WASHINGTON -- Opening shots were fired yesterday in what promises to be a summer-long partisan war over health care reform as the fourth and weakest version of President Clinton's proposal cleared a Senate panel.
With a melancholy air that contrasted sharply with the celebrations greeting passage of other versions of the plan, the Senate Finance Committee voted 12 to 8 yesterday to adopt a compromise proposal that fails to meet Mr. Clinton's goal of guaranteed health care for all Americans.
Mr. Clinton and Senate Majority Leader George J. Mitchell of Maine, who will combine the bill with a more sweeping version passed earlier by another Senate committee, both said after the vote that they remain determined to meet the goal of "universal coverage."
But the Finance Committee's refusal to adopt Mr. Clinton's plan to make employers buy health insurance for their workers was a powerful signal of how difficult their task of achieving universal coverage will be.
"We believe very strongly that this is a measure that can pass the Congress," said Sen. John H. Chafee of Rhode Island, one of three maverick Republicans who crossed party lines to help shape the compromise.
The Finance bill endorses the broad thrust of Mr. Clinton's
program to overhaul one-seventh of the nation's economy to expand coverage and to lower costs. But it relies more heavily on tax incentives, insurance market reforms and generous subsidies for the poor to close a gap that now leaves 15 percent of Americans without health care. It would attempt to check inflation in medical costs by taxing the most expensive insurance plans.
Mr. Mitchell would not say yesterday whether he will restore some version of the employer "mandate" in the bill he offers on the Senate. He chided reporters for being too focused on the "vehicle" for achieving guaranteed health insurance when his top concern was reaching the "destination."
Meanwhile, Mr. Clinton and congressional Republicans lobbed radio broadsides at each other yesterday intended to stir voter anxiety as the two sides square off for floor debates on the legislation in August.
Mr. Clinton used his weekly radio address to try to raise fears about the alternative health care plan unveiled last week by Senate Republican leader Bob Dole of Kansas, who rallied at least 39 Republicans to his side.
The Dole plan relies exclusively on insurance law reforms and subsidies for the poor to expand coverage. Mr. Dole boasts that his bill contains "no price controls, no mandates [for employers to provide insurance] and no taxes."
But the president called the proposal "fatally flawed" because it gives "absolutely no help and security to the middle class." He noted that the Dole plan would subsidize low-income people by taking money from the Medicare program for the elderly.
The Dole bill "requires no contribution from the interest groups that are making a great deal of money out of the health care system now, and no contribution from those who are not paying anything now into the system," Mr. Clinton added.
Republicans countered with a protest that the Democrats are re-writing versions of the Clinton health care plan so fast that none of the lawmakers understand what they are voting on, or get estimates of what its cost might be.
"With the Democrats in charge of the process, Congress will know more about O. J. Simpson's blood type than they will about their own health care bill," said Rep. Christopher Cox of California, who delivered the GOP's radio response to Mr. Clinton's address.
Yesterday's committee vote concludes an extensive review process by five separate panels that began 10 months ago, when Mr. Clinton first presented his health care proposal to Congress.
One major House committee was so bogged down in controversy that it was unable to approve any version of the bill.
But the high-water mark for Mr. Clinton came earlier last week when the powerful House Ways and Means committee approved legislation that embraces all the core elements of his plan, including the requirement on employers.
By contrast, the Finance Committee bill sets a goal of expanding coverage to 95 percent of all Americans by 2002 and creates a national commission to recommend steps Congress should take that level is not reached.
Unlike the joyous White House reaction to the Ways and Means vote, Mr. Clinton's response yesterday was muted. He said the Finance Committee vote moves health care reform "another step forward to passage."
Jay Rockefeller, a West Virginia Democrat who has been the most passionate advocate of the Clinton plan in the Senate, joined with Mr. Dole and five of the other eight committee Republicans to vote against it.
Montana Democrat Max Baucus, who objected to the bill's tax
on high-cost insurance plans, also voted "no."