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The last two months of planning were a giant exercise in practical politics. Most of the likely allies were on board. Big Labor and senior citizens were natural supporters: both had been granted huge concessions early in the spring. Nurses and hospitals, also beneficiaries of reform, could be courted and perhaps won. Some of the big insurers were playing along; others were coy; small firms were downright hostile. Small business was opposed, probably forever. But Magaziner wanted to sign up the politically powerful American Medical Association or, short of that, keep it neutral.
In July, A.M.A. executive vice president Jim Todd spent a Sunday afternoon in Magaziner's office eating Chinese takeout food and raising questions about the plan. "Reserve judgment," Magaziner said. Many advisers close to Magaziner thought his courtship of the A.M.A. was futile or even dangerous. He had already agreed to suppress one type of liability reform opposed by the doctors, and Clinton's advisers feared that more concessions were inevitable. They were right: by midsummer, price controls were gone, abandoned in favor of caps on insurance premiums. "We could kneel on broken glass and give the A.M.A. everything it wanted," said one task-force member, "and still they will oppose it. They are going to push us as far as possible, and then they are just going to screw us."
Two weeks ago, Todd was back with more demands, including malpractice relief: a $250,000 cap on jury awards for pain and suffering. Magaziner resisted. "What about a $500,000 cap?" asked Magaziner. Todd hesitated, but later threw a Hail Mary: "Could we appear in the Rose Garden behind the President when he announces?"
Magaziner's bartering worked. Late last week, the A.M.A. had yet to criticize the plan. It was the sort of tinkering that explained why the White House insisted into the weekend that everything was subject to change, particularly in return for support from Congress and interest groups.
Clinton's final health-care meetings took place in five two-hour sessions two weeks ago. Some aides were surprised at the lineup: attending were Clinton, his wife, Vice President Al Gore, his wife Tipper, most of the Cabinet, their top aides and leading White House advisers. The first day didn't go well: Clinton's conclusions leaked almost in their entirety to the press. For the next four days Clinton sat quietly, listening to his aides argue, taking notes and deciding later behind closed doors. He backed away from a plan to tax alcohol and opted instead to tax only cigarettes. He considered three forms of premium caps and decided on the one that would be the easiest to explain.
Clinton listened to his top advisers debate the wisdom of cutting $238 billion out of Medicare and Medicaid over the next five years, and heard warnings that House liberals led by Henry Waxman of California would oppose the plan if a slash that deep was made. But Clinton reassured them, "We need to lead with what we think is the best approach. If Congress changes it, fine, but we will have looked at all the options and we will know why we chose what we choose."