Just as the
myth about Hillary's invovlement in SCHIP has been debunked, when in actuality Hillary's involvement was to pressure Bill Cliton not to veto it, the facts about the 1993-94 healthcare plan debacle surfaces. It puts Bill Clinton at the helm, first being extremely rigid, excluding Congress, and then peeling away at the plan at the last minute to appease conservative Democrats and Republicans:
Did Hillary doom health reform in 1993? It's time to get the facts straight about the Clinton plan and why compromise failed. Here's the real story, from the Prospect co-editor who was a White House senior health policy advisor at the time. Paul Starr | September 14, 2007
Five days after his inauguration in 1993, Bill Clinton named his wife to chair a newly established President's Task Force on National Health Care Reform. From that moment, the public had the impression that Hillary Clinton and the task force under her direction were responsible for coming up with the administration's reform plan. And when that plan went down to defeat, many people assigned her a large share of the blame.
Now that Hillary Clinton is a candidate for president, the health-reform debacle is again receiving attention, this time as a basis for judging what kind of a president she might be in her own right. The trouble with such judgments, however, is that they are usually rooted in a series of misunderstandings about the Clinton health plan, Hillary's role in the reform effort, and the reasons for its failure. The mythology of "Hillarycare," as the Republicans like to call it, is only partly the result of right-wing misrepresentations of the plan as a "government takeover" and malicious personal attacks on Hillary. The press never got the story right in the first place, and recent biographies and articles about Sen. Clinton have added to the misconceptions.
By the time Hillary became involved in health-care reform in late January 1993, Bill Clinton's thinking about the problem was already well advanced. The previous September during his campaign, he had settled on the basic model for reform -- a plan for universal coverage based on consumer choice among competing private health plans, operating under a cap on total spending (an approach known, in the shorthand of health policy, as "managed competition within a budget"). Though the media scarcely registered it at the time, Clinton had described this approach in a speech and referred to it in the presidential debates. Moreover, he saw health-care reform through the prism of economic policy, believed that reducing the long-term growth in health costs was a national imperative, and insisted that even while making coverage universal, health-care reform had to bring down future costs below current projections for both the government and the private economy. Among Clinton's close advisors, Ira Magaziner championed the view that these aims were achievable. When he became the director of the health-reform effort and Hillary the chair, their job was not to choose a policy, but to develop the one that the president had already adopted.
Despite all the attention it received, however, the President's Task Force -- consisting of members of the cabinet and several other senior officials -- proved to be useless for reaching decisions and drafting the plan. It immediately became the subject of litigation and dissolved at the end of May without making any recommendations. Bill Clinton actually never gave up control of the policy-making process, and the work fell to a small team of advisors and analysts that Magaziner directed. Beginning in March and continuing in a stop-and-go fashion until September, the decision meetings about the plan took place outside the formal structure of the task force, usually in the Roosevelt Room of the White House, and the president ran the meetings himself.
My knowledge of this process is first-hand. Magaziner first brought me into the internal discussions of health policy during the 1992 campaign after reading the manuscript of a book I had written, The Logic of Health Care Reform (Grand Rounds Press, 1992), which developed the idea of managed competition within a budget. As a senior White House health-policy advisor working under Magaziner, I took part in the decision meetings and presented some of the issues to the president. The first lady was an active force in these discussions, but there was never any question that the president was in charge. We took our guidance from him. That, of course, was how it should have been (who else but the president ought to make such decisions?), except that many reporters and the public thought that Bill Clinton had handed over the policy to Hillary and that she would report back to him, which was not the case.
