Most of the major healthcare initiatives in President Clinton's fiscal 1999 budget plan have two things in common.
"They all have strong public support, and none causes fiscal problems for the government," said Ron Pollack, executive director of the consumer group Families USA.
There's a sticking point, however: They are opposed by GOP leaders. Normally, that would mean they were "dead on arrival," the capital's parlance for budget proposals from presidents without a congressional majority. And that would be especially true in an election year, when partisanship is normally at a fever pitch.
But one of Clinton's many political skills is his ability to find populist issues that put the Republican leadership back on its collective heels. "This is not a coincidence; it is done by design," said Frederick Graefe, a lawyer with Baker & Hostetler in Washington, of the president's gambit.
The most ambitious of the proposals -- to allow early retirees and persons who lose their health benefits after age 55 to buy into Medicare -- is a prime example of the strategy.
Administration officials say the program would pay for itself, but they also say any unforeseen additional costs would be paid for by savings from increased healthcare anti-fraud efforts.
The staunchest supporters of the early buy-in plan are liberal Democrats in Congress, organized labor and consumer organizations.
They point to statistics showing that people between 55 and 65 are losing insurance at the fastest rate of any age group.
Opponents say the only people who will choose the buy-in will be those too sick to remain in the work force. That adverse selection, the critics argue, will further drain the Medicare Part A trust fund.
The groups that support the early buy-in also are supportive of another major White House initiative, a patients' bill of rights. While that proposal will be introduced separately by congressional Democrats, there is funding in the budget to implement the changes called for in the bill of rights.
Among other things, the bill would expand patients' ability to appeal a managed-care plan's coverage decision. It would also prohibit physician "gag clauses" and allow easier access to specialists.
While similar bills in the House and Senate have strong support among rank-and-file Republicans, party leaders oppose the measure as government micromanagement of healthcare that will lead to increased costs to business.
Politically, the president's proposals have the Republican leadership boxed in. They oppose the popular measures, but they can't afford to be seen as thwarting public will in an election year.
Sen. Pete Domenici (R-N.M.), chairman of the Senate Budget Committee, acknowledged the Republicans' predicament when he said, "The president has presented a very, very good election-year budget."