By Edwin Chen and Aliza Marcus
Hillary Clinton, offering a new prescription for providing all Americans with health-care insurance, is seeking to avoid a repeat of her first, failed bid to revamp the system.
While Democratic presidential rivals John Edwards and Barack Obama released health-care plans several months ago, the issue is more complex for the senator from New York.
Clinton's previous effort gives her a voice of authority on health-care coverage now, with 65 percent of Americans in a July Gallup poll expressing ``a great deal'' or ``a fair amount'' of confidence in her on the issue. That's more than any other White House contender. At the same time, it evokes memories of the bureaucracy-laden, 1,342-page proposal that critics still call ``Hillarycare.''
``It's very tricky for her,'' said Robert Blendon, professor of health policy and political analysis at Harvard University in Cambridge, Massachusetts. ``But she's not going to get elected president unless she can get through to people on health care,'' said Bob Laszewski, a Washington health policy analyst.
Labor unions, an important Democratic constituency, have demanded that the candidates offer specifics on the issue, which put Clinton in a particular bind.
Andrew Stern, president of the Service Employees International Union, said Clinton will offer a universal plan after taking care to lay the groundwork for it and head off comparisons with her 1993 health-plan debacle.
Working Against `Impression'
``She's working against an impression,'' Stern said in an interview yesterday. ``If she came out with another huge comprehensive idea, everybody would say, `There she goes again.' You know, big government, big plan.''
When Clinton offers her proposal next week to cover the 47 million Americans who lack insurance, she will probably stake out the middle ground, appearing bolder than Senator Obama of Illinois and more pragmatic than former Senator Edwards of North Carolina.
Obama, 46, has proposed mandating health-care coverage only for children. Clinton, 59, will likely make coverage mandatory for everyone, said a campaign aide who declined to offer details because he didn't want to pre-empt her speech, scheduled for Sept. 17 at a medical center in Des Moines, Iowa.
Edwards, 54, would go further and create a government-run system to compete with private insurance. Every American would have the option of signing up for a program similar to Medicare, the U.S. program for the elderly and disabled.
Universal Coverage
An expansive universal coverage proposal by Clinton may provoke fresh attacks from interest groups, such as the insurance industry, that thwarted her last effort, while a more cautious approach would invite charges that she has subjugated her values to her White House ambitions.
Clinton's dilemma is a case study of a candidate's attempt to convert a potential liability into an asset while opponents seek to make it a fatal flaw. Clinton may have the upper hand as pressure for an overhaul of the $2.1 trillion-a-year U.S. health- care system has grown since the legislative failure of 1993-94.
Costs have continued to outpace inflation, the number of uninsured has increased and fewer employers are offering coverage to workers. The Business Roundtable, led by the chief executives of companies such as General Motors Corp., has joined union leaders in urging coverage for everyone.
The government's accepted role in health care has expanded, with Medicare adding prescription drug benefits, and the federal government subsidizing coverage for 6 million children in low- income families.
Mandates
The plan Clinton devised after her husband, President Bill Clinton, named her to head the task force in 1993 would have mandated specific benefits and required employers to offer coverage or pay a tax.
The proposal proved so complex that it invited ridicule. An insurance industry group produced a series of television ads featuring ``Harry and Louise,'' a fictional couple struggling to understand the plan. Her proposal didn't make it out of committee even though Democrats controlled both chambers of Congress.
This time, Clinton is proceeding carefully. ``I've tangled with this issue before - and I've got the scars to show for it,'' she has said repeatedly. ``But I learned some valuable lessons from that experience.''
While Edwards and Obama offered their plans for universal coverage early in the campaign, Clinton focused first on proposals to cut costs and improve the quality of care, a bid to reach out to those who already have coverage.
Need for Consensus
Clinton also is touting the need to build a consensus among all players in health care. Yet she has continued taking a tough line against insurers, vowing to ``put an end'' to the industry discrimination against consumers with pre-existing medical conditions.
``I intend to dramatically rein in the influence of the insurance companies,'' Clinton said during a Sept. 12 forum posted on the Yahoo! Inc. Web site. ``They have worked to the detriment of our economy and of our health-care system.''
Clinton's fervor all but guarantees another titanic fight over health-care issues. ``When you put out a comprehensive plan, you put a big target on your back,'' says Drew Altman, president of the nonpartisan Kaiser Family Foundation.
``The history of health-care reform in this century is that proposals were either too big or too small,'' said Karen Ignani, executive director of America's Health Insurance Plans, successor to the organization that sponsored Harry and Louise. It is not likely the industry would find the Clinton plan to be just right.
``It's a risk for her, but a risk she has to take,'' said Doug Badger, a Washington lobbyist and formerly Bush's senior health policy adviser.
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