It may be ancient news, but discussing why the Clinton White House bungled health care reform is certainly not wholly irrelevant considering that Hillary Clinton is the strong favorite to be the next president of the United States. After all, it seems probable that she would have the responsibility for fleshing out the Affordable Care Act and making it a permanent fixture in our politics. But, even without currency, the history is interesting and informative.
At the outset of the Clinton reform effort, the administration did not anticipate that the Republicans would feel compelled to oppose reform as a bloc. The most important document in this history is William Kristol’s December 2, 1993 memorandum. It began this way:
What follows is the first in what will be a series of political strategy memos prepared by The Project for the Republican Future. The topic of this memo is President Clinton’s health care reform proposal, the single most ambitious item on the Administration’s domestic policy agenda.
These four pages are an attempt to describe a common political strategy for Republicans in response to the Clinton health care plan. By examining the president’s own strategy and tactics, this memo suggests how Republicans might reframe the current health care debate, offer a serious alternative, and, in the process, defeat the president’s plan outright.
The most important part of the memo is its political rationale. Defeating the health care bill was considered to be important for winning a larger ideological battle about the role of government and how the two parties were perceived by the public.
Any Republican urge to negotiate a “least bad” compromise with the Democrats, and thereby gain momentary public credit for helping the president “do something” about health care, should also be resisted. Passage of the Clinton health care plan, in any form, would guarantee and likely make permanent an unprecedented federal intrusion into and disruption of the American economy–and the establishment of the largest federal entitlement program since Social Security. Its success would signal a rebirth of centralized welfare-state policy at the very moment we have begun rolling back that idea in other areas. And, not least, it would destroy the present breadth and quality of the American health care system, still the world’s finest. On grounds of national policy alone, the plan should not be amended; it should be erased.
But the Clinton proposal is also a serious political threat to the Republican Party. Republicans must therefore clearly understand the political strategy implicit in the Clinton plan–and then adopt an aggressive and uncompromising counterstrategy designed to delegitimize the proposal and defeat its partisan purpose.
The reforms would have signaled a “rebirth of [the] centralized welfare-state.”
…the long-term political effects of a successful Clinton health care bill will be even worse–much worse. It will relegitimize middle-class dependence for “security” on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.
It goes mostly unstated today, but these are the same reasons that the Republicans have opposed ObamaCare so vociferously. Last August, Senator Ted Cruz argued explicitly that the rollout of the exchanges needed to be prevented or the middle-class would become addicted to the subsidies:
Cruz, who has thrilled his conservative base with his promise to shake up business as usual in Washington, says that once the insurance subsidies kick in at the beginning of 2014, it will be too late to undo the Affordable Care Act.
He said that is precisely President Obama’s goal.
“His strategy is to get as many Americans as possible hooked on the subsidies, addicted to the sugar,” Cruz told a Kingwood Tea Party gathering. “If we get to Jan. 1, this thing is here forever.”
This analysis, whether right or wrong, formed the reasoning behind last fall’s government shutdown. If the Republicans retain control of the House in the upcoming midterm elections and take over the Senate, it’s possible that they might succeed in gutting ObamaCare, but even Ted Cruz is on the record as predicting that it is already too late to roll back the law completely.
In this sense, the ideological war that the Republicans won back in 1993-94 was lost in 2010, and particularly after Obama’s reelection in 2012. Yet, the GOP is still thrashing about, trying to figure out a way to put the genie back in the bottle.
Do the Democrats have any reason to fear nominating someone to defend this victory who so prominently failed on the same battlefield in the early 90’s?
I think the answer is mostly ‘no.’ Twenty years have elapsed, Congress has changed, the Democratic Party has changed, and Hillary Clinton has gained a tremendous amount of experience, as a senator, a presidential candidate, and a high profile cabinet member. In particular, she now understands her opponents much better than she did back in 1993.
But for much of 1993, the White House didn’t see the political realities that would bring the plan crashing down — including the pressures within the Republican Party that eventually created a solid wall of opposition.
She doesn’t have to pass the law, she just has to keep it going. She knows enough now not to think that she can get the Republicans to cooperate in making the law more efficient. If it is to be reformed, it must be on the strength of overwhelming Democratic majorities.
If Hillary can deliver those majorities, and other Democratic candidates cannot, then she will be in the best position to protect and improve Obama’s health care victories.
As Democrats size up the 2016 field of candidates, they will want to assess how well each candidate understands the history of the health care wars, and how big their coattails might be. Hillary has weaknesses that will concern progressive Democrats (including me), but this area should be one of her strengths.
I’m more interested in what the failure of HillaryCare means for 2009-2010.
It means that everyone who keeps asking “Why didn’t the White House do all the work, frame a package, tie it up in a bow and hand it to Harry Reid and his Senate majority and say ‘Pass this! Why did they even let the Senate, never mind Max Bauchs and Ben Nelson, get their hands on it?” is an idiot.
From Sandhurst to West Point to St. Cyr, they teach “Never reinforce failure.”
Twenty years have elapsed, Congress may ahve changed, the Democratic Party may have changed, and Hillary Clinton may have changed — but the internet hasn’t.
In 1993, the internet was mostly email, listservs, and an experimental thing from UICU called Mosaic.
