Oh Noooo!

By GEORGE J. CHURCH

Ted Koziol, a retired General Motors assembly-line worker, flew into a passion. At a January meeting in Venice, Florida, called by Republican Congressman Dan Miller to hear his constituents' views, Koziol burst out, "My health benefits are great! Do not touch what I worked 34 years to earn! What our President is talking about now is to tax my insurance or take it away. Right now I can choose my doctors. Regardless of what Hillary says, that's not the case with their plan."

Though he drew loud applause in Venice, Koziol at the time was part of a distinct minority in the nation. But his fears have spread so widely that, just as congressional subcommittees begin serious debates on health care, polls for the first time show more people against the President's plan than for it. A TIME/CNN poll last week by Yankelovich Partners disclosed 45% against, 41% in favor -- a startling swing from 50% for, 33% opposed as recently as January. Some apparent reasons: 70% now think Clinton's plan would make them pay more for medical care; 55% believe that they would have less choice of which doctor to see, and 41% fear that the quality of care they receive would go down, vs. only 16% who expect it to improve. And the more people think they know about health-care reform, the less they like Clinton's plan; the 22% in the TIME/CNN poll who said they understand the debate "very well" opposed it 60% to 37%.

To be sure, what people think they know might not be so. The White House charges that critics have been running expensive ads contending that "there are all kinds of things in my plan that aren't there," as President Clinton put it in an interview on CBS This Morning. Koziol to the contrary, for example, the plan would have little if any effect on the benefits he gets from GM, and it proposes no direct new taxes except for one on tobacco (though new insurance premiums that some companies and workers would have to pay are often considered a tax by another name). As for fears of declining quality of care, a more cogent criticism would be that the Administration has made the benefits it would guarantee to everybody more generous than most insurance plans now provide -- raising a serious question of whether the plan contains anything like an adequate method of paying for them.

Aides preparing Clinton for his CBS interview last week began with a blunt sample question, phrased by political adviser Paul Begala: "Your health-care reform is in trouble, the polls look bad, ((Senate Republican leader Bob)) Dole says your plan is dead." (Actually, Dole carefully qualified his statement, saying "in its present form.") The President's response, says Begala, "was all energy, energy, energy. To Clinton the notion that he's getting into trouble is invigorating." The President and Hillary Rodham Clinton plan an intensified grass-roots campaign to build public support. Bill Clinton gave an example Wednesday by phoning eight people who are struggling to care for seriously ill family members and telling them his plan will assist them to hire help.

It looks, however, to be an uphill struggle. Large public majorities still favor Clinton's goals; 65% of those questioned in the TIME/CNN poll agreed that "the Federal Government should guarantee health care for all Americans." But the Administration has done such an inept job of justifying its plan that it seems to have lost control of the debate. Some congressional voices already pronounce two of the basic elements of Clinton's approach dead. They are the alliances that would force most health-insurance buyers into mandatory purchasing pools, and the requirement that most employers pay at least 80% of their workers' insurance premiums. Clinton, on CBS, inferentially conceded that Congress might not approve either element -- though he challenged the lawmakers to come up with some substitutes.

In all the debates, the Administration has been endlessly weighed down by the sheer complexity of its 1,342-page bill. "Sure it's complicated, because it's working with the existing system and the existing system is phenomenally complicated," says Princeton sociologist Paul Starr, an architect of the plan. But that explanation is no help in winning support. Asked if even he comprehends all the details of the plan, a White House aide who is helping develop the Administration's sales pitch replies incredulously, "Of course not!"

