Clinton faces compromise or failure on health reform

PRESIDENT Bill Clinton's hopes of achieving a health-care reform guaranteeing coverage for all Americans have all but died for this session of Congress. With no more than nine business weeks left on Capitol Hill before November's mid-term elections, Mr Clinton must choose between a less ambitious bill focused on changes in the insurance sector, or - probably - no bill at all.

So much became evident last week as various versions of the legislation lay becalmed in various Congressional committees, while an opinion poll suggested mounting public opposition to Mr Clinton proposals.

In both House and Senate the bill is effectively stalled. Senator Daniel Patrick Moynihan told Mr Clinton that none of the proposals now circulating commanded a majority on the Finance Committee, which he chairs, and which will ultimately settle the measure's fate in the Senate. Things are scarcely better in the House, where the tax- writing Ways and Means Committee, which decides how the reform package is to be paid for, has been forced to put back key votes for fear of a loss that would doom the entire enterprise.

The biggest-sticking point is the 'employer mandate', requiring companies to pay 80 per cent of the costs of covering their employees, which is detested by Republicans as well as some conservative Democrats, especially in the Senate. With only 40 votes needed to filibuster, the 44 Republican Senators have an effective veto.

But they may not need to use it. So fragmented is the health debate that even Mr Clinton's skills at coalition-building may be defeated. Invariably, every concession to one group risks alienating another. Coverage of abortion is one tripwire. Another is the proposed tobacco tax that will help finance reform. The new Ways and Means chairman, Sam Gibbons of Florida, tried to win over Democrats from Southern tobacco-producing states by cutting the tax - only to have other Democrat committee members threatening revolt.

After discussions with Senator Moynihan this week, the President said he was ready to compromise. One touted formula is a 'trigger' system which would give the market (doctors, hospitals, insurance and drug companies) a chance to achieve the cost cuts required to pay for universal coverage. If not, the 'employer mandate', which Republicans claim will bankrupt companies by the thousand, would be automatically introduced.

But Mr Clinton's room for manoeuvre has its limits. He could probably secure a bill removing some of the iniquities of the existing system of insurance, by ensuring health coverage is 'portable' when a person changes jobs, and making it illegal for insurance companies to refuse coverage to someone because of a pre-existing condition.

But universal coverage, at some date, is the President's bottom line. Introducing his legislation nine months ago, he said he would veto any bill that failed to provide it. Mr Clinton's choice now is whether to make the best of a bad job, or hold out for a deal he cannot get - and then use the forthcoming election campaign to blame failure on the Republicans. Despite everything, a Wall Street Journal poll found some 70 per cent in favour of some kind of health-care reform.