Most of the discussion regarding health insurance reform in Washington these days is not about the substance of the bills. Those issues have been debated enough that everyone's position on everything is well known. Instead, the talk is about the motives of the major players.
And it's not just idle curiosity. The question has real consequences for provider groups that must decide whether to push for a spartan version of the health insurance reform plan or a more expansive proposal.
Late last month, the Republican-controlled House passed a health insurance reform bill that includes controversial provisions to encourage medical savings accounts and limit malpractice liability. The Senate is scheduled to vote on its version of health insurance reform April 18.
There are generally two schools of thought about what congressional Republicans are up to.
The first, and by far the most straightforward of the two, is that Republicans really want to enact the best, most comprehensive health insurance reform package that is politically feasible.
The second, which borders on a conspiracy theory, is that the Republicans secretly want to kill the bill. As a result, the theory goes, they are adding a number of issues to the bill-like medical savings accounts and medical malpractice reform-that are important to traditional GOP constituencies but are poison to Democrats and are sure to sink the package.
People who support this scenario say the Republicans want to build a record of votes on healthcare reform that they can take back to the voters and party-backers, but they also want a plan that's sure to be vetoed by the White House.
That way, Senate Majority Leader and soon-to-be GOP presidential nominee Bob Dole will be able to say, "Republicans voted for healthcare reform, but President Clinton is against it."
There is ample evidence to support either theory.
Those who think the GOP is on the up-and-up about health insurance reform say Republicans are desperate to avoid the "do-nothing Congress" label Democrats have begun dragging out of their election-year closets.
House Speaker Newt Gingrich (R-Ga.) has said the middle-class uneasiness tapped into by maverick GOP presidential candidate Patrick Buchanan could be alleviated by passing a health insurance portability law that would allow people to keep their health insurance if they change jobs or lose their employer-sponsored health insurance.
Gingrich also has made it clear in comments to the press that he doesn't want to see health insurance reform fail over medical savings accounts.
One other reason to believe the GOP really wants a bill to pass is that provisions like antitrust relief for physicians, which would be a logical addition if GOP leaders were only interested in buying off traditional constituencies, weren't included in the package.
But there is also evidence to support the claims of those who say this all may be a calculated series of political maneuvers designed to kill the plan.
The entire conspiracy theory hinges on the notion that many moderate Republicans, more than 170 House Democrats and President Clinton all have indicated their support for the stripped-down health insurance reform plan offered by Sens. Nancy Kassebaum (R-Kan.) and Edward Kennedy (D-Mass.).
If Republican leaders really wanted to pass a bill, they could do so quickly, the conspiracy theorists say. But the Senate plan was held up for months by conservative Republican senators who used a parliamentary procedure that allowed them to keep the bill from reaching the Senate floor for a vote without divulging their identity.
Furthermore, as political analyst Stuart Rothenberg said recently on CNN, if a health insurance bill passes, "both sides will claim success; the question is who will make it stick."
That's an easy one to answer. The signing ceremony on the White House lawn in the fall, just months before the November election, will look like an outtake from a Cecil B. DeMille movie, with every consumer, insurer and provider group represented. Clinton will take credit by using the same political shrewdness that allowed him to pin the blame for the government shutdown on the GOP. Dole, who has trouble generating political intensity, will be left to say, "But we did all the hard work."
Provider representatives and the lobbyist community seem split about 50-50 on the issue.
Said one Republican lobbyist who thinks the plan has no chance of passage, "If you want to pass a bill, this is a stupid way to do it; and (Republican leaders) may be a lot of things, but stupid isn't one of them."
One thing that concerns nearly every group involved with health insurance reform is the awkward position they've been put in by the uncertainty over the congressional agenda. While most are on record in support of a "clean" version of the Kassebaum-Kennedy plan, they are being pressed by House Republicans to support provisions like malpractice reform.
At a hearing of the House Commerce Committee, a representative of the National Association of Manufacturers said he supported the Kassebaum-Kennedy plan because it stood a better chance of becoming law than the more controversial House plan.
But after a barrage of questions from Republican representatives who questioned why the group didn't support provisions like malpractice reform, NAM sent a letter to Republican leaders supporting the House plan.
Other groups also have been put in the same predicament.
"It's pretty hard to say we don't want malpractice reform this time around when (congressional Republicans) stuck their neck out for us and passed it earlier this year," said one provider lobbyist.