1994 Redux: Clinton Hasn’t Changed A Bit

National Review Online: Latest Healthcare Plan Would Still Lead To Government Takeover

(National Review Online)  This column was written by James C. Capretta.

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In his 1994 State of the Union address, President Bill Clinton waved his pen at the Democratic-controlled Congress and said he would veto any health-care-reform bill that did not “guarantee” the right to health insurance for every American. The threat worked. Congress didn’t send him a bill he would have to veto - or any reform bill at all, for that matter.

Then-First Lady Hillary Clinton, heading up her husband’s health-care task force, undoubtedly had a hand in that disastrous 1994 line in the sand. Now that she is running for president, she says she has learned her lesson. But has she? It hasn’t seemed so over the last two months on the campaign trail, as the take-no-prisoners rhetoric and finger-pointing ultimatums have returned with a vengeance.

The 1994 effort was a debacle of biblical proportions for the Democratic party. To win the presidency, everyone assumed Hillary Clinton would need to erase memories of her flawed leadership of that catastrophe. And doing so would mean showing voters she had the capacity for a different kind of leadership, one based on openness to the private sector, appreciation for the complexity of the task, and policy flexibility - not 1990’s style war-rooms and the promised destruction of opponents with differing views.

For a time last fall, it seemed as if Clinton understood she had an image problem that needed correcting. In announcing her new plan for health care, she stressed choice and pluralism. She claimed - falsely - that under her plan no one would be forced to drop the coverage they have today if they were happy with it. She suggested the plan is built on general principles, not detailed legislative particulars, and she pledged to work with Congress to formulate a workable compromise. She even endorsed Republican-sounding tax credits to bolster her claimed support of more private health insurance options.

Conservatives, of course, never believed for a minute that her overall goal had changed, and rightly so. Her plan is cleverly drawn, but a careful reading shows it would lead to a government takeover. Still, there was no denying a change in salesmanship.

The only problem was that the new, seemingly more open-minded Clinton didn’t work - politically, that is. She lost her frontrunner status for the Democratic presidential nomination and a slew of caucuses and primaries to Senator Barack Obama. It turns out that he, too, had a health-care plan he was touting, one that isn’t all that different from hers. And he had already cornered the market of voters interested in promises of consensus-building leadership.

In recent weeks, in a last-ditch attempt to draw clearer distinctions with Obama, Clinton has done what comes naturally to her, promising, that if elected, she will again lead a no-holds-barred campaign to defeat any and all opponents who stand in her way on health care. And, just like her husband did in 1994, she has defined the fight as a struggle between those who support “universal coverage” and those who don’t.

Of course, it is convenient, and not a coincidence, that Obama is on the wrong side in this fight, as Clinton describes it. He has refused to endorse the provision which Clinton argues is the non-negotiable foundation of Democratic health-care orthodoxy: mandatory enrollment by every American in government-approved health insurance. Clinton has virtually accused Obama of heresy for daring to defy a tenet of the universal-coverage church.

In response to Clinton’s attacks, Obama has pointed out that such a mandate would hurt exactly those households a “universal” health-care plan is supposed to help - low-wage families who can’t afford private coverage but who are ineligible for public programs. It would seem these families would be forced into a choice between bad and worse with the Clinton mandate. Either they pay premiums for coverage they cannot afford and forego other necessary goods and services for their family, or they pay a lesser financial penalty to save some money but still go without coverage. Either way, they are worse off financially than they are today.

But that’s exactly the dilemma Clinton wants to force onto the public agenda. She understands that mandatory insurance enrollment would be the engine for a health-care train with many more cars attached to it, and these would inevitably shift the balance of political pressures toward a government-run system.

It’s not difficult to see her logic. If the government requires everyone to have insurance, it will quickly become incumbent on politicians to make sure there are “affordable” options for everyone too, based on ability to pay. For a time, that might be accomplished with lavish new subsidies, which Clinton promises in her plan. But, if costs continue to escalate rapidly (as they would under her approach), pressure would build for predictable and reliable controls, as neither the government nor households could manage indefinitely with premium increases far exceeding wage gains. Inevitably, the federal government would respond to escalating costs the same way it has tried to reign in Medicare spending, with elaborate payment schedules, price setting, and heavy-handed regulation aimed at artificially lowering costs and limiting the supply of services.

