Clinton tries health-care hard sell

WITH President Bill Clinton's political fortunes largely hanging on the outcome, the political chess match that is US health-care reform is moving into a fraught and unpredictable end-game, with no certainty thus far that either of the separate Democratic proposals tabled in the Senate and the House can win a majority.

At what was only the third full- dress White House press conference of his 19 months in office, Mr Clinton on Wednesday evening staked out his position, lambasting Republicans for their refusal to co-operate and strongly endorsing the Senate version of health reform prepared by Majority leader George Mitchell.

Yesterday the White House followed up by opening a PR and lobbying campaign, including a series of televised two-minute addresses by Mr Clinton from the Oval Office. These, say his aides, will run every night until Congress makes 'its historic choice'. America, said the President in last night's first address, had perhaps its 'last chance this century' to enact significant health reform. To achieve this, Mr Clinton is making concessions. Despite his efforts to pretend otherwise, the Mitchell plan, which aims for 95 per cent coverage by the year 2000, falls short of his proclaimed bottom line of guaranteed health care for all. But Mr Clinton defended it as a realistic bill, 'the most ambitious' that could get through the Senate.

It is but a distant cousin of the original Clinton plan, drawn up by Hillary Clinton's celebrated task force late last year. Gone is the requirement that employers pay 80 per cent of insurance premiums to finance extended coverage. Senator Mitchell is seeking subsidies to help the most vulnerable sections of the population, to be paid for in part by increased tobacco taxes and a new tax on higher-cost insurance policies.

Even then, 14 million people will still be uncovered by the end of the century, and the cost of the proposals is expected to be huge. The House plan, by contrast, would achieve universal coverage by 1999. But as Mr Clinton tacitly acknowledges, its retention of the 'employer mandate' is anathema not only for Republicans but for some conservative Democrats as well. And at this late stage, the logistics of health reform are as tricky as its politics. The Democratic leadership of House and Senate insist that both chambers will stay in session until each has voted on a bill. This may simply prove impossible.

Neither the Mitchell plan nor the more radical alternative drawn up by House Majority leader Richard Gephardt has yet been given formal legislative shape. Neither has been properly costed. Floor debate is unlikely to start before 12 August, the date orginally set for the recess - meaning Congress will lose at least a week, maybe more, of its summer holiday.

Fears are growing that the big floor votes may yet have to be put off until after the recess. This would further compress time for a Senate/House conference to thrash out a joint bill which in turn must be approved by both chambers before this Congress breaks up for November's mid-term elections. The political arithmetic, if anything, is tighter. The President can expect no help from Republicans: 'Each time we offer a compromise they move away,' he complained on Wednesday evening. In the House, where party discipline is greater and the Democratic majority a solid 80, Republicans are less of a factor. Not so in the Senate.

Shorn of an employer mandate and offering a slower transition to universal coverage, the Mitchell version represents Mr Clinton's best chance of a compromise. But it is proving too much for some conservative Democrats, and too little for liberals. Even with his 56 soldiers marching as one, the Senate leader is short of the 60 votes to thwart a Republican filibuster.

Polls show the public wants some kind of health reform, now. Republicans could yet pay a price in November's mid-term elections if they are perceived to have blocked it on their own.