As the White House people see it, the situation borders on insurrection.
As the secretary of health, education and welfare sees it, the situation is not even a situation at all.
But the fact is that the internal struggle to shape President Carter's national health insurance plan has driven a wedge between White House domestic policy chief Stuart Eizenstat and HEW Secretary Joseph A. Califano Jr. -- a division appearing at least as formidable as the well-publicized split on the foreign policy side of the Carter family, between Secretary of State Cyrus R. Vance and Zbigniew Brzezinski, Carter's national security affairs adviser.
"Stu kept saying do it this way, and Joe kept delaying and delaying -- and then he did it his own way instead," says one high-level Carter assistant. "Finally it got to the point where Joe Califano seemed to be carrying Teddy Kennedy's water on national health insurance."
And that is where the insurrection comes in. Because in the Carter White House, even appearing to carry water for Sen. Kennedy (D-Mass.) is not a good way to make the team.
Details of just how the split came -- and how the president let it go on relatively unchecked -- provide a significant portrait of how policy sometimes happens in the Carter administration. It is a paint-by-numbers sort of portrait; separately the details look jumbled, together they form what Carter himself used to call a significant "mosaic."
It is a picture of a White House policy chief who makes requests on behalf of the president; of a powerful and confident Cabinet officer who prefers to do things his way instead; and of a president who seems to hold firmly the reins of power, but who does not yank firmly on the reins to bring under control the steed that is carrying him along.
It came down to this:
Throughout the fall and winter, Eizenstat (backed, in a burst of rare unanimity, by the White House senior staff) felt that Carter should propose only the most limited of plans -- a single phase covering only catastrophic illnesses. They say the White House kept asking Califano to submit options for this narrow, limited approach.
Califano and his HEW officials favored a much more comprehensive plan. Their concession to economic realities was that the various phases of the comprehensive plan would become effective only when economic indicators showed that inflation was under control. This basically is what they finally submitted last month. The plan is much closer to what Kennedy and organized labor were pushing than was the narrower plan favored by the White House assistants (although Kennedy says the Califano plan still does not go far enough).
"The plan Joe came up with simply was not what we were asking for," says one senior White House assistant. "It did not provide detailed options for a catastrophic-only plan -- a one-phase only plan. And that is what the president wanted."
The view from the sixth floor at HEW is somewhat different.
"I gave the president exactly what he asked for," says Califano. "... I do not believe they ever asked for it [a phase one-only plan]." He pauses. "No," he says firmly. "Absolutely not."
Califano and the Carter White House had been at odds ever since the beginning of the administration over such matters as Califano's determination to fill vacancies without catering to the political patronage needs of the White House. There was the case of the Chicago Democratic machine, which wanted only a regional HEW job, and got nothing; and there was the inadvertent axing from an advisory board of the wife of then-New Orleans Mayor Moon Landrieu, who was an early Carter supporter.
But that was politics, not policy.
Last fall, however, Eizenstat and the Carter senior staff concluded that it was time to cut back on the comprehensive health insurance program that Carter had spoken of with promise in his campaign days.
Inflation was the No. 1 concern of everyone, the White House assistants believed. Also, Congress would not pass a comprehensive health plan, and the administration would suffer a public relations defeat if it proposed a larger plan that was then decimated on Capitol Hill.
So the Carter senior staff favored a plan limited to coverage of catastrophic illness cases only. And, according to four high level White House aides, Eizenstat then asked Califano and his department to come up with options for a limited one phase-only bill.
Califano says he does not remember this happening.
At that time Califano's aides were telling the White House that a catastrophic-only bill would be a mistake; that it was the least efficient of health plans; that it would appeal only to the middle class -- so who would be looking out for the interests of the poor? They said that catastrophic plans do not address the problems of preventing illnesses in advance through proper medical care; that a catastrophic plan would only encourage people to stay in hospitals longer than necessary.
HEW was pressing for the full, comprehensive route.
Meanwhile, according to the White House sources, they began to hear that what Califano really wanted was to embark on a lengthy round of hearings and debates across the country on the matter. It would take all summer, which would mean there would be no bill proposed this year.
"That sounded like a familiar stall to us," says one White House official. "It sounded like the sort of thing we kept hearing from Ted Kennedy and labor in the past -- about how they would rather have no bill at all for now than to have a catastrophic-only bill, which would mean they would never get more than that from Congress.
"And another thing was that Joe's road show would only make the president look like a cheap piker; I mean, he'd be out there talking about all of these big grand plans, and then Carter would wind up announcing only a small little plan. How would that look?"
Over at HEW, Califano says he never wanted to go out on a national tour. "I'd already done that in the beginning of 1977," he says. "We went all over the U.S.A. then. Why would I want to do that again?"
