Preparing for Health Care II Chastened by Failure, Clinton Officials and Allies Vow New Approach in Next Congress

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LAST Friday, aides in the Clinton administration's health-care "war room" packed up the last of the voluminous files that had fed their health-care reform effort and sent them over to the National Archives for safekeeping.

"We've been told we can get them back within an hour," one aide says. A most important service, because the Clintons might need those files when they pick up the health-care reform issue with the 104th Congress.

"Health-care reform is not a boxing match that goes 15 rounds and then it is over. It is a journey," Hillary Rodham Clinton said at a recent meeting of the Association of American Medical Colleges.

The struggle to reform the unfair system will continue, she said, something that was echoed by numerous lawmakers.

But this time, the debate should start early, involve small steps, and be bipartisan, many lawmakers and observers say.

"It will be very tough, even to do anything incremental, especially if the Republicans get control of both chambers," one Democratic aide says.

Bipartisan groups hope their bills to reform the insurance marketplace - considered a big step by its sponsors but a small step by Democratic leaders - will be at the center of the debate.

Also, incrementalism is what many Republicans had wanted and still want. For success in the new Congress, the administration and Democratic leadership must be willing to "start in the {ideological} middle," said Rep. Nancy Johnson (R) of Connecticut.

It is unclear whether this is the path the Clintons will choose. They have not yet decided on an approach, and they probably won't until after Nov. 8, officials say.

Others, including single-payer advocates, will push for federal waivers for states that want to experiment with their own health-reform plans.

Christopher Dodd (D) of Connecticut and colleagues plan to introduce a children's health-care reform bill at the beginning of the session.

Democrats also are talking up the merits of the Federal Employees Health Benefits Plan, which could signal future action there.

"We need a unified message so we are not divided and conquered," pediatrician Dr. Irwin Redlener, director of New York's Montefiore Medical Center, said to children's health advocates who were meeting on Capitol Hill last month to salvage a health-care reform strategy out of the political wreckage of the 103rd Congress.

Economist Henry Aaron of the Brookings Institution warns that if health care reform backers want success, they should not repeat the mistakes made by the White House and the 103rd Congress.

"Expecting a large bill to be passed was exceedingly optimistic," he says. The health-care system comprises one-seventh of the nation's economy and reforming it is a massive undertaking, he says. …