As the process ground on last week, the example of the exhausted eccentric edging toward consensus came to symbolize the oddities of the larger health-care debate. Every grasping member was suddenly an unpredictable health-care philosopher, a Moynihan manque. Bob Dole, confronted with the fact that he no longer favors covering everyone, was acting as if the president’s bottom line were an epistemological issue (What is life? What is truth? What is “universal”?). There was more than enough politics to go around, but the esthetic of the issue was less the usual grubby horse trading than an impossibly difficult math proof that even the professor doesn’t fully understand. And you can’t leave for vacation until you’ve tackled at least part of it.
So they did. Senate Finance, the trickiest eye of the congressional needle, advanced a bill by finessing the most central health-care issue of all-how to pay for it. The committee rejected Moynihan’s proposal of a 1 percent tax on big businesses, and handled the exasperating issue of employer mandates (your boss pays for health insurance) in a time-honored fashion. It postponed the mandates question pending the appointment of a commission, this one scheduled for the year 2002. In Beltway lingo that’s known as a “soft trigger” - if universal coverage is not reached, mandates may or may not be triggered, but they will certainly be studied. This is the solution of choice in Washington: Further Study After We’re All Gone. As Dole, who now rejects mandates outright, joked, only Strom Thurmond will be around to find out what happens.
This road of fudge was trod with flip-flops. Chafee backed individual mandates (you buy your own insurance) - then abandoned them. John Breaux helped originate the idea of a “hard trigger” (employer mandates at a later date) - then voted against it. Dole had said months ago that he was for universal coverage - and now champions the fight against it. Bob Packwood is happy he’s being asked about health care instead of women (“This has been very therapeutic for Bob,” says a fellow senator), but he readily admits to reversing himself on employer mandates, an idea he had helped originate during the Nixon administration. Democrats say he deserted mandates because he needs Dole in his Ethics inquiry. The jokier version is that he shied away from anything with the words “man” and “date” in it.
There were a few more heroic moments. Senate Finance historically raises taxes only after most members have been bought off with specific goodies for wealthy special interests. But in a fit of responsibility - with all but one member actually in their seats and debating rather than wandering around or whispering to aides the committee approved 11-9 an amendment by Bill Bradley to raise a bit of revenue and tamp down health-care costs by taxing gold-plated health plans. As Bradley noted, these are the very plans used by the lawyers and lobbyists in the audience. Cigarette taxes were headed for a big boost, too.
That wasn’t true on the House side, where tobacco-state representatives held the bill hostage to keeping that tax down. But it was a measure of the growing momentum for some kind of legislation that passage by the House Ways and Means Committee last week was seen as no big deal. Rep. Sam Gibbons, the new chairman of Ways and Means, was supposed to be a weak successor to Dan Rostenkowski, whose indictment supposedly doomed health care in his committee. Gibbons turned out to have prodigious LBJ-like head-counting abilities as he expertly shepherded universal coverage through on a series of party-line votes.
Even Dole, who is apparently running for president, realized last week that he couldn’t look like a total obstructionist on health care, so he put forward a plan that quickly attracted 39 GOP cosponsors. It prevents discrimination against those with pre-existing conditions, offers huge subsidies to the poor (a first for some of the conservatives who signed on), but still leaves millions uninsured. So intent are the Republicans on avoiding tax increases that even cigarettes were left totally unscathed. The revenues, such as they are, come from unspecified Medicare and Medicaid savings. In other words, the Republicans have accomplished the considerable feat of acting even less responsible than the Democrats in figuring out where the money is to come from for their reforms.
Even as his bill - the so-called “chairman’s mark” - advanced, Moynihan did not dominate as some had hoped. His draft was much amended. Yet the chairman probably did the best he could with a balky conservative panel that insisted on bipartisanship. At the beginning of the week, no one had a committee majority on anything. By the holiday, Sen. George Mitchell and liberals on the committee had swallowed hard and made common cause with moderate Republicans. Moynihan’s committee has come to represent the idea that something that at least calls itself universal is better than nothing.
The problem now is that the many versions reported by the committees are so different from one another that the real nutcracking still lies ahead, most likely in a bloody floor fight. Polls show the public strongly supports both universal coverage and employer mandates, but the mood of Congress (bolstered, perhaps, by a million-dollar Ross Perot campaign for the GOP) remains almost totally unpredictable.
The four Republicans defying Dole - Chafee, Durenberger, John Danforth and James Jeffords (who has supported Clinton all along) - now wield considerable clout, in part because several Democrats insist that they will go along only if support is bipartisan. Except for Jeffords, these GOP members adamantly oppose the hard trigger favored by liberals (who finally got to be called “hard” while the conservatives were “soft”). Although the Clintonites are sounding as if killing hard triggers guts the whole plan and would be worse than nothing, that’s just short-term posturing. Next month some compromise between hard and soft triggers will be brokered on the floor.
If health care is Bill Clinton’s Vietnam, last week might represent some light at the end of the tunnel. But the endgame will be the legislative equivalent of a tremendously complicated war. In recent weeks Moynihan has apparently believed that the Clintons were being misled by Mitchell as to how much they can ultimately get. The White House is still playing its cards close, but perhaps some of the votes in the Finance Committee will convince Clinton how limited his options are. Three months are left in this session, and three huge steps remain: floor action, the conference committee resolving House-Senate differences and final passage in both houses. Then Clinton has to decide whether the bill is universal enough to sign. But something is coming down the tracks. The likeliest result will be what the late Vermont senator George Aiken suggested during the Vietnam War: eventually, just before recess this fall, everyone will declare victory and go home.