And if Eizenstat and his aides think HEW was stalling, Califano says, they are wrong. He concedes he was maybe two months late in getting his plan to Eizenstat. "But that delay was attributable to me and my analysts getting derailed on the budget process," the secretary says. "It was not a stall."
Relations betweenthe Eizenstat and Califano shops grew strained. Among those caught in the middle was Kennedy. It used to be that White House and HEW officials would get together with Kennedy and his staff to discuss and bargain about a health plan. But suddenly a two-track approach emerged. The White House officials would call up Kennedy and meet to brief them on some development. And then HEW, unaware, would come over and brief them on the same thing. The Kennedy people kept their own counsel and endured both briefings.
Meanwhile, the deadlines of November and then December came and went without Califano submitting his plan.
"Eizenstat was really getting angry," recalls a White House aide. "Finally he went to the president and suggested he write Califano and tell him flat out to get his options to the White House by the time he got back from the [Jan. 5] the Guadeloupe summit."
Carter agreed to intercede. But his memo, written just before he left for the summit, was not the firm, precise command that many White House aides think it was. Nor did it specify that what was needed were phase one-only options.
To Secretary Joseph Califano :
I need to decide strategy on the National Health Plan before the State of the Union. I know you are working hard on this .
I would like to review a range of options on the scope of the plan, and on the timing of submission to Congress. In addition, I would like you to develop strategy for incorporating health initiatives already approved for submission to Congress into the plan, to the maximum extent possible .
Please work with Stu, Jim McIntyre, Charlie Schultze so we can meet with you when I return from Guadeloupe .
I appreciate all that you are doing on this difficult and critical issue .
When Carter returned from Guadeloupe, Califano's plan was ready for the White House. On Jan. 19, in the Cabinet room, Califano briefed the president and other officials.
Califano say he does not believe the split between himself and Eizenstat is really very pronounced.
"I think Stu and I are essentially on the same track," he says. But he adds: "I was making the point that you can't just pick out phase one-only or phase one and two without having a total vision, a longer-range vision of where it is going."
There remain today some small questions about that briefing: for example, whether the president was satisfied with the plan or whether he was not.
White House officials say the president was not.
"Califano had submitted his report and the president never even read it because it was more than 100 pages long," says one White House official.
"It was a comprehensive plan, with five stages that were clearly labeled, and he was saying that you could just pick out any one stage and make it your one phase-only plan."
Another White House official says: "The president told Joe, 'I want more work done on the types of phase-one plans that we can propose.' He told Joe to take it back and work on it -- we had suggested he tell Joe that. He also told Joe to consult with people on the Hill and in labor."
Califano remembers it differently:
"We briefed the president for two hours. "We had a chart... And I began the briefing by giving the president a plasticized Health care card -- that's what we'll be calling them -- with the president's Social Security number on it. We gave him the first one... The briefing was a terrific briefing -- and I've been in lots of briefings over there... He seemed very pleased."
Califano recalls Carter telling him to "take this briefing and give it to the leaders in Congress and the health industry. Ask them what their opinion is of the general overall plan, and how would they do it fo ra phase one or phase one and two plan only?"
And this is where the matter stands now.
What the White House people believe is that Califano is reworking his plan to come up with specific, detailed options on how to implement a limited phase one-only plan, probably one that would provide for insurance against catastrophic illness expenses only.
What the secretary of health, education and welfare believes is that he is just out consulting now, and that he is going to report back on what people say -- but that he does not have to do any major reworking of his basic comprehensive plan.
They are going to meet again, both say, in a couple of weeks. And then, it appears, they will go through it all over again.
EPILOGUE: The Carter White House assistant, a domestic policy man, has paused to think about how he should phrase his reply. He has been asked why, if the president really wanted it done one way, he had not been more forceful in getting a Cabinet member to give him the sort of plan that he wanted.
Finally the aide is ready with his carefully phrased answer. It is a shrug, hands out, palms up.
Would Lyndon Johnson have permitted his Cabinet member to so dominate his chief domestic staff member? "No," the Carter aide says, "I don't suppose he would have."
And would Johnson's chief domestic assistant have put up with a Cabinet official who gave him such a rough time? "I doubt it," says the aide, smiling as he recalls how Califano had earned the reputation of being a tough, aggressive handler of Cabinet members when he had Eizenstat's job.
Califano figures that he is not really a domineering sort. It is just, he says, a matter of changing times.
"Back then it was all a matter of new programs and new policies... the Great Society," he says. "Now it is a problem of managing -- and you can't manage from the White House."
Eizenstat has a different perspective. "Joe is just damned well determined that nobody is going to get the upper hand on him," he is once said to have remarked. "But just as he always had his final say in the president's ear in the 1960s, now I have that final say."