BRYN MAWR, Pa. -- President Clinton came to a prestigious women's college here yesterday to talk about controlling the federal budget. But in what promises to be his increasingly familiar prescription for the nation's problems, he suggested health care reform as the solution.
The event at Bryn Mawr College was an all-day conference on controlling entitlements -- the government programs such as Social Security, Medicare, Medicaid and food stamps that automatically increase without congressional action each year because, by law, Americans are "entitled" to the benefits.
"Medical spending is going up like a rocket -- Medicare and Medicaid have tripled since 1982," the president said. "But on the entitlements issue, I would argue the real culprit is health care costs, and we can only address it if we have comprehensive health care reform."
The White House has estimated that it can save tens of billions of dollars in administrative and excess health care costs from the Medicare and Medicaid programs if its universal health insurance bill passes. Congress is expected to vote on the legislation next year.
Entitlements constitute half the federal budget and make up the only sector of significant spending growth in a budget that has averaged well over $200 billion a year in red ink for a decade.
"Health care reform is the answer," added Robert Boorstin, a White House aide who accompanied the president here.
But others in attendance at the conference argued passionately that health care is only a small part of the answer, and they maintained that the federal government must make a host of other hard choices. These choices range from such controversial options as reducing the annual cost-of-living increases for government pensions and Social Security to "means testing" certain benefits, so that well-off retirees receive smaller benefit checks.
"The means-testing of entitlements is going to happen," said former Massachusetts Sen. Paul E. Tsongas, one prominent critic of deficit financing. "It has to happen. The issue here today is not if, but when."
"I have serious doubts that creating a new entitlement [health insurance] will cure the deficit -- I think it will add to it," added former New Hampshire Sen. Warren B. Rudman, a Republican who has joined forces with Mr. Tsongas in a group called the Concord Coalition. "It doesn't take a rocket scientist or an actuary to see that you either have means testing of entitlements lTC or you double payroll taxes in the next 10 or 15 years."
Though various administration officials argued fiercely against this proposal after he left, Mr. Clinton came to Bryn Mawr, spoke, chaired a two-hour panel discussion, lunched with students and shook hundreds of hands without managing to expose himself to the phrase "means testing."
Consequently, it was only after his Marine One helicopter lifted off to take him to a New York fund-raiser that the conference really got going.
Sen. John C. Danforth, a Missouri Republican, brought the drowsy audience to its feet with a fiery speech in which he said, "I want to disabuse you of a notion you might have gotten earlier today that there is a painless way to solve this problem."
Mr. Danforth dismissed those who say that programs such as Social Security are sacrosanct, calling them "selfish whiners," and said that politicians in Washington already know what they must do and that the only question is whether they will summon the courage.
Sen. Bob Kerrey, a Nebraska Democrat who has been tapped by Mr. Clinton to chair a commission on entitlement reform, also spoke of a pervasive fear in Congress that "doing the right thing will have career-ending consequences."
Mr. Kerrey made sure not to sugar coat the issue of entitlements.
"Here are the numbers: Between George Bush's last budget and Bill Clinton's first budget, entitlements grew by $44 billion," Mr. Kerrey said, noting that almost all of it was from increases in Social Security, Medicare, Medicaid and pensions for retired federal workers. "That kind of cross-generational transfer of wealth from people who are working to those who are not is unsustainable . . . and immoral."
Some of those on the other side were equally passionate.
Shirley Chater, the Clinton-appointed Social Security commissioner, said she does not believe Social Security should be means-tested, calling the program "a lifetime contract with the American people."
Former Social Security commissioner Robert M. Ball, added: "Social Security . . . is doing what it was intended to do. Leave it alone!"
But Jonathan Karl, a co-founder of Third Millennium, a group of angry post-baby boomers, told Mr. Ball and John Rother of the American Association of Retired Persons that Social Security was "fiscal child abuse." Mr. Karl, 25, added: "The AARP calls Social Security a 'sacred trust,' but to Third Millennium it is a scam."
In his own remarks, Mr. Clinton paid homage to both viewpoints.
He referred once -- and only in passing -- to the United States' $4.4 trillion national debt. But he did boast that his budget bill made a start on reducing deficit spending, by actually cutting $130 billion in planned government spending over the next five years.
The president also spoke evocatively about the human needs being filled by entitlement programs.
"It's important to point out . . . that behind every one of these entitlements there's a person," he said. "Today, nearly 34 million people go to see a doctor, or get medical care because of the Medicare program."
In the end, however, the question left in the air was the one raised at the outset by the conference's host.
"When did we come to think it was all right to spend money we didn't have?" asked Democratic Rep. Marjorie Margolies-Mezvinsky, who won Mr. Clinton's appearance at the so-called "Entitlement Summit" in her district in exchange for her vote on the budget bill. "Children want their leaders to find the political courage to confront the national debt in a meaningful way."
FEDERAL SPENDING -- WHERE THE MONEY GOES
Almost two out of every three dollars the federal government spends in the 1994 budget year will go toward programs over which Congress and the president exercise little control -- so-called mandatory programs, often termed "entitlements," and for interest on the national debt.
MANDATORY PROGRAMS ... ... ... ... ... ... ... ... AMOUNT
Social Security ... ... .. ... ... ... ... ... ... $410 billion
Medicare ... ... ... .. .. ... ... ... ... ... ... 148 billion
Medicaid ... ... ... ... ... ... ... ... ... .. .. 91 billion
Food stamps and nutrition for the poor ... ... ... 40 billion
Low-income aged, blind and disabled (SSI) .. .. .. 27 billion
Welfare (AFDC) ... ... ... ... ... ... ... ... ... 16 billion
Federal worker retirement ... ... ... .. .. .. ... 11 billion
TOTAL ... ... ... ... ... ... ... ... .. .. .. ... $745.6 billion
Net interest on the federal debt ... ... ... .. .. $206.4 billion
Spending which Congress appropriates every year as it sees fit (discretionary
spending) ... ..... ... ... ... ... .. . ... .. .. $542.0 billion
TOTAL FISCAL '94 SPENDING ... ... ... .. ... .. .. $1,494 billion