THE HIGH-WIRE act occasioned by the lack of a clear majority in the House -- the odd and disabling fact that the majority leadership spends much of its time defending minority positions against the House's will -- continues. The issue now is managed care. Speaker Dennis Hastert's margin is such that, if no Democrats come his way, he can afford to lose only four Republicans and still maintain control. On managed care, he is threatened with the loss of at least 21 who have signed on as supporters of a regulatory effort he seeks to deflect. He is looking for a way to bring them back. He wants to hold a vote, lest Democrats charge him and the party with keeping a popular -- not to mention mostly worthy -- bill from becoming law. But a loss if he lets the bill onto the floor would embarrass him and disappoint important Republican constituencies alike.

It's an awkward choice and not the only issue on which Mr. Hastert now finds himself thus pinched. He is bringing a campaign finance reform bill to the floor next month because members of his own party threatened to join Democrats in signing a discharge petition that would have forced it to the floor had he refused. The leadership will try to keep it from passing by trumping it with an innocuous bill. If that fails, opponents will try poison-pill amendments, whose adoption would likely cause Democrats to vote against the underlying measure; then Republicans might not have to bear the blame for its defeat.

The speaker has had to resort to similar tactics -- appearing to push in one direction while pushing in another -- to pass the tax and spending bills that are supposed to summarize what Republicans stand for, and thereby what is at stake, as the country makes the turn into next year's elections. To finance the tax cut it wants to grant, the leadership is supporting spending cuts for which it lacks the votes. The speaker was able to put together a majority for the tax cut only because of the understanding on all sides that the president instantly would veto it as excessive. Moderate Republicans opposed to the bill were able to vote aye, secure in the knowledge that it would be only a gesture. Likewise on appropriations, where for lack of the necessary votes, Mr. Hastert basically has deferred the cuts that the financing of the tax bill would require. The hope is to work out a deal with the president later in the year in which he will bear the responsibility for what the Republicans will denounce as spending increases but nonetheless support.

The managed care issue is particularly difficult for Republicans, in that it is forcing them to choose between two traditional constituencies, physicians and employers. The docs -- not all, but many -- detest managed care for undercutting their prerogatives and income. They'd be happy to see the industry regulated, as Democrats seek to do in the name of patients' rights. But employers who pay for employee health insurance support aggressive managed care because it cuts their costs. The insurance industry, which has morphed into the managed care industry, also opposes serious regulation.

The Republican leadership likewise favors light -- some would say, token -- regulation; the Senate already has passed a token bill over Democratic opposition. But a handful of House Republicans who are members of the medical profession have led a mini-revolt to the other side. A compromise has been worked out by Reps. Charles Norwood, a Republican dentist, and John Dingell, ranking Democrat on the Commerce Committee, that in some respects is an improvement on the original Democratic bill; it's amazing what good ideas old-fashioned legislative give-and-take sometimes can produce when the members try. The administration supports the compromise. That's what Mr. Hastert still hopes to defeat. It's as good an emblem as any for the year thus far.