Presidents often downplay their own direct involvement in decision making to put some distance between themselves and policies that may eventually prove to be unsuccessful. Part of the job of cabinet members and advisors is to take the blame when things go wrong. Clinton's appointment of his wife to chair the task force did not, however, create the necessary distance and deniability. Not only did the fiction of Hillary's personal responsibility for the health plan fail to protect the president at the time, it has also now come back to haunt her in her own quest for the presidency. According to recurrent accounts -- most recently in Carl Bernstein's shoddily researched biography A Woman in Charge -- it was supposedly Hillary's secretiveness and rigidity that led to fatal decisions about the White House health plan and political strategy. Careful reporting after the failure of the health plan showed these charges were false, but Bernstein and other writers continue to recycle them. Misunderstanding the politics behind the plan, they give a distorted account of why it was defeated. The health-reform debacle was critical in framing Hillary's public image, and despite her years of accomplishment in her own right, she still carries the burdens of that failure. It is time to get the facts right and clear the air for the discussion of health-care reform in what may be another Clinton administration.
<...>
During the 1992 campaign, Clinton had not given health-care reform top billing -- his primary issue was the economy, and he probably talked more about welfare reform than about health care. But higher deficit forecasts that fall led him to change his priorities soon after the election. Abandoning his promise of a middle-class tax cut and retrenching on other measures, Clinton opted for deficit reduction in the hope that it would lead to lower interest rates and higher economic growth. The deficit forecasts also highlighted how critical it was to control the cost of health care. If health costs kept gobbling up revenue, they would make long-term deficit reduction impossible and sharply circumscribe what the new administration could accomplish in other areas. Comprehensive health-care reform therefore held more than one attraction. If reform contained health costs, it would contribute to the success of Clinton's economic program. And at a time when he was downgrading other progressive commitments, a high-profile commitment to universal health insurance would bolster his popular support, particularly among Democrats. At one of the Roosevelt Room meetings on the health plan, Clinton remarked that in 1936 the Depression had not ended, but Franklin D. Roosevelt had won reelection because he had passed Social Security and other measures. Perhaps health security could do the same for Clinton in 1996 even if his economic program did not bring results by then. Both health-care reform and the economic programs were gambles, he suggested, but he was comfortable with the odds on both of them, and he could win if either one paid off.
<...>
The overall direction of policy was not Hillary's choice. She had not been present at the key meetings during the campaign when Clinton had discussed health policy with his advisors, and in the first days in the White House, she was just familiarizing herself with the approach to reform that her husband had adopted. In a meeting with me in her office during the administration's second week, she spoke of "my husband's plan" and thanked me for an article of mine, which she said was helpful in explaining the approach. Whether she fully agreed with that approach, I wasn't sure. But if she had her reservations, she put them aside and, believing strongly in the aims of reform, worked hard to achieve them. The model for reform, after all, only defined its broad outlines; literally hundreds of important questions about the policy still had to be resolved in turning it into legislation.
But the troubles of the President's Task Force began immediately. Before making the announcement, the White House had not thought to check with legal counsel about the implications of formally designating a "task force," and soon it was facing lawsuits challenging the first lady's role and demanding that the meetings be public. Under the task force, Magaziner organized some 30 "working groups" concerned with such issues as the design of the purchasing alliances and with the analysis of the plan from different angles, including costs and ethics. (I helped set up these groups and was responsible for running a "cluster" of three of them.) The membership of the working groups quickly rose to more than 500 -- mostly federal employees, many of them added at the request of their departments, as well as some independent experts, congressional staff (Democrats only), and state health-care officials (Republican as well as Democrat). Their meetings were intense but short-lived -- they dispersed early in the spring, before the plan was written. We also conducted hundreds of meetings with representatives of different organizations that wanted to communicate their views to the White House.
<...>
So why not compromise? In fact, the Clinton health plan began with a compromise, and the expectation in the White House was that it could be passed only with more compromises. When he made managed competition part of his plan in the fall of 1992, Clinton was moving toward the center right and laying the basis for a future deal with the conservative Democrats and moderate Republicans who also backed managed-competition proposals. Between January and October 1993, however, other political considerations led Clinton to tack left. Rejecting the view of his economic advisors who favored a bare-bones benefit package, he opted for broad coverage, and he also decided to include a new Medicare prescription drug benefit for the elderly, which he had promised during his campaign. The bigger the program, the tighter the cost controls would also have to be.
