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What went wrong with the Clinton plan?
Health care non-reform the last time

September 28, 2007 | Pages 8 and 9

HILLARY CLINTON is getting praise for having made a more "realistic" health care proposal as a presidential contender than when she led Bill Clinton's task force on health care reform. She doesn't deserve it. ELIZABETH SCHULTE reveals the truth about the Clintons' health care debacle.

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WHEN HILLARY Clinton unveiled her new health care proposal, it got an immediate response from Republicans. "It's a European-style socialized medicine plan," complained presidential contender Mitt Romney, "that's where it leads--and that's the wrong direction for America."

Did he say Europe? Romney should have said Massachusetts, his home state, since Clinton's plan resembles in many ways the one he signed into law when he was governor--which requires individuals who aren't covered by an employer's health care plan and who aren't poor enough to be eligible for public assistance to spend their own money on coverage from a private insurance.

Hardly what you'd call "socialized medicine."

But by and large, the line in Washington and in the media was that Hillary Clinton had "learned her lesson" from her last attempt to reform the health care system during the presidency of her husband 14 years ago. "We tried to do too much too fast," Clinton told a 2006 conference of the Federation of American Hospitals. "I still have the scars to show for it."

What else to read

Washington Babylon by Alexander Cockburn and Ken Silverstein documents the sleaze of the Washington political system, naming names and exposing the scandals of the Clinton era.

Lance Selfa's "Eight Years of Clinton-Gore: The Price of Lesser Evilism" in the International Socialist Review goes through the health care reform disaster and the administration's other broken promises. For a more general socialist analysis of the Democrats, you can download an ISO Web book by Selfa, The Democratic Party and the Politics of Lesser Evilism.

Read the CounterPunch Web site, edited by Cockburn and Jeffrey St. Clair, for all the current dirt on Hillary Clinton and the other 2008 presidential contenders.


So Clinton won't fool around with socialist health care plans that cover every person--like the one Michael Moore proposes in his movie Sicko. This time around, the argument goes, Clinton is going to be "realistic."

But if you look at the actual history of the Clinton administration's health care reform proposal, you'll see just how "realistic" Hillary Clinton was all along.

Despite widespread public excitement about the possibility of a health care plan that would cover everyone in the U.S., the Clinton administration's health care debacle was a series of half-measures and compromises that fizzled away and died.

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EXPECTATIONS WERE high among workers in the run-up to the 1992 election of Bill Clinton. After eight years of George Bush Sr., and more than a decade of take-from-the poor-and-give-to-the-rich Reaganomics, it looked like the tables would finally be turned on what was known as Corporate America's "decade of greed."

Along with other promises like a bill banning employers from permanently replacing strikers, Bill Clinton took over the White House vowing that every person would gain access to health care. At the time, some 37 million people were without health insurance.

Clinton set up a "Task Force on National Health Care Reform" and put Hillary Clinton at the helm.

One common myth about the Clinton plan--in fact, one that Moore's Sicko repeats--was that the administration came up with an otherwise excellent proposal, but big business blocked it from being enacted. The reality is that the Clintons never intended to propose anything that would cut into Corporate America's profits--even if that meant killing the goal of universal health care.

Hillary Clinton's health care task force put on a show of meeting with activists like Dr. Quentin Young of Physicians for a National Health Program (PNHP) and others in early 1993, but the administration had no intention of considering proposals for a Canadian-style single-payer plan covering all Americans.

Dr. David Himmelstein, a colleague of Young in PNHP and supporter of a single-payer system, gave an account of a meeting with Hillary Clinton that appeared in a September 1993 Washington Monthly article.

"Himmelstein's studies, published in The New England Journal of Medicine since 1986, show that the U.S. could save as much as $67 billion in administrative costs alone by cutting out the 1,500 private insurers and going to a single government insurer in each state--easily enough to pay to cover every uninsured American," read the article.

"Hillary Clinton had heard it all before. How, she asked Himmelstein, do you defeat the multibillion-dollar insurance industry? 'With presidential leadership and polls showing that 70 percent of Americans favor [the features of] a single-payer system,' Himmelstein recalls telling Mrs. Clinton.

"The First Lady replied: 'Tell me something interesting, David.'"

Single-payer didn't stand a chance. Instead, the Clinton administration focused on a corporate-friendly "universal" health care plan.

This nevertheless raised the hopes of millions of uninsured workers. "With this card, if you lose your job or you switch jobs, you're covered," said Bill Clinton, speaking before Congress in September 1993. "If you're an early retiree, you're covered. If someone in your family has, unfortunately, had an illness that qualifies as a pre-existing condition, you're still covered...And if an insurance company tries to drop you for any reason, you will still be covered, because that will be illegal."

