Picture of Health

By Michael Duffy/Washington

Bill Clinton had just finished signing some letters in the Oval Office last Tuesday night when he paused for a moment to take stock. Earlier in the day he had signed his cherished national-service bill, and he was preparing to spend the evening making more than 60 changes to a draft of the health-care speech he would deliver the following night. Obviously pleased to return to two issues that had served him well in the campaign, Clinton shoved some papers into his briefcase and said to an aide, "I think things are really coming together. We're doing what we were elected to do."

Perhaps the Clinton presidency is just getting under way. After a nearly disastrous start that left him questioning his own performance, Clinton has repositioned himself as a problem solver. He and his aides are learning that they can frame the debate on only one issue at a time, and sometimes not even then. And while there are plenty of questions outside the White House about the wisdom of Clinton's course, there is also palpable relief inside that the President is finally on the move. As Hillary Clinton told 150 White House officials at a midnight East Room celebration following the speech Wednesday, "It's the end of the first quarter, and we're in the game."

Though short on specifics, Clinton's speech Wednesday night proved that he is remarkably persuasive at making the case for his policies -- a key test of leadership. "If Americans are to have the courage to change in a difficult time, we must first be secure in our basic needs," he said. "The health-care system of ours is badly broken, and it is time to fix it." By personalizing a complex subject with stories of people who had lost their health insurance or faced a choice between medicine and food, Clinton asserted what a senior official described as "moral passion" and established that the cost of doing nothing will exceed the cost of change. White House officials admit that Clinton must still explain how the plan will be financed. But there is resistance to being too precise. "I would not assume that the public is going to want to know every detail," said a senior Administration official. "The public is far more interested, as far as we can tell, in knowing that the plan is rooted in sound values."

The White House is monitoring public opinion closely. The Democratic Party invited nearly 100 disaffected Clinton supporters and Perot backers in Dayton, Ohio, to watch the speech Wednesday night and use hand-held dials to register their approval and disapproval. Though such sessions aren't as reliable as telephone polls, the results encouraged the White House that its message was on target. Support for Clinton's health-care plan more than tripled over the evening, several officials reported; Clinton's personal approval rating among the group jumped nearly 50%.

A new TIME/CNN poll supports this conclusion. In the survey, 57% said they favor Clinton's health-care plan. And for the first time in four months, Clinton's overall approval rating exceeds his disapproval rating: 50% of those polled on Thursday night approve of his performance as President, in contrast to 41% who disapprove. To a White House that believes 43% is a "mandate," this is good news. "People feel he is trying," said George Stephanopoulos, the President's senior adviser. "Whether they agree with him or not, they feel he is doing big things." At the same time, a nettlesome rival is losing steam. In the TIME/CNN poll, the portion of those surveyed who have a favorable impression of Ross Perot dropped to 44%, down from 52% in August.

According to Stan Greenberg, the White House pollster, Americans believe the prospect for change is improving now that Clinton has turned his attention to such middle-of-the-road concerns as health care, free trade and "reinventing" government. A day after his health-care speech, Clinton flew to Florida for a Nightline-televised national town meeting on health care and for more than two hours demonstrated his formidable grasp of the problem. "It has been a long time since the public has seen him wrestle with the problems of everyday working Americans," said a White House official. "They didn't see it on gays, and they didn't see it on the budget. Now they see it." Mandy Grunwald, an outside political adviser, put it more succinctly: "He's fighting the right fight."

The Clinton team has lately improved its lot by tempering its relations with Congress, where members of his own party have been giving him fits since the day he was inaugurated. After 12 years out of power, Democrats have had trouble getting accustomed to being part of a governing majority and felt free to treat any President like the opposition. "It takes an adjustment," admits Senate majority leader George Mitchell. "There's a substantial difference when the President is of your party. The necessary discipline and restraint are not in the tradition of the Democratic Party."

Clinton exacerbated the problem several ways. By slaloming between liberals and moderates during the spring and summer, Clinton appeared to be just a middle-aged Democrat, rather than clearly old or new. Such artful ambivalence is often necessary in Washington, but Clinton's was on display all the time, and he gave both factions license to carp at him as inconsistent. In addition, he gave insufficient deference to committee chairmen like Sam Nunn and Pat Moynihan and paid dearly for the slights: Nunn has nearly shut down Clinton on gays in the military, and Moynihan last week suggested that Clinton's health- care financing scheme was spun from whole cloth.

The White House would have dismissed such criticism in March, but Clinton is more solicitous now. Two days after Moynihan took his potshot, Clinton invited the Finance Committee chairman and Nebraska Senator Bob Kerrey to the Oval Office, where they urged him to level with Americans about the costs of his health-care plan. Americans must be told, Kerrey said, that they will have to pay more for better health care either in the way of higher premiums or in lost benefits. Otherwise Clinton would run the risk of overpromising and underdelivering. Clinton did not go as far as Kerrey wanted, but within hours he beefed up the section in the speech on "personal responsibility."

