It’s not that easy. The administration is still divided over some of the cost estimates contained in the plan. The “bean counters” at Treasury and the Office of Management and Budget are fighting what they see as politically risky over promising by policy adviser Ira Magaziner and his aides. Although the internal debate won’t affect Clinton’s overall strategy for reform, it has already forced changes at the margins. Last week, Magaziner scaled back his estimate of the savings health reform should produce in federal spending, from $91 billion to $71 billion. Administration officials also said the new national health board that Clinton wants to create would have a somewhat lessened regulatory role, apparently a reaction to Republican charges that the board would have too much power.
But the core controversy centers on the costs of subsidizing health care for retirees, and it is not over yet. As drafted by Magaziner and others, the Clinton plan would subsidize home health care for the elderly and in-home nursing care for the disabled. It would also subsidize prescription drugs for Medicare recipients and pay 80 percent of the health costs for workers who retire between the ages of 55 and 65. Many don’t trust Magaziner’s figures for these benefits, and one official said, “Ira’s expecting a bedside miracle” to pay for them. Other sources said Treasury Secretary Lloyd Bentsen and OMB chief Leon Panetta want to delay some or all of these subsidies for at least a year to see whether reform actually produces the savings Magaziner predicts.
Clinton is holding firm on home health care and prescription drugs. But the bean counters did persuade Magaziner to reduce the proposed subsidy for early retirees from 80 percent to 40 percent during the first three years of the program, saving about $10 billion.
All this may help the Clinton plan on Capitol Hill, where skeptics abound. Congressional whales like Ways and Means Committee chairman Dan Rostenkowski are spouting about the delay, and the administration suffered a potentially major loss this month when the Democratic Leadership Council, a group of moderate-to-conservative Democrats with strong ties to Clinton, backed a less regulation-minded version of reform proposed by Rep. Jim Cooper of Tennessee. Health reform may be a driving goal of Clinton’s presidency–but so far, it seems to be stuck in “park.”
