Going Flat Out

By JAMES CARNEY/WASHINGTON

When Bill Clinton's campaign for President was faltering, a bus tour into America's heartland helped lift him into a lead he never relinquished. Last Friday, with the success of her husband's presidency at stake, Hillary Rodham Clinton kicked off another bus tour, this one designed to rescue the Administration's campaign to overhaul the U.S. health-care system. Before a sweltering crowd packed into a plaza in downtown Portland, Oregon, the First Lady called on Congress to "do the right thing" by voting for a bill that satisfies the White House's primary goal: guaranteed health insurance for everyone. "The message is simple!" she shouted. "If we do not provide health insurance to every American, then we have failed all Americans!"

Dubbed the Health Security Express and organized by supporters of Clinton- style reform, bus caravans from Portland, Dallas, Boston and Independence, Missouri, will wheel across the country, picking up passengers and making made-for-media rally stops before converging on Washington next week, just as Congress is beginning full debate on its modified versions of Clinton's plan. The President hopes the bus caravans will help him sell a message he thought he had got across 10 months ago. When the President unveiled his reform plan last September, polls showed that most Americans favored his approach to overhauling the system.

Now the public is skeptical. It has increasingly come to see in health-care reform a risk instead of an opportunity. In a TIME/CNN poll conducted in July, 31% of those surveyed believe they would be "worse off" under Clinton's plan -- up 10 points since September -- and only 15% think they would be better off. "People generally understand the need for change," says Congressman Bob Matsui, a California Democrat. "But they're concerned about getting hurt." Even more alarming for the Administration has been the remarkable efficiency with which the President's opponents have succeeded in vilifying the Clinton plan. In the TIME/CNN poll, 49% opposed the Clinton approach, while only 37% supported it.

The shift in public opinion has forced the Administration to narrow its goals. Last week Clinton publicly signaled his willingness to compromise on his central objective -- health-care coverage for 100% of the population. "You've got to get somewhere in the ballpark of 95 or upwards," he said. "I'm quite open on that."

The next day, when loyal supporters protested, the President claimed he was sticking with his original goal. But on Thursday night, Senate majority leader George Mitchell sat down in the Oval Office with the President, the First Lady, Vice President Al Gore and new chief of staff Leon Panetta and delivered some bad news: no plan as ambitious as Clinton's could pass the Senate. Instead Congress would try to produce a "less bureaucratic" plan. Universal coverage would still be the goal, but it would have to be phased in very slowly. With less than three months before congressional elections, Clinton had little choice but to concede. Republicans are expected to slice deeply into the Democratic majorities in both houses, meaning the odds will only grow longer for Clinton if he fails to get legislation this year.

Despite the dismal polling numbers, the President's advisers point out that a majority of the public supports his goal of universal coverage, even though many of the same people recoil when asked whether they endorse the Clinton plan. In the TIME/CNN poll, 61% say the government should guarantee health care for all Americans. Support for universal coverage has remained fairly consistent, even as interest groups opposed to the Clinton plan have spent millions of dollars campaigning against it. Says Lorrie McHugh, a White House spokeswoman on health care: "People don't realize it's the Clinton plan they like."

Yet asking people whether they support universal coverage is one thing; asking how much more they are willing to pay for it -- whether in taxes, higher insurance premiums, wage cuts or forgone raises -- is another, especially when 85% of Americans have insurance. While 50% of those surveyed in the TIME/CNN poll said they would be willing to pay something extra for universal coverage, only 15% of those people said they would pay more than $50 a month. For 43%, anything more than $30 extra was too much.

The Administration has long contended that cutting back on waste and inefficiency in the health system would generate enough savings to pay for universal coverage, but many independent studies have shown that a Clinton- style plan would cost Americans who already have insurance anywhere up to $200 extra a month. The Clintons settled on the employer mandate, in which businesses would be required to pay 80% of the tab for their workers' coverage, as the most politically realistic way of financing universal coverage. It has the advantage of hiding the true economic impact of the cost of reform: employees think they're getting a freebie, while employers know they will pass on the cost. Says John Sheils of Lewin-VHI, a firm that has conducted several major studies on health-care reform: "Everybody thinks the other guy is paying for it."

But people are getting suspicious. Of those polled by TIME/CNN, nearly two- thirds expect to pay more for health care under Clinton's plan. Senator Joseph Lieberman, a moderate Democrat from Connecticut, believes that what many Americans mean when they say they support universal coverage is that they want their existing coverage to continue. Says Lieberman: "People are beginning to worry that they'll end up paying more and getting less."

