That is a major reason why Clinton barely mentions cost controls anymore and is ready to jettison some of his more elaborate bureaucratic proposals.
Hope versus reality. Support for reform remains high: In a CBS News/New York Times poll, only 9 percent of respondents favor standing pat. But optimism is dwindling; 56 percent now predict Congress will not pass anything this year.
As always in Congress, the key question is whether party leaders will look for a consensus policy position or seize an issue to exploit in the next election. For now, both sides have staked out rather hard-line bargaining positions. Senate Republican leader Dole says he will accept no bill that requires employers to provide benefits; Clinton says he will accept no bill that does not include universal coverage. But most analysts think that some form of employer mandate is necessary to achieve universal coverage. As