He promised that preventative care would be covered as well as substance abuse and mental health treatment. The plan, he said, would rival Social Security in its groundbreaking improvements in workers' lives.

But running through the administration's argument for health care reform was the concept of "shared responsibility" between employers and employees--that no one was getting a "free ride." Clinton's speeches on the subject stressed the importance of bipartisanship and compromise.

By the time the administration's proposed "Health Security Act" reached Congress on November 20, 1993, it was a watered-down proposal centered on private health maintenance organizations (HMOs)--based in part on input from the Health Insurance Association of America (HIAA).

The HIAA would later run its infamous "Harry and Louise" TV ads decrying the Clinton plan as "big government." "This plan forces us to buy our insurance through new mandatory government health alliances," complained Louise. "Run by tens of thousands of bureaucrats," said Harry. "Having choices we don't like is no choice at all," replied Louise. "They choose, we lose," they said.

Ultimately, insurance companies, large and small, decided that the series of concessions made by the Clintons in formulating their plan weren't enough.

During 1993 and 1994, 660 lobbyist groups spent more than $100 million to stop health care reform. According to a report from the Center for Public Integrity, organizations with health care interests funneled $25 million to members of Congress. About a third of that went to members sitting on one of five committees overseeing health care.

It was money well spent. Several health care proposals made their way to Congress over the coming months, each more watered down than the one before it..

By the time a bill introduced by Senate Majority Leader George Mitchell (D-Maine) came to the floor in August 1994, it was of little consequence--abandoning any requirement that employers provide health insurance for workers for at least another 10 years at least. Establishing universal coverage would be put off for nearly as long. Still, it failed.

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HEALTH CARE reform wasn't killed by big business. It was allowed to waste away--and the Clintons sat by and let it happen. As a result, the ranks of the uninsured grew at least by 3 million people during Bill Clinton's presidency.

The Clinton health care reform disaster showed that furthering corporate interests and backroom deals aren't flaws or exceptions--they're part and parcel of the Washington political system.

So, for instance, members of Congress regularly move on to roles as corporate lobbyists, and visa versa. "William Gradison was member of Congress on Sunday, and a head of HIAA--producer of the infamous Harry and Louise ads--on Monday," wrote Alexander Cockburn and Ken Silverstein in their book Washington Babylon.

Corporate interests, not the "will of the people," come first in Washington. For this reason, real health care reform didn't stand a chance under Clinton without a movement to back it up.

A Gallup poll in late 1994 showed that 72 percent of the public considered major health care reform a high priority. But that sentiment was never expressed in any organized form. Unfortunately, instead of mobilizing pressure, labor unions and liberal organizations gave the Clinton administration the space it said it needed to negotiate.

Today, some liberal commentators blame the Clinton health care debacle--caused, they say, by "going too far, too fast"--for Newt Gingrich and the Republicans taking over both the House and Senate in the 1994 congressional election, dubbed the "Republican revolution."

But it was in large part the rightward shift of Clinton and his fellow Democrats that paved the way for the Gingrichites to triumph. The vote in favor of the GOP in 1994 was less an embrace of the Republican Right and its agenda than it was a rejection of the Democrats and their trail of broken promises.

From this point, the Clinton era ushered in unprecedented attacks on workers and poor--on issues of crime and immigration, as well as welfare spending. These attacks paved the way for further assaults down the road.

If the Clinton administration is mistakenly remembered today for confronting the health care bosses, the industry knows better. Hillary Clinton's Senate campaign war chests have brimmed with health care money. She was ranked the number-two recipient of donations from the industry, trailing only former Sen. Rick Santorum (R-Pa.), according to the Center for Responsive Politics' analysis of 2005-6 campaign finance.

Today, while the U.S. spends more on health care than any other Western country, and 47 million people still live without health insurance, we should be drawing very different lessons from the Clinton years.

"Hillary Clinton did learn a lesson from her 1994 fiasco on health care reform," Rose Ann DeMoro, executive director of the California Nurses Association/National Nurses Organizing Committee, wrote this month. "Unfortunately for most of us who don't have an Inc. after our name or a private jet to cart us around, it was the wrong lesson...

"She might have decided to cut them out of the business of profiting off pain, suffering and medical debt, and proposed a very different solution, such as expanding Medicare, Medicaid, or the State Children's Health Program to cover everyone.

"Accommodating the insurance behemoths, and effectively offering them massive public subsidies--using the considerable power of government to force everyone to become paying customers of the private insurers--is not the kind of leadership on health care we need."

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