THE ENDGAME ON HEALTH CARE

The progression of the health care debate has been most interesting. Inasmuch as we may now be nearing the endgame, a review is in order.

Last September, President Bill Clinton and co-President Hillary Rodham Clinton offered Americans a plan that proposed to "guarantee universal coverage to all Americans that can never be taken away." Their guaranteed universal coverage plan set up a seven-member Health Care Board (dubbed in this space the new "Politburo of Health Care"). This board would be appointed by the President, to make command decisions regarding all our health care. As originally proposed, the Clinton plan had four key elements:

1) An Employer Mandate: a law requiring all employers to provide health care coverage to employees.

2) Mandatory Purchasing Alliances: the famous regional health care purchasing collectives, to which every business, and every man woman and child in America, would be forced to belong.

3) Global Budgeting: The all-powerful Health Care Board would, in consultation with the regional alliances, establish a fixed amount that could be spent that year on health care for all citizens. The cap could not be exceeded without appealing to the unelected board members.

4) Premium Caps: Price controls on health insurance coverage. The government would control prices in health care.

In September, owing principally to a masterful presidential speech to a joint session of Congress, and to largely fawning and uncritical media coverage that accepted the Clintons' premises, overnight polls showed 57 percent of Americans favoring the President's plan. (A few keen observers noted at the time that this number was below overnight support for the President's tax-laden economic package, which ultimately squeaked through in 1993 by one vote in each house of Congress.) Much of the early press coverage and commentary dwelled on what a great salesman Mr. Clinton undeniably is, rather than focusing on the real meaning and substance of the plan he was selling. (Question: when you go to purchase an automobile, do you ask for the best and slickest salesman in the joint?)

Last week, a CNN poll measured support for Clinton-style HillaryCare at 38 percent, continuing the steady descent pollsters have tracked as the public becomes more keenly aware of the details of the plan. For the first time, a majority of Americans is telling pollsters that they oppose HillaryCare.

Of the four key elements of the President's plan, none is today present in any of the bills -- House or Senate -- that is going anywhere. One after another, Democrat-dominated committees in each body have informed the President and co-President: No Health Care Board. No Employer Mandate. No Mandatory Purchasing Alliances. No Global Budgeting. And no Premium Caps.

To take just one example, let's review what global budgeting would mean. The all-powerful health bureaucrats would decree how much could be spent on heart operations in a given year. Suppose that they guessed short, and all the health dollars they had allocated to heart bypass operations were used up by September 30. What happens to a person who shows up with cardiac symptoms on October 12, or later, whose physician recommends that surgery? Out of luck.

Thus, in tandem with price controls, would health care rationing be imposed under the Clinton plan, despite their denials. Need kidney dialysis, but you're over 55? Sorry: The health care bureaucrats could rule you out of order.

This, to take just two examples, is the real meaning of the Clinton plan. And this is why lopsided Democratic congressional majorities, spooked by an unbroken necklace of Democratic defeats in nine major elections across America, are not going to enact HillaryCare. The word got out: This was the biggest attempted power grab in American history, and it could yet prove to be classic overreaching, the Afghanistan of American liberalism.

Will there be a bill, signed by the President, before fall adjournment? Very possibly; to retain credibility, the President wants to sign something, anything he can claim as a victory. What features of HillaryCare might it contain? That's unclear. But, in a brilliant move, Sen. Minority Leader Bob Dole succeeded in crafting a sound, conservative reform bill supported by 40 Republican senators, which may now be the vehicle for action.

Still, there doesn't need to be a bill this year. The debate to this point has been healthy, a continuation, more so. Why not let each party take its case to the American people in this fall's campaigns? Isn't that what elections are for?