I used mostly Cello, but thanks for the memories…
No part of the opposition was as critical as Daniel Patrick Monyihan, then chair of the Senate Finance Committee. Watching the relationship between the White House and Monyihan is critical to understanding the failure to get passage. Because it is this opposition that caused President Obama to let Max Baucus write the Obamacare bill, which resulted in a WellPoint-written bill–one that advantages large private insurers that operate Blue Cross-Blue Shield franchises or operate on the same business model.
It is less the Republican opposition than the Democratic opposition that is of interest in Hillarycare. And it is the rationale for not seeking a single-payer government program but instead trying to gee-haw the stakeholders that will also be interesting.
If the Republicans flatfooted the Clinton administration in 1993 it is because (1) Clintons were almost totally outside DC at that point and (2) Republicans departed from past practice and began a scorched earth policy that has only intensified over 22 years.
You might see some personal animus in Bill Kristol viciously attacking the President that denied his mentor a second term. And wanting to do to Clinton what he perceived Democrats did to Quayle.
On the other hand, it was only six years ago that Ms. “3 AM Phone Call” ran arguably the most inept frontrunning presidential campaign in living memory, one whose failure hinged largely on the people she surrounded herself with and – wait for it – not understanding her opposition or its strategy.
I was mostly pleasantly surprised by the job she did as SoS, and the Benghazi spectacle ought to have cured her of any remaining delusions she might have about modern Republican sanity. But she’s still got the people problem. And her experience has been touted as a strength before where it turned out…not to be. I don’t think anything about a prospective Clinton presidency is a slam dunk.
Nor do I, and for the same reasons.
Heresy! Al Gore ran the most inept frontrunning presidential campaign in living memory.
Except for John Kerry.
I am calling for your expulsion from the progressive community!
And here I thought it was Mike Dukakis.
Wow that’s a tough choice. I think I go with Gore. Lose three debates to Bush and then blamed it on Clinton. God how this country has suffered because
of Gore fumbling the ball.
He did win but not by enough to cover repug cheating and courts. I’ll give him that.
Ah, but William Jennings Bryan f*cked up. Three times.
Nope — as the DEM party frontrunner, Gore won the nomination. And did so against a strong and experienced challenger. Clinton lost the nomination to a first term Senator.
I thought about Gore – that’s why I said “arguably” – but he did win the nomination. No question his general campaign was a disaster, though.
This is why I always got so annoyed with the blame-Nader crowd. Nader didn’t cost Gore the presidency; Gore did. It’s like fans blaming their team’s upset loss on a bad call. The game shouldn’t have been close enough for the call to matter.
He also won the general election. That was despite the ballot box stuffing and voter suppression in FL. And being forced to let his campaign “go dark” are securing the nomination and forced to choose Lieberman as his VP.
The worse recent general election campaign was that of Dukakis. Although to be fair to his campaign team, the blame should more properly be assigned to DEM primary voters because Dukakis was a weak candidate.
Appointing Nuland-Kagan was not what I call genius. When you’re about keeping your enemies closer you have to remember that they’re still enemies.
why is she the enemy? She’s a career State Department official.
Ridiculous. She lost because she was facing a once-a-generation opponent. If Obama doesn’t run, Clinton coasts to the White House.
Priority #2: Winning with a progressive candidate.
Priority #1: Winning.
Any Dem president will keep the ACA alive long enough for it to be impossible to undue. That’s my priority. Hillary is not my favorite, but she’ll do.
You have those numbered wrong.
It’s more important to make a statement.
Because ultimately politics isn’t about policy.
It’s about telling the world how I feel about things, by making loud and visible choices in candidates, and denigrating those made by other people, who are wrong, and don’t understand.
Oh, and music ultimately about music.
It’s about telling the world how I feel about things, by making loud and visible choices in performers, and denigrating those made by other people, who are wrong, and don’t understand.
Just wanted to clear that up.
very nice!!
Succinctly put. Getting the ACA on solid footing, with the corrections that need to be made, is my #1 thing. Seeing some of the old names back in print and sensing a dejavu of triangulation is already giving me some Clinton fatigue. But if that’s what it takes to win, then ok.
iirc Hillary had a closed process and there were complaints about it; also one issue I have with her candidacy. Obama’s Feb “Health Care Summit” was amazing/ on video, is amazing
I don’t fault Hillary for not getting healthcare reform done back then. But I do credit Obama and everyone else on the team (Kennedy esp.) who learned from that prior experience and got something done in 2009. That anything as complex as ACA got through Congress is a miracle.
But I don’t know if Hillary learned anything from her 1990s experience. I don’t know what team she would put together and whether they would continue with innovative work in line with some of the great stuff in ACA.
But, Ezra Klein says that the success of Obama’s presidency will hinge on whether the implementation of ACA (and other law) goes well during his second term. I think success in the next 2 years will help any Dem president beginning in 2017.
Pardon me if you’ve already read these:
Analsys of Congress and the politics of getting healthcare reform done, written just after Hillary’s effort failed:
http://stripe.colorado.edu/~steinmo/stupid.htm
The details of the putting together ACA:
http://www.amazon.com/Inside-National-Health-California-Milbank/dp/0520274520