The Senate Finance Committee, chaired by Daniel Patrick Moynihan of New York, became the last of five committees that have been tackling health care reform for nearly six months, to approve a draft bill on Saturday. The process now shifts to the Senate and House of Representatives.
With the Democratic leadership determined to achieve passage of a final bill in October - before crucial mid-term elections in November - the stage is set for intensive campaigning over the issue with the President and Hillary Rodham Clinton as lead players.
The Moynihan model does not match up to the President's proposals in two ways: it drops a requirement for employers to pay a portion of their workers' premiums and seeks only to ensure insurance coverage for 95 per cent of Americans, and only by 2002. Although few doubt that some compromise will be achieved in Congress, the extent to which the promise of universal coverage is diluted will determine whether President Clinton will be able to embrace it or will feel compelled to reject it. He said earlier this year that he would veto any bill that ducked the universal pledge.
For now, he intends to 'remain firmly committed to guaranteed health coverage for every American that can never be taken away. We must achieve universal coverage if we are to reform our health care system and assure hard-working, middle-class Americans that they will have health care when they need it'. However, Democratic Senator John Breaux, a member of Mr Moynihan's committee, made it plain yesterday that a compromise would have to be reached.
The original Clinton plan incited ideological conflict in Congress by seeking to mandate minimum contributions by employers and to require people to belong to regional insurance co-operatives. All notion of compulsion is furiously opposed by Republicans and many Democratic moderates. Three versions heading to the floor, one championed by Senator Edward Kennedy, retain the employer-must-pay provision.
Ross Perot, the Texan billionaire, has offered dollars 1m ( pounds 700,000) to the Republican Party to finance a prime-time television programme to knock down the Clinton plan and the TV airwaves are filled by anti-reform commercials funded by the health insurance industry.
To achieve the 95 per cent coverage, the Moynihan compromise would revise laws to make insurance more accessible to greater numbers and offer tax subsidies to help low-earners pay their premiums. It would bar companies from denying coverage to people with pre-existing medical conditions.