WASHINGTON
DO-OVER Hillary Clinton failed to sell her health care plan in 1993, but will try again Monday.
Rarely does a politician, a party or a political system get a chance at a do-over.
Yet when Senator Hillary Rodham Clinton rolls out her comprehensive health plan in Iowa on Monday, it will be just that: Mrs. Clinton, or whoever the next president might be, has a second chance to fix a system that has, in many ways, deteriorated in the 14 years since the Clintons’ last attempt at an overhaul.
But will it turn out any differently this time? Can another big national health plan survive the furious lobbying of the interest groups, the divisions between the parties, the ambivalence of the public?
It is, clearly, a moment of political opportunity: Strong majorities of Americans, once again, tell pollsters they want guaranteed health care for all. Some of the most powerful interest groups — representing business, labor, hospitals and insurers — have tried to set aside their differences to call for action.
The number of uninsured is approaching 50 million, the average cost of family coverage has risen 78 percent in the last six years, and more and more employers say they cannot afford to provide health coverage and still compete in a global marketplace.
The major Democratic presidential candidates have offered plans aimed at expanding coverage and lowering costs — Mrs. Clinton’s is only the latest — and the major Republican candidates acknowledge that there are serious problems in the system.
But it is worth remembering: Health care reform seemed inevitable in the early 1990s, too.
It was almost inconceivable, in the spring of 1993, when nearly three-fourths of Americans said they supported the Clinton plan and political consensus seemed easily within reach, that everything would collapse in the end.
The Democrats, and especially Mrs. Clinton, promise that this time will be different. Like Vietnam, the failure of the last health initiative has been endlessly analyzed by those who lived through it, and its proponents say they have learned some lessons. First and foremost: That the last plan was doomed when middle-class Americans came to see it as more risk than benefit — a 1,342-page restructuring of the health care system, creating vast and confusing new bureaucracies, in an effort to extend benefits to everyone.
Those fears were symbolized by Harry and Louise, two nervous 40-somethings created for a devastating advertising campaign by the insurance industry. Between 1993 and 1994, support for the Clinton plan dropped to 43 percent from 71 percent, according to Robert J. Blendon, a Harvard professor and expert on health. The plan literally lost the support of the middle — the middle income, the middle aged, political independents.
In short, altruism has its limits, as does the public’s appetite for trade-offs in their own lives for the sake of the uninsured, said Bill McInturff, a Republican pollster who worked for the insurance industry in 1993 and 1994. “Never, in my years of work, have I found someone who said, ‘I will reduce the quality of the health care I get so that all Americans can get something,’ ” he said. “Every time the debate reaches that point, it collapses.”
This time, candidates are emphasizing the benefits for people who already have insurance — lower costs for coverage, new programs to improve the quality of health care. “Everyone has to feel, at the end of the day, that they will get something,” said one Clinton adviser.
At least by Democratic standards, there is a certain humility to the major universal coverage plans these days, some health policy analysts say. The plans would build on the existing system, as governors in both parties have tried to do in the states — expand public programs for children; shore up the employer-based system; and offer new private and public options for people who cannot get their coverage through work.
And Mrs. Clinton is offering herself as the paradigm of this sadder-but-wiser approach.
For its part, the public may also be sadder but wiser, some analysts say. Most Americans are now in some form of managed care, still a novel concept in the early 1990s. More say they know someone who is going without health insurance, working in jobs that do not provide it. Most people with coverage still say they are personally satisfied with the care they receive but they are worried about the system as a whole.
Some of the romanticism about the virtues of the American health care system may be diminishing, and not just among the audiences who cheered Michael Moore’s “Sicko” this summer. Robert D. Reischauer, president of the Urban Institute and a longtime expert on health policy, noted that recent studies show the United States does not rank at the top on several measures of health care quality, like waiting times to see physicians. “We always had this fallback — that we might cost too much, have a lot of people uninsured, but you bet your bottom dollar that those who have health coverage get the best care in the world,” Mr. Reischauer said. “And the answer is, some here do.”
Many politicians and activists survey this landscape and see extraordinary prospects for major health legislation, if a president were committed to it. In fact, frustration has been simmering on the left over what they see as Mrs. Clinton’s excessive caution in tackling the issue again.
But there are also grounds for skepticism that the stars may have finally aligned, many experts say. Politics itself, at least in Washington, has grown more partisan and ideologically charged in the last 14 years, making it more difficult to pass something as complicated as national health legislation. The debate over renewing and expanding the children’s health insurance program is a case in point, with President Bush and other Republicans assailing a bipartisan plan as a first step toward a government takeover of health care.
The debate over health care on the presidential campaign trail is increasingly ideological, as candidates woo their core constituents on the right and the left. Republicans assail the Democrats for advocating nothing short of socialism on health care. Democrats, for their part, are moving toward an increasingly populist attack on the big economic interests, like the insurance industry. Mrs. Clinton has been escalating those attacks in the run up to her speech.
Mrs. Clinton herself can be an extremely polarizing figure on this issue; while memories have faded, Mr. Blendon said, “there’s no question that if she’s the presidential nominee, they’ll bring out the old films and the tapes and the details.”
Paying for universal coverage is always an issue, especially in a budget strained by war, a growth in entitlement spending and a nagging deficit. Moreover, all the talk of common ground and a new consensus for change among the so-called stakeholders — business, the health insurers, doctors, hospitals, unions — can quickly fade.
Universal coverage, after all, has been a dream of the Democratic Party’s since the New Deal — but always just over the horizon.
2 comments:
I chose this article because it is a subject in which I am somewhat passionate about. I recently got married and lost my health insurance for a couple months until my husbands insurance kicks in at his job. We looked and got quotes from many different insurance companies and some were so outrageous that we had our doubts that we were even going to be able to afford any insurance for the time we were without. Luckily we came across some that was reasonable but still does not cover any doctor visits or anything, it solely cover any major accident or hospitalization, so if an emergency were to occur we are not possibly millions of dollars in debt.
I feel this is ridiculous that two healthy young adults have such a hard time finding health coverage that is affordable. I really think that there is a major flaw in the American system and it is really unfortunate at how many Americans do have to go without proper health care because they can not afford it. That is not something that should be optional but should be something people are able to get without worry.
Good post. But tell me more about the actual argument. What is this article trying to persuade you to think?
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