Clinton has argued that her plan will slow cost escalation without price fixing. It would not. She proposes to invest in more widespread use of health information technology and fund research into what works and doesn’t in health-care delivery. These proposals, which most Republicans also support, may result in some modest easing of cost pressures, but no credible expert believes they are a real answer to the larger problem, and certainly they would not be enough to offset the substantial new costs associated with a universal system of health-insurance subsidies.

To slow rapid cost escalation, there really are only two choices. The first would have the United States go the way of Europe and Canada, with all that would mean for reduced access, lower quality, and less innovation.

But there is a better way. A second option would have the government adopt policies that promote a functional marketplace, with cost-conscious consumers selecting from among numerous offerings of insurance and services based on price and quality competition. In time, such competition would increase productivity, improve the quality of services provided to patients, and ease cost pressure, making insurance more affordable for those who want coverage.

Clinton has made it abundantly clear which approach to cost control she favors. Her 1994 plan sought to impose “premium caps” on insurance, which would have quickly become price controls for hospitals, physicians, and products. She staunchly opposed the 2003 Medicare drug bill because it relies heavily on price competition and private insurance. And she frequently rails against “privatization schemes.” There should be no doubt that, once in power, she would couple her mandate to buy insurance with significant new government power to impose cost constraint.

Just like 1994, Clinton wants to frame the choice for the country as between universal coverage, or not. She failed last time because the country was presented with overwhelming evidence that the real choice was between a government-run system and one based on individual choice and competition. The lesson she appears to have learned from that episode is to do all she can to hide her true intentions.

[sevenveils]

The health care industry should not be an industry, instead it should be a public service. To profit from the sick with margins that exceed current oil companies is the main thing that is wrong. Claiming high insurance rates drives up the cost of medicine has proven to be false. In as much as the Catholic church hides and shuffles its pedophiles, the health industry protects and hides its incompetent doctors. Its these incompetent, or drug addicted doctors that are driving medical costs throught the roof.

Still today the medical industry acts like a huge fraternity. It is time to realize that the majority of these medical practitioners are nothing but medicinal restaurateurs and human mechanics practicing cookbook arts, and very little science.

[mpgeglia2]

America spends more on health care than any other country in the world. Before we can even think of insuring every citizen (publicly or privately) then we must figure out a way to reduce the cost.

[incog-nito]

Fact: 85% of all Americans are covered by health insurance.
Fiction: the U.S. ranks near the bottom when it comes to health care in developed nations.

Posted by mac4440 at 08:36 AM : Apr 04, 200

Speaking of facts:

http://www.who.int/whr/2000/media_centre/press_release/en/index.html

It''s hard to have a good debate when people make up things out of thin air.

[Razzl]

"Such a program is not logical or justifiable because it requires coercion to achieve it. If it were a voluntary program, then it would be fine. But how can it be a good one if you have to point guns at people to get them to sign up? No thanks. It can''''t be an improvement if you need to coerce people."

We have another concept called "taxation" that''s involuntary but entirely rational. There are certain needs that have to be met and certain resources that have to be shared even if some don''t wish to recognize their obligation. I''m perfectly willing to hold a gun to your head (if you ever take it out of your ***) to make you pay your fair share so that newborns and old people and everyone in between can be given proper medical care. People like you would impose savagery on everyone else until the savages come to your door, then you would tax us all to provide you with a policeman...

[mac4440]

Fact: 85% of all Americans are covered by health insurance.
Fiction: the U.S. ranks near the bottom when it comes to health care in developed nations.

[incog-nito]

RowdyTexan2: Sorry, but I don''t buy the idea of supporting people whose only job is to take your money, paying some to the doctors and hospitals, and keeping the rest as profit, just so they can have a job. America has become a nation of paper pushers, bean counters, and salespeople. No wonder why the economy is going down the drain. NOBODY is manufacturing, producing, or otherwise doing something useful anymore. Everybody wants to get rich shuffling paperwork around and making life harder for others. There''s a word for such people: parasites.

