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Democrats duel over health plan


WASHINGTON -- Months of sporadic criticism by the White House have accelerated into open warfare against a rival Democratic health care reform bill that threatens to win greater support in Congress than the president's own plan.

So great is the White House fear that Mr. Clinton's goal of guaranteeing health insurance for all Americans will be dropped from legislation enacted next year that interest groups allied with the administration are mounting a campaign to discredit the opposition.

Their efforts will include a multimillion-dollar television advertising campaign and grass-roots phone banks as well as attacks on the chief sponsors, Rep. Jim Cooper, a Tennessee Democrat who is running for the Senate, and Sen. John B. Breaux, a Democrat from Louisiana.

"I think people in Tennessee will gain an appreciation of the problem when they see Congressman Cooper receives employer-paid insurance" through the federal government "and wants to deny it to everybody else," says Ron Pollack, head of Families USA, a health reform advocacy group that works closely with the White House.

Mr. Breaux calls the attacks unproductive.

"We should not be attacking each other," he said in an interview. "We should be working with each other. We're not going to get the comprehensive health care bill by fighting."

Another group supporting President Clinton's reform goals, the American Association of Retired Persons, will begin its own television commercials Dec. 20, emphasizing the need for benefits such as long-term care, which are in the Clinton plan but not the Cooper-Breaux alternative.

Officially independent of the White House but consulting with administration officials, a coalition of more than 20 organizations -- representing consumers, organized labor, senior citizens, health care providers and businesses -- plans to undermine the Cooper-Breaux bill.

Hillary Rodham Clinton attended a coalition meeting last Saturday -- at the home of Sen. John D. Rockefeller IV, a West Virginia Democrat and close ally of the administration -- where the decision to mount a television campaign was made.

Even as the coalition plans to fight, White House officials are courting Mr. Cooper, even inviting him to jog with the president. The administration still hopes to reach a compromise that will result in legislation guaranteeing universal insurance coverage.

But despite some similarities between the Clinton and Cooper-Breaux bills, huge differences remain, and it's unclear how they'd be resolved.

Both plans would have the government subsidize insurance for low-income people and create insurance purchasing organizations that would give consumers and businesses the clout to negotiate better rates with insurers. Both bills would prohibit insurers from denying coverage to people because of health problems.

But the Clinton plan would guarantee all Americans universal coverage by 1998, and pay for it largely by requiring employers to pay 80 percent of the insurance premiums of workers, who would pay the balance. Savings from the Medicare program for the elderly and higher federal tobacco taxes would subsidize payments by the poor and small businesses under the Clinton plan.

The Cooper-Breaux bill does not require employer coverage and strives only to guarantee "access" to health insurance by making it cheaper through purchasing organizations.

The majority of the 37 million uninsured would be able to obtain coverage, Mr. Cooper says, although other analyses of his bill question that.

Although Mr. Cooper and Mr. Breaux say they both support universal coverage, they believe that steps such as employer mandates are too drastic to take initially. "I think government coercion should always be the last resort," Mr. Cooper told a recent meeting of the Democratic Leadership Council, a moderate Democratic group that supports his bill and which Mr. Clinton once headed.

Mr. Cooper and Mr. Breaux depict their bill as a first step that could be followed up in 1996, if necessary, with other legislation.

Mr. Breaux predicts it "represents where the consensus is going to end up."

Their legislation has attracted 57 co-sponsors in the House, 26 Republicans and 31 Democrats, giving it the most bipartisan look of any reform bill.

Clinton aides and coalition supporters worry that the Cooper-Breaux bill has seductive appeal to lawmakers who want to be seen as doing something that would benefit the mostly well-insured middle class, while ducking the problems of covering the uninsured and containing skyrocketing health care costs.

If all Americans aren't covered in a system with cost containment features, then costs will continue to explode, most health economists say. And the cost of treating the uninsured -- who show up at clinics and hospital emergency rooms when they're sick -- would continue to be passed on to those who have insurance in the form of higher rates, the economists say.

For Mr. Breaux, "the question is how do you get there, and how soon -- a middle ground that says we should reform the system first before we start mandating anything."

But administration supporters say it would be politically difficult to achieve universal coverage in steps. Because the Cooper-Breaux bill would address many of the concerns of the mostly well-insured middle class, there'd be little incentive for most Americans to support a future bill that required an employer mandate or taxes to cover those who can't afford coverage.

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