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Health Care's Reform's Cook, Chief, Wife and Detail Lovers : Reform: Interviews reveal a Garamendi recipe, copied by Clinton, baked by First Lady and a cast of hundreds.


WASHINGTON — The winter sun was already setting when candidate Bill Clinton finally arrived at the Regency Club in West Los Angeles for a scheduled five-minute meeting with California Insurance Commissioner John Garamendi. One of half a dozen Democrats seeking his party's presidential nomination, Clinton was shopping for someone to chair his California campaign.

Puffy-eyed and hoarse, the Arkansas governor was grateful for a respite from the all-out campaigning in snow-covered New Hampshire. He perked up even more upon seeing Garamendi, a like-minded reformer. "What do we do about health care?" Clinton asked his friend.

For the next 45 minutes, the two men talked revolution.

The words and concepts they tossed back and forth sounded arcane--universal coverage, global budgeting, health insurance purchasing cooperatives. But the objective was nothing short of audacious--remaking an industry that accounts for a seventh of the entire U.S. economy.

"He found Garamendi's ideas very provocative and asked all the right questions," recalled one of only two other people in the room.

Thus began a little-known, 18-month collaboration between Garamendi and Clinton--and their top aides--that had a dramatic impact on the national health care reform agenda the President will unveil in a nationally televised address Wednesday night.

The President's pending reform manifesto is the product of months of exhaustive work by the 500-member White House Task Force on National Health Care Reform headed by First Lady Hillary Rodham Clinton. Yet in many important respects, it is a virtual clone of the national plan that Garamendi drew up at the President-elect's request before he took the oath of office.

As Garamendi quipped one night last week: "I'm the one to blame."

While Garamendi's meeting with Clinton at the Regency Club in the winter of 1992 started the ball rolling, there were other defining moments in the making of Clinton's health care reform initiative.

As scores of analysts thrashed out complex issues inside the ornate Indian Treaty Room in the Old Executive Office Building next to the White House, there were moments both of drama and drudgery, of elation and despair. There were marathon meetings, all-night writing binges, skipped meals, lost sleep, bungled communications and hurt feelings.

Over the past eight months, as the President and his task force set out to plot the most ambitious piece of social legislation in the nation's history, The Times interviewed all of his senior health policy advisers, as well as top campaign and transition advisers who have returned to the private sector or academia.

The scores of interviews reveal that the process of developing a comprehensive plan to restructure America's $900-billion health care system has been anything but smooth or straightforward. It was, in fact, a tortured process of trial and error--at once open and secret--that disrupted the lives of virtually every participant, leaving everyone exhausted, some embittered--and most exhilarated.


As a longtime governor, Clinton felt strongly that national health care reform must provide coverage for all, rein in spiraling costs and grant states sufficient flexibility to design their own solutions. His only other preconceived notion was that America must not adopt a Canadian-style, single-payer system in which the federal government collects health care dollars and then pays all the bills.

Beyond that, Clinton was wide open--and trying to buy time.

In December of 1991, with the New Hampshire primary only weeks away, the pressure was on for Clinton to come up with something meatier than the three-page statement of principles his campaign staff had prepared. Two of his rivals, Sen. Bob Kerrey of Nebraska and former Massachusetts Sen. Paul E. Tsongas, had detailed proposals.

Working feverishly and alone out of a tiny office in Washington, Bruce Reed, Clinton's issues director, began to flesh out a plan, calling experts all over the country.

"It was the worst two weeks of my life," Reed, a Princeton University graduate and Rhodes scholar, recalled with a laugh. "The problem clearly was bigger than we could solve in two weeks."

Ira Magaziner, a longtime Clinton friend and adviser, argued against providing too much detail. "You don't gain anything by getting specific. Stay general," he counseled.

Reed eventually came up with a draft. On a frigid Saturday evening in January, he and the Clintons hammered out a 12-page statement of principles while eating takeout Chinese food in a small Manchester, N.H., hotel room.

The document promised universal coverage without new taxes. Once it was released, the issue seemed to go away. "All the candidates were for reform, so it just wasn't a cutting-edge issue," Reed recalled.

As Clinton's rivals began falling by the wayside, more and more "experts" began elbowing their way into Clinton's circle of health care advisers, who numbered about 30 at the time.

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