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Health Care Reform history lesson

by Karoli on December 19, 2009

First of all, major props to Harry Reid for pulling over Ben Nelson and getting the 60 votes to bring health care reform to a vote. Today is the second benchmark in an historic effort to get some real changes in our health care insurance, payment and delivery systems…we’re three cloture votes and one up or down vote away from having it be reality.

The furor from the right is expected and understood. What I’m a little surprised by is the depth of the furor on the left, at least in the netroots (and I’m sure it will carry into tomorrow’s talk shows, too). I’m not sure if it comes from expectations that weren’t realistic about how Washington works, or maybe being far closer to the goal than anyone ever expected they’d get.

Just for the record, let’s look at what happened in 1994. From Bill Clinton’s book, “My Life”, here are some select quotes from the part of the book where he faced Republican opposition on a bill far less sweeping than this one.

Clinton’s post-mortem:

“Those who profited from the way health care was financed were spending huge sums to convince the Congress and the people that fixing what was wrong with the health-care system would destroy what it did right.

I thought my argument was effective except for one thing: at the end of the health-care portion of the speech, I held up a pen and said I would use it to veto any bill that didn’t guarantee health insurance to all Americans. I did it because a couple of my advisors had said that people wouldn’t think I had the strength of my convictions unless I demonstrated that I wouldn’t compromise. It was an unnecessary red flag to my opponents in Congress. Politics is about compromise, and people expect Presidents to win, not posture for them. Health care reform was the hardest of all hills to climb. I couldn’t do it alone, without compromise. As it turned out, my error didn’t matter, because Bob Dole would decide to kill health care reform.”


So when you start hearing screams about sellouts and compromise, remember this:

  • Clinton had majorities in both houses
  • Clinton came in with a mandate.
  • Clinton had 59 Senate votes. Not 60.
  • His signal that he would not compromise killed the bills in committee. It was never about Hillary, or anyone else. It was Republicans vowing to kill the bill and having the 41 to do it.

The consequence of that failure was the biggest loss Democrats had since 1946 when Truman had attempted health care reform, because the base stayed home. Here are some of those consequences:

  • George W. Bush defeated incumbent Democrat Ann Richards as Texas Governor, despite Richards’ 60% approval rating.
  • Democrats lost 8 Senate seats and 54 House seats, turning both majorities to Republicans.
  • Bart Stupak won in Michigan running on a conservative platform, as did Kent Conrad.

Clinton closes his post-mortem with this:

“The electorate may be operationally progressive, but philosophically it is moderately conservative and deeply skeptical of government.”

Criticize away, but in so doing, be aware of the other constant battle that Clinton climbed:

“I had done a lot of good, but no one knew it.”

History is a powerful teacher.

  • My picture, Francine, is limited to what's in front of me. Layering a loss on top of a win is not particularly helpful if forward progress is the goal. Some of us would just be grateful for the opportunity to sleep at night without wondering what disaster could strike around the corner.
  • Concern4Civility
    Hardaway & Karoli are both making important points. I am reminded of this famous quotation from Abraham Lincoln: "If I were to try to read, much less answer, all the attacks made on me, this shop might as well be closed for any other business. I do the very best I know how - the very best I can; and I mean to keep doing so until the end. If the end brings me out all right, what's said against me won't amount to anything. If the end brings me out wrong, ten angels swearing I was right would make no difference." --- Meryl333
  • In other words... take your half a loaf and be happy that the insurance companies and drug companies allowed the Democrats to do anything. If all we can get is half a loaf, then I'll take. But I won't be happy. It makes all of Obama's campaign rhetoric ring hollow. Transfomation my ass. "incrementalism you can believe in" would have been a more honest slogan.
  • Not arguing with any of that. And Obama took his plays from Clinton's play book; if Clinton did it, Obama wouldn't, because Clinton failed. I'm not against the reform, but I am against the fact that a deal was made before the discussion even began, which means single payer was never on the table, and any re-pricing of drugs was never on the table. The big costs in health care, outside of those from waste and fraud, are non-standard billing and clinical systems due to multiple insurance companies, non-standard non-outcomes based clinical practice, and the approval of prescription drugs that aren't effective and are costly to produce and sometimes even unsafe. We will hand the insurance companies 30,000,000 new customers that they can overcharge, knowing our tax money will pay for them. We have asked nothing from the insurance companies, and nothing from pharma.

    What will we get in exchange? We will get pre-existing conditions allowed. And Obama will lose big in the next election, because his failure to step up and be transformative in a time of crisis will embolden movements like the Tea Partiers. Everyone in middle America now knows the fix is in. This isn't "change." This is the party of the people giving in to the same big money interests that the Republicans do.

    The difference between Clinton's and Obama's
    is that we are now in a fiscal crisis. We weren't then. In a crisis, you can be more aggressive. But we haven't been. Watch what happens to the taxes and the deficit when we start subsidizing health care that insurance companies don't have to cut costs on.

    I tend to see a bigger picture than just #hcr. I think I am seeing the future of a corrupt country rule by money instead of a desire for independence, greed instead of compassion. And because I read economics as well as health care, I see us heading off a cliff. Unless the tax on medical devices is high enough to support the cost of reform.
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