By Helen Dewar and Amy Goldstein
Washington Post Staff Writers
Tuesday, July 13, 1999; Page A1

The initial hours of the four-day debate showcased the two parties' competing approaches to one of the hottest issues before Congress: How far the government should go in regulating health plans that have become the major source of Americans' medical care.

The partisan sparring, scheduled to culminate in a vote Thursday night, marks the first full-fledged debate in Congress on patients' protections – an issue that is of intensely personal interest to the public and could figure prominently in the 2000 campaigns.

"This is an historic day," said Minority Leader Thomas A. Daschle (D-S.D). "People all across this country have made it clear what is happening today with health insurance cannot be allowed to continue."

For politicians of both parties, the rallying cry for "patients' rights" has become a favorite theme among the current generation of attempts at health reform. Neither of the approaches the Senate is considering would substantially overhaul the health care system – they would not, for instance, extend insurance to all 43 million Americans without coverage. But they would tip the balance of power among doctors, patients and the insurance industry – a balance that has shifted markedly toward health plans in the era of managed care.

The Senate is taking up the issue just a year after the House hastily approved a GOP version with barely any debate. The legislation before the Senate is similar to bills that were advanced last year but died in a partisan standoff before formally reaching the floor. GOP leaders say the House will consider the issue again later this year.

While the outcome in the Senate this time remains uncertain, Republicans expressed confidence yesterday their bill would prevail. If that happens, the White House said, senior advisors to President Clinton would recommend that he veto the bill.

The behind-the-scenes maneuvering during yesterday's debate also underscored the extraordinary parliamentary tactics that both parties are prepared to employ in hopes of winning some advantage.

Republicans tried to gain an edge last week by making the Democrats' bill the vehicle for debate, hoping to make it more awkward for the Democrats to offer their own amendments. But yesterday, the Democrats counterattacked, offering the Republican bill as an alternative to their own. For the moment at least, this means that each party can amend the other's bills, and the Senate can chose between the two at the debate's end.

During yesterday's arguments, Democrats accused Republicans of pandering to the insurance industry without providing adequate protection to patients, while Republicans charged that Democrats would go too far in strengthening government control, increasing medical costs and thus causing more Americans to become uninsured.

Each side armed itself with maze-like charts, grisly photographs and superheated language to promote its own plan and demonize the alternative.

"The Democrat plan means more government, more lawyers, more rules, more uninsured and more government control, but the only thing it does not mean, the one thing it does not provide, is more freedom," said Sen. Phil Gramm (R-Tex.), describing "freedom" as the hallmark of the GOP bill.

Across the aisle, Daschle accused Republicans of offering a "placebo, not a plan." A "profit-protection plan for the insurance industry," said Sen. Edward M. Kennedy (D-Mass.), who is co-sponsoring the Democratic proposal with Daschle.

The pep rallies were drenched in alarmist rhetoric and featured ordinary Americans imported to Capitol Hill to help the politicians make their case.

Standing against a blue backdrop printed with the words, "Patients First," Republicans contended that allowing Americans to sue their HMOs, as Democrats want, would drive up medical costs so much that people no longer would be able to afford coverage, ultimately causing 1.8 million Americans to lose insurance over the next five years.

To illustrate their point, the GOP introduced Richard Gallo, who traveled with his wife and three children from Indiana, Pa., where he opened an office supply store three years ago. Calling the opportunity to own his own business "an American dream," Gallo said that he nevertheless had been unable so far to afford health insurance for his family or his seven employees. And while he hopes to be able to purchase some soon, he said, "if Congress continues to enact bills that will keep driving up the cost, that will be impossible to us."

For their part, Democrats were flanked by D.C. General Hospital employees who wore white lab coats, symbolizing the party's contention it is defending health care professionals and regular Americans.

Daschle introduced Ray Cerniglia, who said that his son, Matthew – a 12-year-old who liked skateboarding and had started to get calls from girls – died of cancer in February after the family failed to persuade their HMO to pay for high-dose chemotherapy and a "stem cell rescue."

"It is crazy that while we are caring for and fighting for Matthew's life, we had to, at the same time, fight our HMO for coverage of a life-saving treatment," Cerniglia said. He said he agreed with Democrats that Congress needs to give doctors more control over medical decisions and that patients should be able to sue their HMOs.

The large, well-funded lobbies with a stake in health care were also out in full force. Speakers at the Democratic rally yesterday included John Sweeney, president of the AFL-CIO, and representatives of a dozen consumer and medical advocacy groups who held up placards with their organization's name. Meanwhile, a coalition of business and insurance interests, affiliated with the GOP but eager to block any bill from passing, is running a major advertising campaign this week.