The White House is also going easy on Democrats who go astray on the North American Free Trade Agreement. Clinton's manifold agenda makes it impossible to do otherwise: the White House made no move to punish Senator Don Riegle, who opposes NAFTA and gave Ross Perot a platform to blast the President in Michigan, in part because he was marking up Clinton's community-development banking bill three days later. Though House majority leader Richard Gephardt and whip David Bonior have announced they will oppose Clinton on NAFTA, both supported the President on the budget, and will repeat the favor on health care. The day Gephardt's announcement appeared on page 17 of the Washington Post, Clinton joked privately that "the only thing good about Boris Yeltsin knocking national service off the front page was that it knocked Dick's speech off too."

Given Clinton's appetite for taking on policy challenges, White House officials say they have no choice but to build a separate coalition for each measure he sends to Congress and then work behind the scenes to minimize the conflicts of interest. "It isn't pretty," said a White House official, "but people are getting used to it.".

Looking back, top aides see the turning point in Clinton's effectiveness as his August vacation, when he decided to concentrate less on the day-to-day operation of the White House. For months Clinton had functioned more or less as his own chief of staff, insisting on seeing dozens of aides daily despite warnings that he needed a stronger doorkeeper. During his vacation on Martha's Vineyard, Clinton tried a new approach for two weeks: talking only to chief of staff Mack McLarty and, on occasion, Treasury Secretary Lloyd Bentsen. Since then, said an aide, "he's just let go." Says a top aide: "He doesn't have to micromanage as he once did. He doesn't have to be the organizer-in-chief, the actuary-in-chief, the commentator-in-chief. That's not what they elected him to do."

It will take discipline to make the new discipline work. The Clinton White House can still resemble a continuous fire drill. The health-care speech was conceived amid the usual creative chaos that the Clintons call home. Disappointed by the initial draft, Clinton asked Deputy Assistant to the President David Dreyer to work on a new version with Jeremy Rosner, a National Security Council staff member with a background in health-care policy. With an outline all but dictated by Hillary Rodham Clinton, Dreyer and Rosner on Tuesday night turned in their draft, which concentrated on six principles: security, simplicity, savings, choice, quality and responsibility.

Clinton edited the second draft overnight and began practicing the speech Wednesday afternoon. More changes were made as Clinton practiced for top aides and a video crew in the small theater in the East Wing. He would cut and add new material off the top of his head as he talked, while aides tried to write it all down nearby. After three dry runs, his wife, dressed in a blue sweatsuit, walked in to listen. When he reached the part about choosing a "talented navigator" with "a rigorous mind" and "a caring heart," both Clintons burst out laughing. "Oh please, stop, enough," said the First Lady, hiding her face in her hands.

Dreyer added the latest changes by 8:30, copying the speech onto three small diskettes and the hard drive of his laptop computer. Clinton made more changes during his limousine ride to Capitol Hill; Stephanopoulos typed those directly into the TelePrompTer. What no one realized was that a White House communications aide had already accidentally merged the new speech with an old file of the Feb. 17 speech to Congress. Then they simply scrolled to the top of the document and waited for Clinton to begin.

When Clinton took the podium minutes later, he was understandably alarmed to see a seven-month-old speech on the TelePrompTer's display screens. Clinton told the news to Gore, who didn't believe it at first. "You're not reading it," said Clinton. "Read it." Gore did, and then said, "I believe that's the February speech." Gore summoned Stephanopoulos, who scrambled to fix the mistake, eventually downloading the correct version from Dreyer's laptop. But for seven minutes, Clinton vamped with just notes. "I just kind of thought," Clinton told an aide later, " 'Well, God, you're testing me tonight.' "

Clinton's aides let it be known last week that the President worried aloud during speech preparation that he had to deliver the bad news along with the good. But he is already being criticized for sugarcoating his plan, and some advisers add that Clinton may have raised expectations too much. "It's heresy to say it around here," said a White House official, "but there's some worry that the speech was a little too good. The plan may not live up to the speech."

That is a danger, but the Clintons seem to sense it. After the speech, the Clintons and the Gores returned to the White House and made a triumphant visit to the troops in the health-care "war room" in the Old Executive Office Building. Greenberg and Grunwald pulled Clinton into an adjacent office to deliver the results of the networks' instant polls. But the new challenge was summed by Mrs. Clinton, who stood on a chair in the middle of the room and said, "After tonight, this is no longer the war room. It's the delivery room."

CHART: NOT AVAILABLE

CREDIT: From a telephone poll of 800 adult Americans taken for TIME/CNN on Sept 23 by Yankelovich Partners Inc. Sampling error is plus or minus 3.5%.

CAPTION: Do you approve of the way President Clinton is handling his job as President?

Do you favor Clinton's health-care reform plan?

From what you know of those health-care reforms, will you and your family be better off?

Do you understand most of the major points in the health-care plan?

Is having to join a managed-care health plan an excessive infringement on your freedom to choose a doctor or an acceptable part of reform?

If a major illness were to occur in your family, could you handle the costs easily?

With reporting by Laurence I. Barrett and Julie Johnson/ Washington