Even by congressional standards, health care reform is a mess. Dan Rostenkowski has just been indicted and dethroned as chairman of the House Ways and Means Committee; not one of five congressional panels has reported out a bill (most were promised by Memorial Day); both Democrats and Republicans are squabbling internally over how much -- or whether -- to compromise. For their part, the voters have decided that (a) they are confused, (b) maybe reform isn't such a great idea and (c) we should probably wake them when it's over. Before the president left for Europe, he asked the leaders responsible for shepherding health care to "move forward." Such bold instructions left some members wondering why the president had bothered to summon them at all.
Everyone in the session knew what remained unspoken: Reform is fast approaching its key political moment. If something doesn't give, it will die. Of course, this psychodrama is all part of the legislative cycle. Such maneuvering aside, much is at stake: Democrats could lose effective control of Congress if health reform does not happen this year. Sure, they will blame the Republicans for any derailment. But with a 78-vote Democratic margin in the House, pinning gridlock on the GOP strains credulity. "We said the most important thing was health care," says Democratic polltaker Mark Mellman. "If you had two years and can't do it, it's a problem."
The Democrats need a deal, not something to whine about. The take-the-issue and-run caucus (which variously includes Energy and Commerce Chairman John Dingell, Senate Finance member Jay Rockefeller and some closet administration believers) argues that since Democrats enjoy more credibility on health care, they could use the issue to Democratic advantage. But such reasoning makes light of the most pressing political reality: Without health reform, all incumbents suffer. When Mellman asked voters whether they would generally favor an incumbent over a challenger, the incumbent won by a 9 percent margin. But when voters were given that same choice in an election where Congress failed to pass health reform, they swung behind the challengers by a 2-point margin. Democrats, of course, have more incumbents -- and more to lose. In fact, if they lose between 20 and 25 House seats and five Senate seats, as some now fear, Congress will be run by a conservative coalition of Republicans and Southern Democrats. And the Senate Finance Committee is due to get three new GOP members -- possibly conservative Phil Gramm of Texas; the others, Gramm clones. If the Democrats want health reform, they had better do it now.
Granted, this is a tricky political process for the White House. The first concern is getting bills that can pass in the liberal- leaning House and the conservative-tilting Senate; the next is writing a passable version in a House Senate conference committee. So when to send signals about an acceptable deal? It has to happen within the next few weeks, say key Senate Democrats. The irony, adds a top Senate Finance aide, is that Clinton has already lost ground by not striking a bargain with committee Republicans "desperate" to write something: He would have won more concessions earlier than he will get in the endgame. "By waiting, the White House walks into [Senate Majority Leader Bob] Dole's hands," the aide says. "Now the White House will be desperate, and the Republicans will know it."
Good soldier. Senate Finance Chairman Daniel Patrick Moynihan will soon be a good Clinton soldier and present a version of health reform requiring most employers to pay for much of their employees' health insurance. The measure will get promptly rewritten by the panel's conservative Democrats and Republicans. Yet maybe the discussion will force some White House guidance in a few key areas. First, how is Clinton going to refine his promise of universal coverage? Second, which of the conservatives' ideas are deal killers in the president's eyes? Third, who in the administration is in charge? "I don't know," complains Louisiana Democratic Sen. John Breaux, a key Finance Committee player. "You need to have one policy person running the show, and we do not."
If the Democrats want health care, the pieces are there. Clinton has plenty of wiggle room on his promise to provide universal coverage; he can stretch out deadlines and argue that something providing insurance to over 90 percent of Americans is the first step toward total coverage. A hefty group of moderate Republicans and Democrats want to push for fairly sweeping reform rather than an incremental laundry list of fixes. And even the most recalcitrant Republicans understand they can score political points by taking credit for reducing big government in the Clinton plan.
For the Democrats, the stakes are higher. Without health reform, they have failed to govern. Republican campaigns this fall will no doubt focus on institutional failure -- of Democratic congressional control and of its Rostenkowski-like corrupt leadership. If the Democrats get health care reform, they could then focus on something the public might like to hear about: a promise that was kept.