<...>
This strategy did not reflect an unthinking, blind rigidity on the part of the Clintons. It just didn't work -- in fact, it failed disastrously. When the debate began, it was reasonable to expect a negotiated deal in Congress; Republicans had introduced their own proposals for health-care reform, and a group around Sen. John Chafee of Rhode Island seemed amenable to compromise. But the whole political climate became toxic; Clinton could not get a single Republican vote for his 1993 budget, and Whitewater broke at the beginning of 1994. All the elements of the conservative coalition, from the anti-taxers to the social conservatives, mobilized against the Clinton health plan and against the Clintons personally, while liberals were ambivalent and Democrats in Congress were divided. Newt Gingrich, Grover Norquist, Bill Kristol, and other figures in the conservative movement saw health reform as an ideological threat because if it succeeded, it might renew New Deal beliefs in the efficacy of government, whereas a defeat of the health plan could set liberalism back for years. Tom DeLay pressed business organizations such as the U.S. Chambers of Commerce, which had been edging toward a deal, to reverse course. Soon Republicans were backpedaling from their own health-reform proposals. The Republican Senate minority leader, Bob Dole, withdrew his first bill and substituted a more limited one and then withdrew that one, too. It was not just the Clinton plan that was stymied; every effort in Congress to find a compromise failed. While George Mitchell, the Senate majority leader, was drawing up a compromise plan in the summer of 1994, Kristol wrote a memo to Republicans advising, "Sight unseen reject it." Near the end, Sen. Bob Packwood told his Republican colleagues that after killing health-care reform, they had to make sure their fingerprints weren't on the corpse. As I wrote in my postmortem in these pages, "The Republicans enjoyed a double triumph, killing reform and then watching jurors find the president guilty. It was the political equivalent of the perfect crime."
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Like Green's article, Carl Bernstein's biography argues that Hillary doomed the health plan because of her secretiveness and rigidity. Bernstein, who can't get the basic facts right, supposes that Hillary was entirely in control. He writes that "by the time Hillary had begun consulting with experts, she already knew where she wanted to go" (as if her husband had not earlier made that decision); that the plan would have replaced Medicare; and that Hillary's "message was unambiguous: she did not want negotiations that would end in compromise" and she "rejected
attempts at getting her to compromise." In fact, Bill Clinton made the very decisions about the health plan that Bernstein attributes to Hillary. He chose to submit an ambitious program to Congress rather than a more limited one, hoping to make compromises later. There were repeated approaches to the Republicans, but as Hillary told Fallows, "Every time we moved toward them, they would move away." As time was running out, in September 1994, Hillary did have her reservations when the president gave his approval to Sen. John Breaux of Louisiana to make one concession after another to get Republican support, but it turned out she was right. The Republicans were the ones who for political reasons did not want negotiations to end in compromise. And that gamble paid off for them in the 1994 elections.
more Paul Starr (born May 12, 1949) is a Pulitzer Prize-winning professor of sociology and public affairs at Princeton University. He is also the co-editor (with Robert Kuttner) and co-founder (with Robert Kuttner and Robert Reich) of The American Prospect, a notable liberal magazine which was created in 1990. In 1994 he founded the Electronic Policy Network, or Moving Ideas, which is an online public policy resource.
At Princeton University, Starr holds the Stuart Chair in Communications and Public Affairs at the Woodrow Wilson School. The Social Transformation of American Medicine won the 1984 Pulitzer Prize for General Non-Fiction as well as the Bancroft Prize. His recent book The Creation of the Media received the 2005 Goldsmith Book Prize.
In 1993, Starr was the senior advisor for President Bill Clinton's proposed health care reform plan. He is also the president of the Sandra Starr Foundation.