Since the debate began, both the President and Hillary Clinton have insisted that universal coverage was their non-negotiable bottom line. In January the President even promised to veto any bill that didn't guarantee it. But increasing numbers of lawmakers, including Democrats, have been saying that getting a program that requires universal coverage is impossible. The reason: Congressional support is lacking, especially in the Senate, for any kind of mandate forcing employers to pay for insurance. And no one has come up with a plan that can cover everyone without some kind of mandate. Until last week, the President had avoided discussing how far he might compromise on universal coverage. But in a speech to the National Governors' Association in Boston, he blinked -- or so it seemed. "You cannot physically get to 100% coverage," he said.

As moderates on Capitol Hill applauded the President's new realism, and liberals lamented his apparent compromise, White House officials quickly denied that Clinton had shifted his position. The President had ad-libbed his way into trouble. Said Leon Panetta: "The President's bottom line is what it has always been: guaranteed health coverage for every American."

The President complained that the point he was trying to make in Boston "somehow didn't get through" -- that a rival plan of modest insurance reforms put forward by Senate Republican leader Robert Dole would hurt middle- class Americans by increasing costs and decreasing coverage. Dole has already gathered 39 GOP co-sponsors for his proposal. Speaking before Clinton at the NGA, Dole softened his rhetoric but not his position, stating that bipartisan cooperation was possible only "if the Administration is willing to come our way." An employer mandate, Dole said flatly, is "not going to happen this year."

As Clinton launched a final drive for health-care reform that in coming weeks will include stump speeches and town meetings, he sounded a new, more populist theme aimed at regaining support for his plan among the middle class. To a crowd in the small town of Greensburg in western Pennsylvania, the President argued that his plan was less about helping the 15% minority without insurance than providing security to the middle-class majority. "The politicians have it, the wealthy have it, the poor have it, ((and)) if you go to jail you've got it," said Clinton. "Only the middle class can lose it." Dole responded to the new theme by accusing the President of practicing "class warfare," but Paul Begala, a Clinton political adviser, exulted in the new rhetoric. "He's back!" Begala said of the President, who campaigned in 1992 on the promise to help "the forgotten middle class."

Even in its early stages, the new effort to rally the public behind reform hasn't met with complete success. Advertisements produced by the Democratic National Committee to pressure stray party members into supporting the President's plan backfired when several targeted lawmakers issued angry public protests labeling the ads heavy-handed and counterproductive. One of the rebels, Nebraska Senator Bob Kerrey, publicly urged people "not to give ((money)) to the Democratic National Committee."

With intraparty acrimony and confusion about the President's position providing dramatic tension, George Mitchell and Richard Gephardt, the Senate and House majority leaders, are in the final stages of melding together Democratic "consensus" bills from the versions produced by congressional committees. Their task: to fashion bills that somehow satisfy the President's insistence on universal coverage without alienating moderate Democrats uncomfortable with an employer mandate. Mitchell has the more onerous task. Few Senators believe that a bill with mandates of any kind -- employer or individual, imposed immediately or triggered sometime in the future -- can attract a majority. And getting 60 votes -- the number needed to block a Republican filibuster -- is out of the question. In the House Gephardt can probably find a majority to back a bill similar to Clinton's. But many House members fear putting themselves on the line to vote for controversial elements such as mandates if those elements are later dropped when the bill is < reconciled with a more conservative Senate version.

As the leadership shapes proposals to Clinton's liking, centrists in both Houses are busy preparing what they believe will emerge as the more realistic alternative: bills that increase coverage above 90% but, because they lack mandates, don't guarantee it for everyone. White House officials say that's not good enough. "Universal has to be in the law, even if it's slowly phased in," says one official. "It doesn't have to be called the Clinton plan, but if it has universal coverage, we declare victory." In Congress that kind of victory is still out of reach.

"If you can explain it to them, you can sell it to them," California's Matsui says of Clinton-style reform. But by sending out confusing signals about what he would settle for, the President made it harder last week for Matsui and other supporters to sell Clinton's plan. The President and his advisers still believe that once Americans begin paying closer attention to the debate, the clamor for universal coverage will force recalcitrant lawmakers to bow to the pressure. It's a chancy strategy. At some point, perhaps not until shortly before a final bill is produced in the fall, Clinton will have to either compromise or risk seeing his hope of achieving health- care reform before 1996 die.

With reporting by Jennifer Brandlon/Portland and Laurence I. Barrett and Dick Thompson/Washington