WASHINGTON -- If President Clinton is to get something resembling his health care reform plan through Congress next year, he's probably going to have to depend on the lawmakers taking a New Year's vow of greater political courage.
After nearly a year of public discussion, many members of Congress say there is still no clear national mandate for the sweeping overhaul of the country's health care system Mr. Clinton has proposed.
And the urgency of the issue appears to be fading as more Americans worry these days about becoming victims of crime.
The sheer complexity of Mr. Clinton's plan to redesign an industry that accounts for one-seventh of the national economy also makes it very difficult for legislators to get an accurate reading of what the public actually wants, pollsters say.
"This is one of those cases, like the Reagan tax reform or the Persian Gulf war, where the political leaders and opinion leaders will have to reach their own consensus on what do to," said David Moore, national editor of the Gallup Poll.
"For the most part, the American people will support them until it turns out later that they did the wrong thing."
So, even in a congressional election year, lawmakers may have to take the chance on getting out in front of public opinion.
Democratic leaders in Congress are determined to win approval for some version of health care reform legislation by next fall.
The issue remains the "centerpiece" of Mr. Clinton's 1994 agenda, White House Chief of Staff Thomas F. "Mack" McLarty III told reporters this week.
Whatever Congress passes will almost certainly be described as at least a first step toward meeting Mr. Clinton's goal of "universal coverage" -- affordable health care for all Americans -- because the president has made that his supreme non-negotiable demand.
But lots of compromises can be made on when and how universal coverage is to be achieved.
And whether lawmakers will undertake in one bold move all the radical changes proposed by Mr. Clinton is still much in doubt.
"I was a little depressed," Rep. Benjamin L. Cardin, a strong advocate of comprehensive health care reform, said in describing public hearings this fall in his metropolitan Baltimore district.
A few months ago, 80 percent to 85 percent of his constituents were ready for major changes in the health care system, he explained. "Now, it's down to 65 percent."
Mr. Clinton wants to provide universal coverage by requiring employers to pay most of the cost of premiums for their workers, who would pick up the rest of the tab.
The federal government would pay for health care for poor people and offer subsidies to help small businesses meet their share of the load.
Costs would be controlled by more sharply regulating the financing of health care.
Insurance for individuals and companies would be purchased through large health alliances, which would bargain for the best deals. A national board would set a limit on insurance premiums.
Though there was general enthusiasm for his concept when Mr. Clinton formally unveiled it in late September, public support dropped as critics started attacking the details.
Republican Sen. John H. Chafee of Rhode Island said support for his more gradual approach to health care reform has increased in recent months as the administration struggled with conflicting estimates of which Americans would have to pay more for health care under the Clinton plan.
"People are very, very skeptical of the numbers," Mr. Chafee said.
Even so, a recent NBC/Wall Street Journal poll found that the president's plan was strongly favored over a less costly alternative offered by Democratic Rep. Jim Cooper of Tennessee, because the congressman's plan doesn't guarantee universal coverage.
Democratic pollster Celinda Lake notes there has always been a contradiction between what people say they want in terms of health care reform and what they actually mean.
"They'll say they want massive health care reform, but in fact what they want is something much less ambitious that just provides them with health care security and controls costs," she said.
Over the next few months, Mr. Clinton and his Democratic allies on Capitol Hill will be pushing and pulling largely among themselves to come up with a compromise plan that somehow meets that test.
Jack W. Germond and Jules Witcover are on vacation. Their column will return to this space Jan. 8.