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
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
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
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
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. …