Starr holds a B.A. from Columbia University and a Ph.D. from Harvard University. He lives in Princeton, New Jersey and is married to Ann Baynes Coiro. He has four children and three step-children.
Today, Krugman cherry picks details to provide another distortion on behalf of Hillary:
I think Paul Krugman simply has this completely wrong. Paul writes:
Paul Krugman:
Bad health care omens: This is disturbing:
Mike Lux, a veteran of the Clinton health care wars, pointed out today that Obama is using as a surrogate on health care Bush Dog Democrat Jim Cooper. Cooper spent a good amount of time in 1993-1994 working to undermine Clinton's health care plan by offering more insurance friendly proposals with former Senator and current lobbyist John Breaux.
This fits in with my sense, based on everything we've seen in this campaign, that Obama just isn't all that committed to health care reform. If he does make it to the White House, I hope he proves me wrong. But as I've written before, from my perspective it looks as if a dream is dying.
What Mike Lux, "veteran of the Clinton health care wars," knows--but is very careful not to tell you--is that in 1993-1994 health care reform needed 60 votes in the Senate in order to defeat a Dole-led filibuster, and that Sen. John Breaux (D-LA) was vote 55. "undermin(ing) Clinton's health care plan by... (working) with former Senator and current lobbyist John Breaux" translates as "working on bills that might actually pass the senate."
Mike Lux knows this. He just hopes that his readers don't.
James Bradford DeLong (b. June 24, 1960, Boston) is a professor of economics at the University of California, Berkeley and a former Deputy Assistant Secretary of the United States Department of the Treasury in the Clinton Administration. He is also a research associate of the National Bureau of Economic Research, and is a visiting scholar at the Federal Reserve Bank of San Francisco.<1>
DeLong is co-editor of The Economists' Voice,<2> and has in the past been co-editor of the widely read Journal of Economic Perspectives. He is also the author of a textbook, Macroeconomics, the second edition of which he coauthored with Martha Olney. He writes a monthly syndicated op-ed column for Project Syndicate.
As an official in the Treasury Department in the Clinton administration, he worked on the 1993 budget, on the Uruguay Round of the General Agreement on Tariffs and Trade, on the North American Free Trade Agreement, on the unsuccessful health care reform effort, and on other policies.
He writes a weblog, Brad DeLong's Semi-Daily Journal, which covers political, technical, and economic issues as well as criticism of their coverage in the media; he also contributes to Shrillblog and maintains a political commentary site, Egregious Moderation.
Here is another key peice of information, John Breaux's involvement with Hillary's current campaign:
By Eric Kleefeld - February 8, 2008, 5:22PM
Former Sen. John Breaux (D-LA) stars in a new radio spot for Hillary Clinton in the state he represented, promoting her record on securing health care for children and National Guardsmen. "So when Hillary Clinton says she'll get health care for every American, I know she'll do it," Breaux says. "And boy, do we need it."
(
Video)
There is one wrinkle with Breaux's presence in the ad, and his talk about health care: Breaux became a lobbyist since leaving the Senate three years ago, first with Patton-Boggs and now his new firm with Trent Lott. Among Breaux's clients, according to media reports as recent as December 2007, is none other than Wal-Mart.
Besides the intended effect of motivating voters who remember Breaux favorably, the presence of a lobbyist for Wal-Mart in a Hillary spot is a potentially sensitive situation, since Wal-Mart is seen as a symbol of corporate greed and unfair labor practices by many Democratic activists.
The Hillary camp has pointed out that Hillary
has shown sustained and aggressive support for organized labor in general and for the rights of Wal-Mart workers to organize in particular. They also argue she tried to change Wal-Mart's policies when she served on the board of directors.
Yeah, a former Senator who lead the triangulating effort, who is now a current lobbyist for Wal-Mart is one of Hillary's spokespersons on health care.
edited sentence out of place
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