[rowdytexan2]

Republican-sounding tax credits??? Now that''s a laugh!

The fact is, that as the US stands today, we can''t just step into a National Health Trust. What would we do with the millions of people who work in the insurance industry? We have NO alternative jobs! So the industry has to be maintained, but regulated. We''ve got to take away their ability to drop you like a hot potato whenever they want to. We''ve got to make insurance coverage mobile, and stop it from limiting or restricting what your doctors orders for you. And to make it affordable we''ve got to regulate profiteering. Why are the elite being allowed to profit off of people''s suffering. It''s insane.

Health care is not FREE even when it''s limited to costs and salaries! Somebody has to pay for it, either in taxes, or in premiums. Choose your poison. Obama''s plan is totally tax dependent and doesn''t get everybody covered. Hillary''s plan regulates insurance companies, and offers you a tax CREDIT to help pay for it and with multi options, even allowing the lowest income earners to sign up for Medicaid. It''s multi option plan and requires everyone to participate one way or the other. We can''t keep allowing people to go down to the ER (the highest level of cost of health coverage) and get medical care for free.

People stop listening to the media and start evaluating these things for yourselves! The Obama and republican bot media will just flat lie to you.

[rational_1]

You mean the way AMERICAN Fascist throw around the word "Liberal"? Fascism is when you crush any opinion of belief that is NOT that of the "party" by any method necessary! That''''s why most of the World Today concider the Republican Party to be FASCIST!! Sieg Heil Bush
Posted by MCVet at 07:37 PM : Apr 03, 2008

So by your definition the Chinese Communists as well as the thankfully defunct Soviets would easily qualify as fascists?

[ubrew12]

Notional ReScrew Ontime: "[Clinton] would veto any health-care-reform bill that did not ''guarantee'' the right to health insurance for every American....Now that she is running for president, she says she has learned her lesson"

God forbid the NRO should have to live in an America in which every American has health insurance. They might have to leave (hey, wait, maybe there''s something to that...)

[incog-nito]

Another hack job by a right-wing rag. They say Clinton''s plan will raise costs. FYI: The reason universal health care is even discussed right now, is BECAUSE the current private system is fast becoming exorbitantly costly for most Americans. They bash Clinton''s and Obama''s plans. And what better plan do they offer? NONE. They say it UHC is bad for America, yet ALL the other industrialized countries have it, and people are doing just fine. In fact, the U.S. ranks near the bottom when it comes to health care in developed nations.

[mcvet]

Such a program is not logical or justifiable because it requires coercion to achieve it. If it were a voluntary program, then it would be fine. But how can it be a good one if you have to point guns at people to get them to sign up? No thanks. It can''''t be an improvement if you need to coerce people.

That is Republican Iraq-war logic. I am not surprised that the Democrats have also learned nothing in twenty years.


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Posted by Dan9111 at 05:37 PM : Apr 03, 2008
+ report abuse

Why don''t you just come out and say it. I''ve got mine and to helll with everyone else. It''s to obvious and everyone reading your post can see through you!! Sieg Heil Bush

[mcvet]

Do you have any idea of what fascism really is or do you just like to throw words around aimlessly?


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Posted by rational_1 at 04:25 PM : Apr 03, 2008
+ report abuse

You mean the way AMERICAN Fascist throw around the word "Liberal"? Fascism is when you crush any opinion of belief that is NOT that of the "party" by any method necessary! That''s why most of the World Today concider the Republican Party to be FASCIST!! Sieg Heil Bush

[mcvet]

None of the plan''s presented by Clinton, Obama or anyone else is going to lead to anything that the PEOPLE of this nation do not want. That became PAINFULLY clear to the Fascist in their attempt to rape Social Security. There is ONE thing for certain though this Nazi Rag and the Republican Party have NOTHING to present as far as a solution to the Health Care Situation. They PROVED that in 6 years of total control of our Government. Thus they and rags like this should sit down and shut up on the subject!! Sieg Heil Bush

[civiltongue]

Neither has the NRO changed, ever. It has been atavistic from its inception.

