Chances are growing that a health care reform bill, once the Demo- crats' top legislative priority, may not make it to the House floor this year. The Democratic leadership has already retreated quite a long way on the issue, dropping a "play or pay" requirement that businesses either provide medical insurance for employees or pay a special tax to cover the uninsured. But despite his exertions, House Majority Leader Richard A. Gephardt (D-Mo.) has been unable to craft a compromise that's assured of the 218 votes needed for passage. Liberals want more radical reform. And Democratic conservatives, who prefer to use the tax code to push employers to use managed-care health plans, object to the bill's stringent price controls.

Unless a solid consensus emerges, Gephardt is unwilling to send a measure to the floor. Failure of the leadership bill would be embarrassing enough, but there's a bigger danger lurking: President Bush and House Republicans are pushing an alternative that would reform the malpractice system and make it easier for small companies to buy medical insurance. This version might just pass. And, warns Representative Ron Wyden (D-Ore.), "if that happens, then Bush has taken away our best issue."

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