Calling The Odds

What remains unclear is the plan's chances forpassing the difficult hurdle of Congress. Dr.David Blumenthal '70, chief of health policyresearch and development at the MassachusettsGeneral Hospital, says the commitment to universalhealth care, cost containment, and the opportunityfor physician choice are essential for the plan'spassage in Congress.

Like other experts, Blumenthal, who was one of47 non-government health policy experts chosen bythe Clinton administration to review the planbefore its release, says the plan will besubstantially modified.

Blumenthal says the plan falls in the center ofRepublicans and Democrats, but that Clinton wouldhave to court the Republican faction in order forthe plan to succeed.

"I think he'll have to barter," he says. "Ijust hope he has the political skill to hold firmon the things he has to hold firm on."

Lee Professor of Health Policy and Managementat the School of Public Health Robert J. Blendonagrees with Blumenthal's analysis.

"He's going to have to involve people who aremore politically conservative," says Blendon."Some of the things in the plan that are moreregulatory will have to disappear."

Emanuel was impressed by Clinton's politicaltechnique in trying to convince Congress to passhis reforms.

"[Clinton's] going to say to the left that'It's my plan or nothing' and he'll say to theright 'It's my plan or Canada,'" he says. "It's amasterful stroke. The left will have to support itbecause they don't want nothing and the right willsupport it because they don't want Canada."

Blendon says a combination of taxes, phasing inthe program over a longer period of time, andmaking benefits less generous will probably benecessary to finance the plan.

"I'm a bit mixed about it," he says, echoingthe grab-bag of expert reactions to the plan.

Emanuel is less optimistic. "I am afraid thathe might discredit health care reform," he says.

If budget savings fail to cover the costs ofthe plan, argues Emanuel, universal access wouldhave to be phased in slowly, perhaps over eight toten years. And this, he says, may weaken Clinton'scase. "It doesn't give the people what theythought they were buying," he says.

Emanuel says Clinton's idea that most Americanswould get the same or better care, while payingthe same or less for it, seemed a bit tooidealistic. "[The idea] seems untenable, and mostAmericans know it," he says.

It appears, however, that at least one consumergroup will be lobbying for parts, if not all, ofthe plan. Michael L. Miller, policy director ofHealth Care for All, says his organizationsupported the plan's broad outlines, but not someof the details.