That was then. This is now.
Then was when, as first lady, Hillary Clinton led the charge for health care reform. Her proposal was so unwieldy, politically naive and arrogantly promoted that it helped Republicans take over control of Congress for the first time in over 40 years and set back the cause of health care reform by over a decade.
Now is when, as presidential candidate, Senator Hillary Clinton needs to put that history behind her and talk to the future. Which is what she did in Iowa today, unveiling the 2007 version of her health care reform plan.
Her approach this time is to be less original, less ambitious and less arrogant. Instead her new plan shares much in common with several other proposals making the rounds — including those of her rivals for the Democratic presidential nomination. This isn’t a bad thing; quite the contrary. It not only lends her plan credibility, but it provides political cover when it comes under attack.
So, for example, she shares with Governor Bill Richardson the concept that if people are satisfied with their existing coverage, they can keep it. She borrows from both Governor Richardson and Senator Barack Obama the idea of using refundable tax credits to help lower income Americans pay for their coverage. And, like Governor Richardson and former-Senator John Edwards she incorporates the idea of a requirement that all Americans obtain health care coverage and expanding MediCare eligibility.
Like many health care reform proposals — at least Democratic reform proposals — Senator Clinton would require insurers to accept all applicants without regard to their risk profile. As previously noted, she wisely balances this with a requirement that all Americans obtain coverage. What’s unclear is how she would enforce this requirement. Poor compliance by consumers would lead to the burden Senator Clinton’s state of New York bears: average insurance premiums roughly 350 percent higher than those in California.
Senator Clinton makes a major point out of avoiding the creation of new bureaucracies (another approach she shares with Governor Richardson). However, there’s something a bit disingenuous about this claim. True, instead of creating a new government health care program she would open up the Federal Employee Health Benefit Program to all Americans. However, the expansion required of the FEHBP to manage such growth would be the actuarial equivalent of creating a new bureaucracy. But with the added downside of probably disrupting the agency’s current mission.
As with all the health care reform plans put forward by presidential candidates, Senator Clinton’s proposal is more a window into her thinking than a blue print for reform. The new president will need to work with Congress to fashion a detailed reform structure. There will be plenty of debate and shaping of ideas in that process. The outcome may resemble what’s being described today, but then again, it may not.
Yet this glimpse into the approach of Senator Clinton is illuminating. By avoiding a single payer approach she demonstrates her willingness to take on the most liberal elements of her party. By imposing requirements on both corporations and individual she invites attacks from conservatives concerning a heavy-handed government approach to health care. In short, given the context of the health care reform debate as it exists today, Senator Clinton’s package is somewhere in the middle (ok, maybe a bit left of the middle, but close enough for government work). This positioning might be expected in the general election, but its a risky move in the primaries. However, it also demonstrates that Senator Clinton learned something then and she’s applying those lessons now.