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Clinton's health plan may upset his timetable ON POLITICS


WASHINGTON -- The clear if unsurprising message in the news leaking out of the White House task force on health-care reform is that President Clinton's plan is likely to be both complex and controversial.

And that prospect, in turn, raises a question about whether the new president can fulfill his own timetable and get a plan passed this year. If he doesn't and the issue comes to a head during the midterm election campaign next year, the complicated politics of the issue could become even more convoluted.

On the face of it, the electorate seems ready for some forceful action on health care. Opinion polls consistently show concern with the inadequacies of the present system running second only to the concern about jobs. One of the reasons George Bush was voted into retirement was his failure to come to grips with such pressing domestic issues.

By contrast, Clinton has made such a commitment, the most obvious evidence of which has been his designation of Hillary Rodham Clinton to lead the task force. She was not put there to flop.

What is less apparent, however, is whether Congress can withstand the conflicting pressures to which it will be subjected once a plan is on the table. The history of congressional action on complex issues is not encouraging even when there appears to be popular support for some serious action.

The key factor, as always, is cost. Clinton has promised a plan that will provide at least minimal coverage for the 37 million Americans who now function without health insurance. What has not been spelled out is how soon that coverage could be provided or how the initial costs can be met. Estimates of those costs range from $30 billion to $90 billion or more.

One of the problems in providing the coverage is that the U.S. population -- unlike that in Canada or Germany, whose systems are always being touted as models -- includes a significant and perhaps permanent underclass of people who cannot be covered through their employers because they don't hold the kind of jobs, if any, where that is feasible. When these people are thrown into the actuarial pool, someone is going to have to pay the cost.

This fact of life leads inevitably to the suspicion there will be new taxes beyond the $2 a pack on cigarettes or other "sin taxes." Indeed, the White House already has avoided ruling out a tax on some employer-paid health benefits. So the first question is whether Congress can bring itself to vote more taxes immediately after doing so this year.

And the second question, even more difficult to answer, is whether a majority can be mustered when the program is depicted by its opponents, as it surely will be, as another expression of the welfare state. If there is one certainty about the debate over health care, it is that the conservatives will be screaming "socialized medicine" and depicting any plan as another attempt to get the working class to carry the freight for those who don't work.

In the long run, the alternative Clinton wants is a reduction in health-care costs. That could involve a temporary freeze on medical costs, a ceiling on increases in health insurance premiums to force the insurance companies to get tough on costs or even some sort of medical fee schedule to which providers would have to adhere. None of those options is likely to breeze through Congress without a long and contentious debate.

This leads inevitably to the question of timing. The White House obviously would like to see the health-care plan considered and passed this year, while Clinton's stock is at its highest point. The alternative would be scheduling the issue in a midterm election year in which all 435 members of the House and 34 senators will be up for re-election. There is always the chance that added pressure might improve the chances for passage. But there is clearly an equal risk that the plan would have a more difficult time in an election year if those start-up cost figures look too threatening.

The result may be a new health-care system that is phased in over a period of several years. That kind of timetable might not satisfy those whose need is most pressing, but politics is always the art of the possible. And even a start is more than the White House and Congress have been able to manage in the past.

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