They might sit side-by-side in Barack Obama’s Cabinet room someday, but Tom Daschle didn’t much like Hillary Clinton’s tactics for fixing health care 15 years ago – so much so that he wrote a book critiquing them.
Now as Obama’s point-person on health care, Daschle’s approach is a simple philosophy of ABC – Anything But Clinton – that he’ll start to lay out at his confirmation hearing Thursday for secretary of health and human services.
Daschle wants an overhaul plan moving on Capitol Hill by spring. Clinton waited almost a full year. Daschle wants lawmakers to take the lead in drafting it. Clinton kept the job inside the White House.
Perhaps the biggest change: Daschle is planning a major grassroots push to build public support for his plan outside Washington, possibly with spokesman-in-chief Dr. Sanjay Gupta of CNN at the helm as surgeon general. Clinton let opponents carry the day with their famed “Harry and Louise” TV spots.
“It is just a world of difference in so many ways,” said Sheila Burke, the chief of staff to former Senate Majority Leader Bob Dole (R-Kan.) from 1986 to 1996, who followed Clinton’s process. “You’ve got people paying close attention to what those lessons were, and they have already avoided some of the missteps.”
The stakes for Obama are high: his promises on health care were among the most specific of his campaign, setting a deadline of the end of his first term to provide universal coverage for “every single American.”
As Daschle sits down for the first confirmation hearing of the Obama Cabinet, senators on the Health, Education, Labor and Pensions Committee are expected to press for details of the incoming administration’s strategy on the issue. The failure of Clinton’s plan was so politically traumatizing the last time around, Congress hasn’t attempted something as sweeping since.
Officials close to Daschle said they didn’t know if he had spoken to Clinton to get pointers for his own effort. A spokesman for Clinton, Obama’s pick for secretary of state, referred all questions to Obama’s transition team.
Despite a $1 trillion budget deficit, a massive economic stimulus bill, two wars and a crisis in the Middle East, Obama and his key Senate allies are quietly laying the groundwork to start moving a bill through Congress as early as March. Democratic and Republican leaders of the Senate health and finance committees are planning to meet next week for the second time since the election, according to Senate aides.
His proposed quick turnaround would be ambitious – and it has its fair share of skeptics both on and off the Hill – but proponents of a health care overhaul say the window of opportunity is narrow. Daschle, who was active as a Senate finance committee member, has argued that timing played a larger role than substance in killing the Clinton health care initiative.
Like Obama, who consistently ranked health care as among his top two domestic priorities, Clinton came into office with the same pledge. But after a quick start, other issues bumped health care off the calendar, and the president’s bill didn’t arrive on Capitol Hill in its final form until November 20, 1993. By then, Clinton’s popularity had suffered from tough legislative battles at home and crises abroad. And critics had months to mobilize against the effort, which was officially abandoned in September 1994.
“In retrospect, we waited too long after President Clinton took office to mount a major push for reform,” Daschle wrote in his 2008 book, “Critical,” in a section titled “What Went Wrong.”
“The health-care debate might have played out differently if President Clinton had launched it in the spring of 1993, when he still had some momentum from his election victory.”
Daschle has expressed the same sentiments to Ron Pollack, executive director of Families USA, a key advocacy group that meets regularly with 19 industry and health groups – including fierce opponents of the Clinton effort – to come to a consensus on a way forward. (In a sign of how tough the process can be, a certified conflict negotiator runs their meetings.)
“Tom Daschle knows well, and indeed he has said this to me directly, the prospects for health reform are aided by doing this in as timely a manner as possible,” Pollack said. He added: “I have every reason to believe the process will begin soon after the recovery package.”
Pollack and others are encouraging Obama to lay out his vision in a major address.
Still, the outlook is murky. With Obama and congressional leaders pushing back their target date by almost a month for passing an economic stimulus bill, other initiatives will get squeezed out. Although Obama argues that fixing the economy means fixing health care, there’s the question of how much political will remains to tackle another big-ticket item after the $775 billion stimulus package.
One Senate Democratic aide familiar with the process said the “expectation on the staff level” is Obama and his legislative allies will make a push by the “late spring.” One Senate Republican aide said “we will be fortunate if we get something for a vote by the August recess.”
And both House Ways and Means Committee Chairman Charles B. Rangel (D-N.Y.) and House Energy and Commerce Chairman Committee Henry A. Waxman (D-Calif.) laughed off suggestions this week that health care reform could be a spring initiative.
“I try not to comment on the Senate or what goes on over there,” Rangel said. But he did offer that his aides are “already working closely with the president's staff.”
When something does emerge, the bill won’t be handed down from the White House, those involved in the process say.
The Clintons made that mistake in 1993. When a 1,342-page proposal dropped on Capitol Hill, it was overly technical, and crafted without steady input from the lawmakers who would need to pass the bill, Daschle wrote in his book.
Clinton instead opted for a task force that essentially took on the bill-writing role reserved for Congress, a move that generated only ill will in a body known for protecting its turf.
“In my view, the White House should have engaged congressional leaders in a more meaningful way at the very beginning, on both the substance of the bill and the strategy for passing it,” Daschle wrote.
Daschle has promised a more collaborative and transparent process, although with Obama not yet sworn in and Daschle not yet confirmed, it’s unclear exactly how it will play out.
Sen. Edward M. Kennedy (D-Mass.), the health committee chairman, and Sen. Max Baucus (D-Mont.), the finance committee chairman, are expected to take lead roles after working separately and together over the last year. Baucus proposed his own plan in November, and Kennedy’s staff has held 14 roundtables with key industry and advocacy groups since June. But they also organized a joint meeting with key members of their respective committees soon after the election.
“There will be a White House component to this that Daschle will supervise, but it will not take shape inside the White House complex,” said Matt Bennett, a veteran of the Clinton administration and co-founder of Third Way, a moderate public policy group. “You won’t see this machinery with the locus in the White House.”
Another shift in tactics involves the concept of playing offense early on.
Daschle encouraged supporters to hold house parties on health care over the holiday season – a direct response to the failure of 15 years ago, when business groups outfoxed the Clintons on mobilizing a grassroots lobbyig campaign outside of Washington. Supporters responded by organizing more than 10,000 meetings across the country, and the transition collected data and testimonials from 4,000 hosts that will be rolled into report for Obama and the new Congress.
Obama’s interest in Gupta, a neurosurgeon and CNN’s chief medical reporter, as surgeon general aims to solve yet another problem of the Clinton effort: Selling the plan to the public.
“The best explainer of health care in the country is Sanjay Gupta,” Bennett said. “So you’ve got this famous, telegenic doctor who will be a big part of the public push.”
Politico staff writer Patrick O’Connor contributed to this story.