Health Care Reform May Depend on Tactical Skills of Waxman, Stark

WASHINGTON —  When President Clinton unveils his sweeping overhaul of the nation’s health care system next month, its fate in the House of Representatives will rest largely in the hands of two Californians.

One is Rep. Henry A. Waxman (D-Los Angeles), one of the House’s most masterful legislative tacticians, a consummate insider with a legendary skill at political maneuver. The other, Rep. Pete Stark (D-Oakland), meanwhile, is not given to walking or talking anyone else’s line.

Waxman is chairman of the House Energy and Commerce Committee’s subcommittee on health and the environment, which has primary jurisdiction over questions of health care policy, such as which, if any, types of benefits will be guaranteed to every American. Stark chairs the Ways and Means Committee’s health subcommittee, which will have to sort out the crucial question of how the plan will be financed.

Each lawmaker praises the other, and says that they are of like mind about making sure all Americans have high-quality health care at affordable prices. Yet together, they present a complex political equation as they divvy up responsibility for passing the plan. Without the support of both, the plan is certain to have tough going.

Waxman’s legislative skills are potentially one of Clinton’s best assets in the upcoming battle. Already, White House and congressional officials say, he has shown a surprising degree of accommodation. For instance, although he had misgivings about Oregon’s plan for health care rationing, Waxman agreed to let the experiment go forward because Clinton had promised during his presidential campaign to support it. In exchange, he made sure that the state imposed some additional safeguards to protect care for poor women and children.

And while he has proposed more radical systems of health reform in the past, Waxman says he can see wisdom of “managed competition,” the centerpiece of the Administration’s plan, which would put Americans in large purchasing cooperatives, where they would have enormous clout in bargaining with health care providers.

“I don’t know if managed competition will live up to all the expectations, but it does seem to me to make some sense to give people as much choice as possible, to let consumers have more of a role in what kind of health care system they may want to be part of,” he said.

Then there’s Stark, who has made no secret of his scorn for the White House task force that is devising the plan--a group he dismisses as theologians and theoreticians discussing material for “18 doctoral theses” without much input from the real world.

“Pete’s attitude is, we’ve been in training for years to do this. Where did all these wonks come from?” said one congressional source.

At one recent meeting, the chief among those wonks, task force leader Ira Magaziner, became so angry with Stark that he accused him of “preaching socialism.” The chairman shot back that Magaziner was “politically asinine.” From there, the exchange quickly disintegrated into a shouting match, with Stark’s subcommittee watching in amazement, according to several sources.

Stark complains that the task force is so wedded to the theory of managed competition that it is refusing to consider other ideas, or to take into account the realistic costs and trade-offs that it will present.

“They’re promising more than they can produce,” Stark said of the White House task force. “They don’t have 600,000 constituents to go home and answer to, so they can’t possibly approach the problem the way my colleagues (in Congress) are going to approach it.”