DES MOINES, Iowa — The word of the day was “choice,” printed dozens of times on the backdrop behind Hillary Rodham Clinton, who announced her “American Health Choices Plan” to remake American health care (in part by using a “health choices menu”).
“This is not government-run. There will be no new bureaucracies. You can keep the doctors you know and trust. You keep the insurance you have if you like it,” Clinton said, though aides later conceded that administering the plan would require hiring more government workers. “This plan expands personal choices and increases competition to keep costs down.”
The New York senator’s Monday speech was shaped by an attempt to avoid the structural and political obstacles that wrecked the Clinton administration’s attempt to introduce universal health care in 1993 and 1994.
For starters, Clinton the presidential candidate detailed her plan in a nine-page press release with just 11 footnotes, a sharp contrast to the 1,300-page document she notoriously delivered to Congress as first lady in 1994.
Clinton’s new plan departed in key and telling ways from her prior failed attempt. This plan insulates small businesses — some of her fiercest enemies at the time — from rising costs. And it is shaped by the recognition that many Americans are satisfied with their current insurance and wary of change.
“Part of our health care system is the best in the world,” Clinton said. “Part of it is broken.”
The rise of universal health care as the central domestic issue of the Democratic primary has handed Clinton what has proved to be both bully pulpit and lightning rod. And criticism of the plan came from a dizzying, and often contradictory, array of angles.
Republicans Mitt Romney and former New York Mayor Rudy Giuliani branded it a sort of creeping socialism and an attack on states’ rights. The Democrats’ criticism was more personal: Illinois Sen. Barack Obama suggested that Clinton lacks the ability to unify Americans behind her plan; Connecticut Sen. Chris Dodd said she lacks the “leadership” skill to steer it through Congress; and former North Carolina Sen. John Edwards, conversely, argued that she is too close to the establishment and wary of confrontation to ram a plan through Congress.
In her speech, Clinton anticipated the criticism from the right.
“It is not a government takeover of health care,” she said.
Mitt Romney, who as governor of Massachusetts signed into law a plan that similarly requires every individual to buy health insurance, complained that Clinton’s plan has too large a government role and encroaches on federalism.
“In her plan, it’s crafted by Washington; it should be crafted by the states. In her plan, we have government, Washington-managed health care,” Romney said, repeating charges levied in the early 1990s. (The candidate spoke in front of St. Vincent’s Hospital in New York City, which later issued a press release complaining the candidate had “misappropriated the image and goodwill of St. Vincent’s Hospital to further a political agenda.”)
“It’s sort of funny to me that [Romney] would cast it as a big government solution, when it’s essentially what he enacted in Massachusetts,” Clinton’s Senate legislative director, Laurie Rubiner, said in response to Romney, adding that the Clinton plan is based on “choice and competition.”
Romney’s spokesman, Kevin Madden, replied that “what works in Massachusetts doesn’t necessarily work in other states.”
Clinton spokesman Jay Carson, meanwhile, returned fire at Edwards, who was the only Democrat to criticize Clinton from the left.
“Sen. Clinton has been fighting for universal health care for 15 years and welcomes any and all new allies i this fight to the table,” said Carson, in what appeared to be a veiled reference to Edwards’ 2004 health care plan, which was not universal.
Edwards also offered an alternative method of passing the bill through Congress: He promised to introduce legislation that would end health care for members of Congress and executive-branch appointees and their families, including his, if Congress didn’t enact universal health care by a deadline. Critics quickly pointed out that might be unconstitutional, and in any case Congress wouldn’t be likely to pass it.
Clinton’s rollout this time around also aims to avoid another of her 1990s pitfalls. Back then, Congress was presented the plan as a fait accompli and asked to ratify it, leading to a fatal confrontation.
The Clinton health care plan of 2007, in contrast, leaves many outstanding questions on policy and politics, such as how to enforce the requirement that citizens buy health care.
“We’re not writing every single detail of this plan,” said Rubiner. “There is tremendous expertise in the Congress that we hope really to tap into when she’s president.”