[it_oldtimer]

The time has come for us to finally get real and nationalize our entire health care system. It''s obviously become totally unavoidable. All other solutions merely put off and prolong that inevitable necessity.

Health care rightfully belongs in the same category as Social Security, Medicare and Medicaid - under the umbrella of our existing national social safety-net infrastructure.

The health care issue is much closer to the hearts (and the pocketbooks) of the vast majority of Americans than the war in Iraq or the "war on terror" is. It''s more important than hiring more police and building more and bigger prisons. It''s even more important than the rising cost of oil.

We all require health care from the cradle to the grave - it''s truly a "Basic Need" - and an ever-increasing number of Americans are now finding it totally affordable.

Guaranteed life-long health care is much more important than most of the things our government readily spends billions and sometimes trillions of dollars on every year. It''s way past time to nationalize it.

[sharncedar]

the classic case study of price and supply and how to manipulate them is the bread of Paris. Attempts to fix the price led to less bread, the only way to get more and cheaper bread, it proved, is to subsidize the production and allow free production.

the way to cheap health care is to subsidize the production of doctors or nurse-practicioners and of hospital-type businesses such as clinics.

the way to expenisve health care is price controls. it''s funny how many times this same mistake is made by people, they always ask for price controls or things like insurance, and that always drives the price up or takes away the supply.

If you want anything to be cheap and plentiful, the only thing successful in any case in history is subsidization of production. How about free medical school? How about matching funds for anyone who opens a clinic? these things haven''t even been tried, why are we talking about "universal insurance" that is madness. That is bad economics.

[sharncedar]

The best reform is to make more kinds of care available and give more control to the consumer- for example the inner cities should have low-cost clinics with inexpensive (perhaps subsidized) pay-as-you-go care for things like the flu, or need for mild antibiotics, or sprains and minor injuries, or a few stitches on a cut. Today people in the inner city or Hispanics go to the emergency room for these kinds of issues. These are things nurses with a few years training could do for cheap. The practictioners should be less than doctors, they don''t need a billion dollar education to comfort people and hand out aspirin and call an ambulance for the truly dangerous cases.

The problem with our health care system isn''t that we don''t have enough insurance, its that we don''t have enough health care providers and we don''t have a lower tier of health care, the AMA enforces an expensive monopoly on health care.

Freedom is better than insurance, it is the monopolies and practices of the big insurers and the hospitals and the AMA which are creating the "crisis" that only they can heal, so they claim.

Imagine there was a monopoly on car repair, and you had to take your car to a big central repair hospital for any service. The prices would be insane, mechanics would be millionaires. Body shops are the closest thing we have, due to insurance compaines.

[dan9111]

The vast majority of the American public, which is desperately in need of affordable health care, WANTS a government program that guarantees the basics to everyone.

Posted by razzl

Such a program is not logical or justifiable because it requires coercion to achieve it. If it were a voluntary program, then it would be fine. But how can it be a good one if you have to point guns at people to get them to sign up? No thanks. It can''t be an improvement if you need to coerce people.

That is Republican Iraq-war logic. I am not surprised that the Democrats have also learned nothing in twenty years.

[Razzl]

The vast majority of the American public, which is desperately in need of affordable health care, WANTS a government program that guarantees the basics to everyone. Like Social Security for retirement, it just makes sense. And for NRO to blather about this as though they imagine Americans to be standing around their tractors cursing the idea of a government health program shows just how utterly and completely out of touch they are with this issue (or how completely they believe their own propaganda). America will become a social democracy in the European model because the conservatives have proven that their do-nothing approach does nothing, but people have needs...

[bookout2]

I haven''t been watching any of the major networks, or
cable network news programs. Unless Katie Couric
has changed or has been studying Walter Cronkite"s
school of journalisn, she still hasn''t a clue. The
entire CBS anchor staff with the wonderful excepion of
Bob Schieffer is in bed with Barack Obama.
Bob must have been watching and listening to Walter''s
superb anchoring technics. Its shows. Go back to
the Morning Show Katie. I don''t get up till 9:30 A.