Health-Care Rematch Expected In 1995 By Both Sides

THERE will be another day for health-care reform.

The public remains too concerned about the issue, medical inflation remains too high, and the number of uninsured people is too big and growing for the next Congress to ignore it.

But it will come back different - humbler in its aims and possibly more gentle in its politics.

Few politicians have begun to think about to start again on fixing the health-care system next year. Several of the most active players on the issue, like Senate majority leader George Mitchell, are retiring with this session. But even with a possibly more-Republican mix of legislators in both the House and Senate next year, health care is widely expected to remain a prominent issue.

As a practical matter, the design for health-care reform drafted by the Clinton White House has been out of the picture for many months now. Yet the imprint of the Clinton plan remained stamped on the politics of health-care reform to the bitter end this week, when Mr. Mitchell formally gave up his last attempts at a bill.

Clinton plan hit

To the public, the Clinton plan remained the heart of major health-care reform, and the public was not pleased.

Conceived on a grand scale not attempted in a generation, the Clinton plan was to refashion a $1 trillion industry, more than 14 percent of the entire United States economy. One veteran of the Franklin D. Roosevelt administration called it the ``unfinished business of the New Deal.''

President Clinton did not enter the 1992 presidential race with health-care reform at the center of his campaign. The issue jelled for him as the campaign progressed, moving nearer the front all the time.

The public was anxious over it. It tapped a broader sense of economic insecurity that was carrying into the economic recovery. Many employees were finding their benefits cut or dropped. Medical costs had risen so fast for so long that a health problem at the wrong time, around a job change for instance, could spell financial catastrophe.

Then-President Bush had stalled and avoided ever sending a health-care reform bill to Congress, one more symbol of a president who seemed out of touch with the anxieties of ordinary Americans. The Clinton team came to see health care as a key opportunity to address public concerns with an activist government.

Rising costs

At the same time, medical costs had emerged as the fastest-growing federal as well as state budget busters. Unless things change, medical costs are projected to carry deficits up and off the charts after the year 2000.

So by the time Mr. Clinton assumed the presidency, he was ready to make health-care reform the ambitious gambit that would define his term in office.

The Clinton health-care reform might not restructure the industry or bring costs under control by the time Clinton runs for reelection, policy analysts and political strategists said during the '92 campaign. But if he could have a health-security card for every American, banishing the fear of losing one's health insurance, that would make a strong and very favorable impression on the electorate.

Within days of his inauguration, Clinton had upped his ante dramatically. He appointed his wife, Hillary Rodham Clinton, as his top staffer on the issue, a move considered risky because it placed so much of his prestige on the line. He promised a health-care plan within 100 days, another echo of New Deal ambitions.

Early speculation over whether that meant 100 calendar days or business days proved unnecessary. Both deadlines passed. Summer came. Up to 500 staff members and outside experts worked in clusters with a complex of procedural ``tollgates,'' all managed by White House aide Ira Magaziner under Mrs. Clinton's supervision.

Working in private, the health-care team seemed to include all the smartest people in the country on the subject in the ultimate school project. Polls showed the public impatient and skeptical that reforms would make any difference anyway.

In September 1993, Clinton finally introduced his plan. His speech was well received, and overnight polls showed more than 70 percent of the public liked what they heard.

That glow faded like a summer suntan. Ironically, as the economy improved, public concern over health care - still high - lost some of its edge. If Americans had ever been willing to launch a fresh New Deal-sized program establishing an entitlement to health care, their skepticism of government reasserted itself.

From the beginning, the White House political strategy served to isolate itself. The Clinton plan never had any Republican support beyond, possibly, Sen. James Jeffords of Vermont. Centrist Democrats did not like it much either. Both Clintons attacked the centrist Democrats, just as they attacked the pharmaceutical industry and health insurance companies. They aimed to establish a stark choice between a Clinton-type bill and no reform at all.

In the end, their strategy may have worked too well. Congress and the public preferred no reform, for now, to the Clinton plan.