Health Care Sense Reborn
Hillary Clinton today will announce her new, universal health care plan for America. It’s largely based on her old health care plan, developed with Ira Magaziner in 1993. Good. It remains the best plan to date, at least in principle, on fixing a health care system that ranks among the worst in the world, and that daily mocks the human rights of 47 million uninsured Americans and millions more who are shabbily insured. But “Hillarycare,” as the 1993 plan was derisively called in its day, was supposedly a disaster of secrecy and big government. Was it? Only if you believe the most effective and immoral misinformation campaign in American history.
Let’s look back at the 1993 plan Hillary Clinton and Ira Magaziner cooked up.
Companies providing health care for their employees would continue to do so. For the uninsured or the underinsured, like those in smaller companies or the unemployed, government would subsidize their health care coverage. Private insurance companies would stay in business. They would be the primary providers of insurance regardless. Bill Clointon was a friend of the insurance industry: he opposed a single-payer system on the Canadian model, where government is the insurer, because he didn’t want to see the insurance industry wiped out. (Too bad: I happen to think that the insurance industry is the plutonium in America’s health care veins.)
But this is where government management would come in: insurance companies would be forbidden from denying coverage to anyone, or from imposing one rate on a 55 year old and another on a 20 year old. Insurance premiums would not be allowed to rise beyond a certain cap each year. Anything wrong with any of those proposals? Of course not. Especially not to conservatives, who pushed exactly the same sort of cap on property tax valuation increases in several states, Florida prime among them.
Those were the proposals deemed unconscionable by the insurance industry and mis-characterized as “overmanaging” the health care industry. The industry was upset that its profits would be capped, and that its unconscionable way of doing business—by creating multi-tiered systems of insurable and uninsurable people—would no longer be legal.
Hillary and Magaziner worked in secret? Not at all. They heard an endless stream oif views from across the industry, but they heard from people in the trenches. They did not hear from special interest pressure groups like the American Medical Association or the Pharmaceutical Manufacturers of America. Nor should they have: this wasn’t about fashioning a plan to make the industries happy. Those were the industries that had broken the American heath care system. Their points of view were not nearly as important as those of people, including citizens, doctors, nurses and innumerable members of Congress, who wanted to fix the system, not perpetuate its failings hyper-profitable to a few. Nevertheless, Congressional Quarterly reported that Hillary’s task force met with 572 organizations. The headline on that story: “Clinton Task Force All Ears on the Subject of Overhaul.”
Not that Hillary Clinton and Magaziner didn’t play into an enormous gaffe originally committed by George Stephanopoulous, the president’s communications director at the time: he would not allow the health task force to talk to the press, but rather address its ideas directly to that amorphous “American public” by way of the talk shows. Big, huge, massive mistake. No question. But that wasn’t a problem of secrecy. It was a problem with White House strategy, and a perception of secrecy. Still, it stuck, no matter how much Hillary Clinton, never a friend of the press, has recognized it to have been a problem, and apologized for it.
And when Clinton was presenting her ideas to the public by way of Congress, no one was complaining. As James Fallows wrote in the Atlantic in a January 1995 piece on the disinformation campaign against the Clinton plan, “In late September 1993, when Hillary Clinton appeared before five congressional committees in three days to explain the rationale behind the bill, not a single legislator complained about ‘closed’ or ‘secretive’ deliberations”: not Robert Dole, not Robert Packwood, not John Danforth—Republican senators who later came out against the bill.” No, the task force became “secretive” only when the insurance and pharmaceutical industries’ K Street boys heard from their shareholders and went to work assassinating the plan’s substance and character using trumped up claims and the business equivalent of race-baiting: painting Hillary as a latter-day predator, who happened to be a bitch-dyke instead of a nigger, they invented the lie that the government was coming between families and their doctors.
There were other issues and other problems with the plan, but in essence it all went back to this: insurers wanted their pie untouched, and they succeeded. “Hillarycare” wanted to change that fatal formula: the United States spends twice, per capita, on health care than most industrial countries, with results that are twice as bad. The pan failed. And things have gotten worse.
Had “Hillarycare” passed with all its faults in 1993, we’d have been a more just, healthier, happier society. We’d be better off even if that old plan passed today, the alternative being so dismal. But “Hillarycare” repaired and cognizant of its previous faults—meaning a vast improvement on the 1993 plan—can mean one thing: the best of the 1993, few of its faults, and many things we’ve learned since. Among them an old lesson: the enemy is still the insurance industry and its Republican lackeys who think bootstraps are somehow a synonym of band-aids.