Health Care Reform

President Obama, a supporter of reproductive rights, forcefully reiterated in his speech to Congress this week that his healthcare plan would not lead to government funding of abortion. The trouble is, abortion foes don't believe him. They are working hard to persuade Americans that Obama is wrong -- and have even created ads that evoke "Harry and Louise," the fictional couple that helped tank the Clinton-era attempt at healthcare reform: "They won't pay for my surgery," says an elderly man sitting at a kitchen table.

Some may find it hard to believe that the U.S. health insurance industry supports making major changes to the nation's healthcare system. The industry, after all, scuttled President Clinton's healthcare overhaul bid with ads featuring "Harry and Louise" fretting about change. But this time, it turns out, the health insurance industry has good reason to support at least some change: It needs it.

As Democratic leaders prepare to bring healthcare legislation before the full House and Senate for votes this month, they soon must decide who will be taxed to pay for expanding coverage -- the wealthy or the insurance companies. Legislation emerging from the House would slap a surtax on upper-income people. But many Democrats, especially in the Senate, fear the political fallout over voting to raise anyone's income taxes. The most prominent Senate bill would impose a tax on insurance companies that provide expensive policies, sometimes dubbed "Cadillac" plans.

As the Clinton White House discovered to its grief more than a decade ago, and the Obama White House is learning, no minefield of American politics is as uncharted and explosive as healthcare reform. And no piece of healthcare reform is as explosive as the issue of cost control. Consider the conniption being thrown by Republican senators and other conservatives over a $1.1-billion provision in the stimulus package to fund "comparative effectiveness research."

As they work to overhaul the nation's healthcare system, President Obama and his congressional allies have pledged to help small-business owners such as Rhonda Ealy and Kelli Glasser. Ealy, who owns a coffee roasting company in Bend, Ore., has put off buying new equipment so she can offer health benefits to her 13 full-time employees.

Every year, Santa Ana strawberry farmer Mack Ramsay pores over health insurance plans for his 35 employees, checking out prices, coverage, deductibles and other fine print from giants like Blue Cross, Blue Shield and Aetna. For 21 years he has chosen instead a little-known, nonprofit healthcare cooperative based in Irvine that provides insurance to about 15,000 Californians and Arizonans mostly working in agriculture.

Senate Democrats debating how to overhaul America's healthcare system are moving toward a showdown over whether to create a government-run insurance program or set up a system of cooperatives instead. A government plan, an idea President Obama endorses, is a centerpiece of the legislation being developed by Sen. Edward M. Kennedy (D-Mass.) and fellow liberals.

An effigy of Rep. Frank Kratovil Jr. was hung outside his office on the eastern shore of Maryland. Rep. Steve Kagen of Wisconsin was shouted down by angry constituents. Rep. Timothy H. Bishop of New York had such a raucous experience with critics on Long Island that he avoids town hall meetings for more manageable settings. The spark for political firestorms around these back-bench Democrats has been President Obama's effort to overhaul the healthcare system.

Policy analysts will be sparring for months over President Clinton's plan to expand Medicare. But one thing is already settled: Insurance for older Americans will be a highly partisan issue in Campaign '98, making it the fourth straight election in which health-care reform plays a starring role. This year's fight, like its predecessors, is rife with political land mines for Democrats and Republicans alike.

First Lady Hillary Rodham Clinton blamed herself Monday for the failure of health-care reform last year and said she had been politically "naive and dumb," a newspaper reported. Speaking to a group of women writers invited to lunch at the White House, Mrs. Clinton also said she is surprised by how she sometimes is perceived, the New York Times reported.