In part, the Administration has been driven into this morass by a strenuous effort to reconcile conflicting goals: cover those people (the latest White House estimate is 39 million) who do not have health insurance, make certain that those now insured can never lose their coverage, improve benefits for the great majority, yet hold down the frightening increase in medical costs. One way might have been to switch to a Canadian-style system in which the government is the sole insurer and pays all medical bills, but the White House rejected that as impossible to get through Congress. Another idea would have been to tax somebody -- employers, employees or both -- on the medical benefits companies provide to their workers. At present most workers pay no tax on the benefits and the employers deduct the insurance premiums from their taxable profits, an arrangement that is thought to cost the government $75 billion a year. But Clinton determined early that nothing labeled as a large tax increase would fly politically. So his planners were driven to a Rube Goldberg scheme of mechanisms designed to hold down costs of extending care to the uninsured; one lobbyist describes it as "an elaborate way of getting around having to tax people."

Sylvester Schieber, a benefits consultant, asserts further that to hold down costs the planners want "to push people ultimately into health-maintenance organizations and for those HMOs to compete with each other. But they know that a lot of people don't want to go into HMOs." So they are offered fee- for-service plans and the right to go outside an HMO for some services. Result: still more complication.

Even so, the legislation is not much more convoluted than the legislative maze through which it must pass. In the House, three committees will have a major share in shaping the plan, and four more will play minor roles. So far, they have been unable to choose among the Clinton plan, a host of other proposals floated by lawmakers, or even a one-from-Column-A-and-one-from- Column-B approach. After two dozen hearings, Henry Waxman, chairman of the health subcommittee of the House Energy and Commerce Committee, gave up on trying to get a majority for any program and tossed the problem to the full committee. Chairman Pete Stark hopes to get a six-Democrat majority of the Ways and Means health subcommittee to sign on this week to a plan focusing on an expansion of Medicare to the non-elderly who do not get health insurance through an employer. That idea has hardly even a remote chance of becoming law, but Stark wants to get something specific on the table.

In the Senate, Ted Kennedy's Labor Committee has reported out major health- , care reform bills in each of the past three Congresses; it probably can do so again. But its product, if any, will have to be reconciled with the product -- if any -- of the Finance Committee, which will not even end hearings and start deliberations until late April. Then come votes in each house, negotiations with the Administration, and a conference to reconcile differences between House and Senate bills that promises to produce one of the all-time hassles.

Ending with what? Much will depend on how Republicans resolve an intense internal quarrel. A conservative group led by Texas Senator Phil Gramm wants to propose only minimal reforms and fight Clinton's plan to the bitter end. Moderates clustered around Rhode Island Senator John Chafee would like to form a coalition with centrist Democrats behind a much broader reform. A G.O.P. health-care "retreat" last week in Annapolis, Maryland, resulted only in a vague agreement to try harder for a unified approach. Where Dole comes down may be crucial, but so far he will not go beyond a typical quip: finding the right position is as difficult "as a one-armed man wrapping cranberries."

It is possible that a congressional majority will come together behind a plan that, while more modest than Clinton's proposal, would allow both sides to claim victory. The President could hail at least a start toward his goal of goals, universal coverage; the Republicans could contend that they saved the country from socialized medicine. But it is also conceivable that the process would bog down irretrievably, and support would grow for some sort of bare- bones, stopgap proposal. Thirty legislators -- 15 Democrats, 15 Republicans -- have now introduced just such a bill. It would help sick people hold on to their insurance, discourage malpractice suits, expand community health centers to aid the uninsured -- and that is about it. In any event, anyone who judges the President's plan to be the ultimate in complexity is being premature; the congressional debate is just getting started.

CHART: NOT AVAILABLE

CREDIT: From a telephone poll of 600 adult Americans taken for TIME/CNN on March 2-3 by Yankelovich Partners Inc. Sampling error is plus or minus 5%. "Not sures" omitted.

CAPTION: Do you favor or oppose President Clinton's health-care reform plan?

Do you think Congress should pass that bill in its current form?

Are there other health-care reform plans that have been introduced in Congress that are better than Clinton's?

Do you think the Federal Government should guarantee health care for all Americans?

Under the health-care reforms the Administration is working on, do you think the amount you pay for medical care will:

With reporting by Laurence I. Barrett, Suneel Ratan and Dick Thompson/Washington