Obama Health Care Reform Strategy Sidesteps Clinton’s Missteps

The number of mistakes made by the Clinton Administration in pushing for health care reform in 1993 are embarrassingly numerous.  One of the most damning was their heavy handed approach with Congress. Instead of engaging with lawmakers from the beginning, the task force led by then First Lady Hillary Clinton worked behind closed doors. Democratic Congressional Members were pushed out of the loop and expected, I assume, to fall in line with their Democratic President because, well, he was their Democratic President. Oh, and of course because the health care reform package developed by the task force was so obviously wonderful.

Leaving aside the lack of wonderfulness in the plan they developed, this approach was nothing short of political malpractice. The president may propose, but it’s Congress that enacts legislation. Any effort to dramatically change something as expensive and personal as health care will generate opposition. Some of that opposition is based on sincere differences of opinion concerning public policy. Some emerges from economic or political agendas threatened by the changes. In either event, it’s important to have a strong base with a unified message to withstand the inevitable attacks. The Clinton Administration’s approach — imposing their viewpoint on Congress — meant they had few supporters when and where they needed them most. The result was a political rout that helped open the way to a Republican takeover of Congress in 1994.

Whether based on temperament or wisdom earned at the Clinton presidency’s expense, President Barack Obama and his team are approaching health care reform in a far different manner. Their outreach to Congress has been extraordinary. They are not only working with Congressional leaders to design the plan, but are helping to create a unified message as well.

The Associated Press reported on a meeting today between several Democratic Senators and White House political advisor David Axelrod. Their goal, according to Senator Dick Durbin, was to “coordinate our messaging so we present a health care reform effort that the American people trust.”

The meeting was, in part, a response to advice circulated among Republicans by Dr. Frank Luntz outlining ways to attack the Democratic proposal. Dr. Luntz is a highly regarded GOP consultant and an expert on political messaging, the author of Words That Work: It’s Not What You Say, It’s What People Hear. He urged Republicans to be “on the side of reform.” while attacking the Administration’s proposal as leading “to the government setting standards of care, instead of doctors” and “to the government rationing care.”

The 26-page report has caused quite a stir on Capital Hill. Democrats in Congress wanted to make sure they were prepared to withstand the suggested assault. The meeting today with Senators and with House Leaders yesterday were designed to do just that. It was reinforced by a message to the grass roots following President Obama developed during the campaign that now operates as Organizing for America.

What was agreed to was a three-pronged message: medical costs must be lowered, people must have choice in their health care coverage, and care must be affordable for everyone. How these principles are put into action has yet to be determined. No legislation has yet emerged from the numerous Congressional hearings underway.

It’s the lack of explicit information that makes framing the reform effort so important. Until there’s actual legislation to read, all the public has to go on is the general policy positions pronounced by various parties. Eventually, we’ll see a bill, but how the public reacts to it will be influenced to some degree by the spinning that occurs before its release.

By involving Democrats in Congress early in the process of developing the legislative language and working with them to shape a unified message, the Obama Administration is sidestepping one of the most damaging missteps of the Clinton Administration. Ultimately what will matter is the legislation itself. But the mere fact that President Obama and his team are avoiding the mistakes made 16 years ago, is an indication of how different the battle will be this time.

News Channels Fail to Explain Clinton Health Care Plan Failure

With President Barack Obama launching his health care reform initiative last week with a White House summit, the news programs have, not surprisingly, been recalling the last major push for change. For those who missed it, that was in 1993 and 1994. Then President Bill Clinton, who, like President Obama, had campaigned with a pledge to change America’s health system, assigned then First Lady Hillary Clinton to spearhead his Administration’s effort to provide affordable health care for all.

In recalling this recent history the news channels make it sound like the only reason the Clinton effort failed was the opposition of special interests. But for the insurance industry’s Harry and Louise ads, some greedy doctors and uncooperative Republicans, the Clinton Administration’s reforms would have breezed through Congress ushering in a golden era of health care. This is far from what happened.

Yes, special interests campaigned hard against the Clinton reforms, but they had a lot to work with. As I’ve written before, the Clinton effort failed in part because it was fashioned behind closed doors and in part because it wasn’t a very good proposal.  The task force that helped the First Lady draft the proposal excluded input from many in Congress and shunned many stakeholders. So when it emerged from the inner sanctum it  lacked broad buy-in. The take-it-or-leave-it attitude of many in the task force didn’t help matters.

What they proposed was both complex and elegant. They sought to enact “managed competition.”  This approach would have forced most Americans to drop their existing coverage and instead obtain insurance from government run “purchasing pools.” The carriers offering coverage through the pools would offer only plans designed by the managing government agency and would be expected to use their clout to negotiate deep discounts from health care providers. There was a lot more to it — a lot more — but those were two of the key provisions.

It wasn’t just special interests (which the news channels identify as insurance companies, the business community and some doctors) who thought it was a bad idea poorly executed. So did many Democrats in Congress and liberal think tanks. The Clinton health care reforms were attacked and even ridiculed by, well, most everyone who wasn’t on  the task force. It’s not that these critics didn’t recognize the need for reform. They just believed the Clinton package was bad reform. 

Any proposal seeking massive changes to a system as complex as America’s health care system is going to be controversial. It is also highly likely to be seriously flawed. The purpose of the legislative process is to allow interest groups (special and otherwise) to debate the plan’s details, to identify the flaws, and to the extent possible, fix them.

Given the numerous flaws in the Clinton Administration’s plan and the take-it-or-leave-it attitude of its proponents, Congress decided to leave it. Did special interests play a role? Certainly. (Full disclosure: I testified on behalf of health insurance agents against the Clinton plan  at three Congressional committees hearings in 1993). But to credit its defeat solely to those interests is to overstate their strength and to absolve the authors of too much guilt. They were the ones, after all, who put forward a poorly designed package with a striking lack of political skill. A better plan more ably presented might have passed in 1993. We never got the chance to find out.  

In oversimplifying history, reducing what happened to a tag team bout between Bill and Hillary on one side and Harry and Louise on the other, the news channels are doing the country a disservice. Yes, special interests from across the political spectrum will protect their special interests (that’s why they’re called special interests). But the Obama Administration’s health care reforms will stand or fall on their merits, just as the Clinton Administration’s did.

That’s the way it should be. And that’s the way it should be reported.