WASHINGTON -- Over the past few days, Rep. Benjamin L. Cardin has been tutoring his colleagues on why half a loaf of health care reform is probably worse than none.
The Baltimore Democrat estimates that he has spent 12 hours meeting with about 35 potential swing votes on President Clinton's health care reform bill in hopes of persuading them to resist modest alternatives that look attractive but that Mr. Cardin says will do more harm than good.
"Only about three have been unwilling to listen," Mr. Cardin said of his sessions with the Democratic moderates.
"The rest really want to learn. They are thirsty for information. I was encouraged."
These are do-or-die days, not only for the health care reform effort but also for its most fundamental concept: universal coverage. The House version of the Clinton bill that House Majority Leader Richard A. Gephardt of Missouri is scheduled to present formally to his colleagues today is at least 50 votes short of the 218 needed for passage.
The problem is mostly its reliance on a proposed requirement that all employers pay 80 percent of their workers' insurance premiums by 1999.
Business resistance to this requirement has been so stiff that many lawmakers have been looking for a way out. A tax increase is unacceptable for most. And there isn't much support for the proposal to require individuals to buy their own insurance, even with government help.
"Passing a health care reform bill is very important to the Democrats both substantively and politically," said Rep. Steny H. Hoyer of Maryland, who chairs the House Democratic Caucus. "But they're like most other Americans: They're not sure what's the best way to do it."
More and more Democrats have found appeal in the go-slow, incremental approach advocated by Republicans and by some bipartisan groups in the House and Senate. There are several such proposals. Most call for beginning with re
forms in the insurance market to provide equal access for the sick as well as the healthy, the old as well as the young.
Tax incentives would help small businesses provide insurance for their workers, and workers could take their insurance from job to job. Subsidies would be provided to help low-income people buy insurance.
But these approaches are expected to increase insurance coverage to no more than 90 percent of Americans, from the current 85 percent, while driving up premiums for the young and healthy to cover the old and sick.
Mr. Cardin argues that without universal coverage and some kind of requirement that everyone participate, young, healthy people will drop out of the system, driving the premium costs for the remaining pool of insured Americans even higher.
A member of the House Ways and Means subcommittee on health, which produced the first draft of the bill on which Mr. Gephardt's proposal is based, Mr. Cardin was chosen to conduct these tutorials because he is among the most knowledgeable members on the issue. His task, however, is decidedly uphill.
"Dick wants to know what we can do to win over groups at a time," Mr. Cardin said. "He was really depressed when I told him they had to be convinced one by one."
The proposal Mr. Gephardt will unveil today is still subject to change and compromise, almost until it is taken up by the House two weeks from now.
Among the controversies sidestepped for now is how to handle abortion coverage without upsetting the delicate political balance on that issue -- a seemingly impossible task.
In his bill, Mr. Clinton included abortion services as part of the benefits package that would be guaranteed to all Americans, a provision vigorously opposed by anti-abortion forces.
Gov. Robert P. Casey of Pennsylvania, who supports the Clinton plan despite his opposition to abortion, argued at a news conference here for preserving what he called the status quo on abortion by requiring women to buy and pay for abortion coverage separately.
But abortion rights advocates counter that Mr. Casey's solution would take away abortion coverage that most women already have today, automatically offered and partly paid for by their employers.
A major factor in the fate of the House bill is likely to be the mood of the Senate, which House leaders had hoped would be the first to endorse the explosive employer "mandate."
But Senate Majority Leader George J. Mitchell is having trouble fashioning a compromise health care reform proposal that can ++ win at least 51 votes.
He has been rebuffed by moderates who are dissatisfied with his proposal to drop the employer requirement to 50 percent of the cost of insurance and delay it until after the turn of the century if 95 percent coverage has not been achieved.
Meanwhile, Senate liberals met with Hillary Rodham Clinton yesterday to discuss amending Mr. Mitchell's bill on the Senate floor to speed the timetable for extending guaranteed health care to all Americans.
"We began talking about our strategy for next week . . . and our determination to present amendments on the floor to improve upon what the majority leader may be offering," said Thomas A. Daschle, a South Dakota Democrat who is running to succeed Mr. Mitchell as majority leader.
Mr. Mitchell is also said to be weighing options that include phasing in reforms on different timetables for different states and targeting subsidies to high-risk groups, such as women and children, first.
Sen. Barbara A. Mikulski characterized the Mitchell proposal as a "moderate bill."
"We'll go on the Senate floor, there'll be amendments and we'll duke it out," the Maryland Democrat said. "That's called democracy."