Health Plan Ready to Debut Clinton, Gop Orchestrate Scenarios

Article excerpt

WITH REPUBLICANS offering to sing at least some harmony, President Bill Clinton will take his administration's opening notes for soothing the nation's health-care lament to Congress this week.

The general outlines for the administration's plan to overhaul the health-care system remain much the same as Clinton described more than a year ago during the presidential campaign. It requires most employers to give their workers health insurance, sets a national package of basic benefits, sets up purchasing alliances to give buyers clout in the insurance marketplace, and promises to control stratospheric costs through "managed competition" among insurance companies, doctors, hospitals and others in the health industry.

But even in the last days before the plan's debut, some of the details that have bedeviled its drafting remained murky and changeable. Chief among those is how to pay for all of the plan's estimated $700 billion price tag in the next five years.

"We're paying for it, first, by savings as we bring the growth in health-care costs under control," Ira Magaziner, who has been Hillary Rodham Clinton's second-in-command in drafting the plan, said last week. "Secondly, we're going to be imposing some type of sin taxes on tobacco and perhaps something else."

He declined to specify other sources of funding. "That is one decision that is still not made yet - the composition of the sin taxes," he said. New beer taxes seem unlikely, according to Congressional sources, and the cigarette tax estimates range from 70 cents to $1 a pack.

Magaziner and other officials, cautioned against taking literally the 245-page draft of the plan leaked to news organizations and lobbyists all last week. "The draft," he said, "is just that." Both the leaks and Magaziner's hints of more changes still to come have become staples of the administration's work on health-care overhaul.

In last several months, details of the plan have changed often - 150 changes just this week, according to the Boston Globe - as tidbits about the plan surfaced in the news media. Often the leaks were "trial balloons," sent up by the drafters to see how much resistance there would be to, for example, taxing higher-level insurance benefits or hospitals. Both proposals were quickly shot down.

As the draft and administration officials have outlined it, the White House's version of an overhauled health-care system would look generally like this:

Most Americans - including many of the 37 million uninsured - would get health coverage through employers. Large companies would be required to pay for it; smaller ones would get government subsidies, at least for the next five years, to cover the new cost for them.

The administration is sending mixed signals about whether it also wants to require workers to pay a 20 percent share of the premium. White House officials last week said not. But on Thursday, the president told a resentful audience of small business people that they as well as "everyone in America should make some contribution to his or her health insurance."

This employer-mandate is among the Clinton plan's most controversial elements and is the core distinction from health-care overhauls proposed by congressional Republicans. In the Senate, Republicans would require individuals to buy insurance, subsidizing the poor through vouchers.

The basic benefit package would offer broad coverage, including preventive medicine ranging from mammograms to general physicals. It would also cover some psychiatric, alcohol and drug abuse treatment.

Companies and individuals would buy their insurance through state-supervised "health alliances" offering a variety of policies from basic to more coverage. Many of the policies are expected to favor "managed care" through health maintenance organizations that treat patients under a set budget.

But - in a move to head off criticism and concern about personal choice of doctors - at least one policy that pays on the usual fee-for-service to doctors is expected to be offered in each state, but at a higher price to consumers. …