Let's Play Doctor

Politicians of both parties say managed care is an increasingly hot issue. The question now: Will they just fight over it or actually try to do something?

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But with less than two months of lawmaking left before Congress adjourns to run for re-election, there is also plenty to fight about. Democrats are firm that patients be allowed to sue their health plans, an idea that Republicans and their business constituents find heretical. The House Republican bill contains a few land mines of its own, such as medical savings accounts (a risky experiment, Democrats say, and a sop to G.O.P. campaign contributors) and limits on malpractice awards (which the Democrats and their trial-lawyer allies warn would prevent the injured from recovering what they are due). Says Republican Ganske of his leaders: "They have included a melange of controversial ideas to make sure the bill won't pass."

That suits many congressional Democrats just fine. "We're not going to pass a meaningless and toothless bill and say it's important," vows Senator Ted Kennedy. A bloody brawl over managed care may be the Democrats' best hope for winning back the House. Which may suit the White House for its own reasons. Clinton aides say that ever since the tobacco bill went down--after the President assented to Republican amendment after Republican amendment, only to see the G.O.P. kill the whole package in the end--Clinton has lost his appetite for dealmaking. Says a Clinton strategist: "It really slapped down the forces for bipartisanship in the White House."

Some democrats are predicting a victory that will be swift, clean and total--if not on the floors of Congress then at the ballot box in November. Unlike tobacco, they say, this debate will not get caught in arguments over taxes and how to spend them. But that ignores the fact that it has been largely one-sided thus far. What opponents of reform will have to do is convince voters that the legislation would give them rights they don't need at a cost they don't want to pay.

Managed-care executives concede privately that this is a difficult argument to make when Americans have at least 10 years of nerve-racking experiences with managed care. But that doesn't mean the industry doesn't have some important and powerful friends. Says an executive: "We want to create an environment where the inside game is hell." When Republican Ray LaHood signed onto one of the managed-care reform bills, two executives of Caterpillar, his district's largest employer, quickly flew to Washington to register their unhappiness with him. Small-business owners--the operators of hardware stores, real estate agencies and Laundromats who form the bedrock of G.O.P. support at home--are even more upset at the prospect of a bill that could raise their insurance costs. Six Republicans, including Norwood, have already removed their names from the Norwood bill. A health-care-industry official put it bluntly, "You gotta climb over [local business leaders'] dead bodies to get to us."

That is the message the industry is trying to sell through such sympathetic characters as real-life small businessman Bonifas. But Americans may also remember how a fictitious couple named Harry and Louise devastated the Clinton health-care plan in a similar political ad five years ago. As they sat at their kitchen table, Harry and Louise fretted that the choices being promised by the government were really no choice at all. "They choose," Harry said, to which Louise countered, "We lose." Voters might say that's precisely the problem with managed care.

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