WHEN President Clinton addresses the nation's governors tomorrow in Boston, the final phase of an epic battle for national health-care reform will be under way.
With the hour growing late, Mr. Clinton is making a bold gambit. Dismissing suggestions for a middle-of-the-road compromise, and bashing Republicans, he is demanding congressional approval of three central principles that have guided his search for a new US health-care system.
The president is appealing for broad support from the public for a plan that provides universal coverage, requires mandatory funding by business, and includes tough cost controls.
Anything less will leave ``the future of middle-class America [and the economy] in doubt,'' Clinton told an audience in Greenburg, Pa.
As many as a half-dozen Cabinet and sub-Cabinet officials and a dozen White House aides have descended on the National Governors' Association meeting in Boston this week to support the president's lobbying effort on health care.
But less than an hour before Clinton addresses the summer meeting of the governors, Senate Republican leader Robert Dole of Kansas will speak to the same audience of state chief executives.
Senator Dole sees the health-care fight getting rough. ``It's going to get kind of ugly, I think, in the next few weeks,'' he warns.
White House officials bill the Clinton-Dole appearances in Boston as virtually a head-to-head debate on health care. But the confrontation could challenge the governors' traditional bipartisan approach to issues.
Previously, the governors have called for ``universal access,'' something less than Clinton's ``universal coverage,'' for all Americans. The governors have also previously supported the concept that health insurance be ``portable,'' but have not demanded that employers pay for it - positions that sound closer to Dole than Clinton.
At a White House background briefing last week, senior officials charged that GOP-style plans fall short of the nation's needs.
``Incremental or partial plans and reforms just don't meet the test, primarily because they leave out the broad middle class,'' says a White House official, who asked not to be named.
``Those in the middle class who can't get insurance won't be able to get it under the reform plans that are being proposed by Republicans,'' the official says. ``Those in the middle class that are insured still are at risk of increasing insurance premiums, and the risk of losing their insurance.''
The official insists: ``Those [GOP] proposals ... are basically going to increase the deficit and put the squeeze on seniors. Medicare is being squeezed in order to help finance those [Republican] plans without giving anything back to seniors.''
But while there is strong public sentiment for Clinton's concept of universal coverage, there is no such consensus in Congress, which must find a way to pay the multibillion-dollar cost.
Majority Democrats remain divided. There has been no general rallying to the president's cause on Capitol Hill, despite White House pleading. Republicans, meanwhile, are drawing together in favor of something far short of the president's universal goals.
`Take it or leave it'
Clinton has yielded to some criticism from Republicans and fellow Democrats. For instance, he gave up his idea for mandatory purchasing alliances, which were excoriated in the famous ``Harry and Louise'' television ads. But on his core proposals, Clinton seems to say to Congress, ``Take it or leave it.'' Most Republicans will leave it. In the Senate, approximately 40 of the 44 Republicans are united behind the Dole alternative.
The Dole plan has two major parts: It would change insurance practices and offer subsidies to low-income families. While not guaranteeing universal coverage, it encourages universal access.
White House officials criticize the Dole plan as nothing but the status quo, but the senator's plan would address several major middle-class concerns:
It would guarantee the ``portability'' of insurance if an employee quit a job or moved to another employer. It would also require insurance companies to accept any applicant, though there would be a six-month wait for coverage of any preexisting medical condition. And the proposal would allow individuals to purchase insurance under the Federal Employee Health Benefit Plan.
Even so, critics complain that as many as 24 million Americans would probably remain uninsured, still more than half the current estimate of 38 million uninsured.
By dwelling on broad themes, particularly the concept of universal coverage, Clinton hopes to nudge Congress toward a final plan with the broadest possible guarantees.
On Capitol Hill, the committee work is complete. Four committees, two in the House and two in the Senate, have reported out bills. Leaders in the two houses are now piecing together broad legislation for floor debate by lawmakers beginning in the Senate in late July and in the House in early August.
A right for all
White House officials insist that they hold the moral high ground in this showdown. Health care should be a right for all, not just the for privileged, they say. As Clinton put it recently:
``More and more Americans are losing health-care coverage. In the last five years, 5 million more Americans are without health care coverage.... Politicians have it [health coverage]. The wealthy have it. The poor have it. If you go to jail, you've got it. Only the middle class can lose it. I don't think that makes sense....''