After months of languishing, health reform's byzantine legislative process finally took on a life of its own last week. Sure, Republicans and Democrats were still bickering, the insurance industry was back with a new "Harry and Louise" ad and Senate Minority Leader Bob Dole had metamorphosed into the Darth Vader of reform. Yet one House committee actually cleared a bill. And even more important, a bipartisan group of seven Senate Finance Committee moderates took control of the issue from their leaders, writing a package that had eluded everyone else. Nothing is close to final, but the frenzy behind closed doors makes one thing clear: This is the beginning of the endgame.
Complexities. The problem is that no one can yet predict the outcome. Bill and Hillary Clinton remain committed -- publicly, at least -- to universal coverage. Yet they quietly watched the bipartisan efforts of the Finance Committee renegades who produced a plan calling for eventual universal coverage -- without requiring that employers foot the bill. The complex plan sets the goal of covering 95 percent of all Americans by the year 2002. If that does not happen, a special oversight commission would then recommend how to achieve the goal -- and Congress would have to vote quickly, but it would not be required to enact anything. Initially, the group then called for an "individual mandate" to take effect in the absence of action, requiring people not insured through work to buy their own insurance. A coalition of labor and consumer groups attacked that idea as unfair to the middle class -- and the senators backed down. New Jersey Democrat Bill Bradley was one compromiser who wanted both individuals and employers to ante up. "People have to work their way through this," he said, adding he may yet oppose the committee's final measure. "There are so many moving parts."
For its part, the White House remained mum. So did Democratic leaders; Senate Finance Chairman Daniel Patrick Moynihan applauded the work but refused comment on the product. Privately, the White House and Democratic leaders did not like the plan. But they wondered whether it could still work as a way to prod some bill out of Senate Finance. Dole continued to warn Republicans not to become patsies for Democrats. Group member David Durenberger made it clear that was not his intent. "This is the closest we're going to come to doing health care reform right in America at any time." Still, some in the "G-7" looked for promises to stick together; others wanted an embrace by the White House. Neither was forthcoming. House GOP leaders, meantime, told their colleagues to avoid any deal on reform. "This fight makes Beirut in the '80s look calm," says one GOP strategist.
Most of the damage last week was Republican. A defining GOP moment on health care came when Dole called a session in his office with key players -- who proceeded to bash one another. Some argued that the GOP should take the issue and forget working for any bill. Dole, unwelcomed by moderates who did not invite him or other leaders to their sessions, announced he was drafting a bill with ranking GOP Finance member Bob Packwood. Dole pleaded for Republican unity; Durenberger then wanted to know "who defines what a Republican is these days?"
Dole's dilemma. Dole may have figured that was to be his job, but he has yet to define himself. His internal conflicts on health care reform mirror the largest divisions in his party, between the willing legislators and the political opportunists. One top White House aide said he thinks that last week Dole decided to lead the opportunists. "This is the Dole who wants to run for president and wound this one," the aide said. "He wants to block the president in the worst way."
The assessment angers Dole, who says he still wants to write a bill that could win the support of 30 Republicans. "I don't give up easily. It's all timing around here," he told U.S. News. But he cautioned his moderates not to be Democratic pawns: "We have to think of where the party comes out." Chances are, it won't be in one place, considering the makeup of the 44-member Senate GOP: Between 10 and 15 conservatives want nothing to pass; a handful of moderates want to get a bill and the rest remain uncommitted.
At the White House, there is some internal division about how to proceed: There are some -- Mrs. Clinton is apparently in this camp -- who think the administration should go for a simple majority in the Senate and worry about gaining Republican support when a bill comes out of conference committee. There are others who believe that the measure must have Republican support all along to keep its credibility. "Nothing is resolved," says one insider. "We need to get the bills out of committee first."
In the crazy world of health care reform, last week's flurry of activity was progress. "It's like lava flowing down the side of a volcano," says Sen. John Danforth. "Fluid and hot." And it will not cool down anytime soon.
