Where Hillary Clinton failed, the team of President Barack Obama and HHS Secretary Tom Daschle is determined to succeed—and the political momentum is all on their side.
The last time Democrats led a major push to have the federal government establish universal health care coverage, Ed Gillespie, then an aide to Dick Armey, defined a simple strategy that Republicans could use to defeat the Clinton administration’s initiative.
“We don’t have to tell the American people what’s wrong with this plan, we just have to show them what the plan is,” Gillespie told his fellow Republicans, Armey recently recalled.
On January 26, 1994, the strategy manifested itself when Senate Minority Leader Bob Dole, in his response to President Clinton’s health care–focused State of the Union address, unveiled a chart containing 207 boxes that graphically illustrated the complexity of the proposal drafted under the stewardship of First Lady Hillary Clinton.
“Let me point out some of the new bureaucracies that the president’s plan will create,” Dole explained. “Way up here is the National Health Board. Over here is the Advisory Commission on Regional Variations of Health Expenditures. And here’s the National Institute for Health Care Workforce Development. Now, you and I are way down here, way at the bottom.… [T]he president’s idea is to put a mountain of bureaucrats between you and your doctor.”
Armey, who was chairman of the Republican Conference in the House at the time, says that while it wasn’t easy to defeat the legislation, Democrats shot themselves in the foot by overreaching, and in the end, “Hillary Clinton lamented that they could never get past that chart.”
But a lot has changed in the intervening 15 years. Americans are as fed up as ever with the state of the nation’s health care system and its skyrocketing costs. Businesses, doctors, and insurers—groups that helped defeat previous attempts at universal health care legislation—have now become active proponents of reform. Democrats have racked up large majorities in both chambers of Congress and have retaken the White House during an economic crisis that has been likened to the Great Depression.
“Democrats are much smarter about how they are going to do it than they were back then,” Armey observed. “I think it represents a very, very formidable task to try to stop it this time around.”
Sen. Jim DeMint (R-SC) also conceded that it would be an uphill battle. “Because of down economic times and the promise of free health care, I think we’re in real danger of losing this,” DeMint said.
The stakes could not be higher for conservatives. Putting the state in charge of the nation’s $2 trillion health care system—which represents one-seventh of the U.S. economy—would be the coup de grâce to small-government conservatism, because much like other federal entitlements, a government-run health care system could never be undone. National security conservatives who want to ignore the issue would soon realize that health-care spending will eat into the defense budget and social conservatives will be dismayed by the power that the federal government will be granted over life-and-death medical decisions.
IN THE DAYS FOLLOWING last November’s election there was a view among some conservatives that it didn’t matter what Barack Obama’s liberal heart desired, because his hands would be tied by the costs associated with the nation’s economic crisis. But all that talk dissipated—or at least should have dissipated—when President-elect Obama tapped Tom Daschle to serve not only as his Secretary of Health and Human Services, but also as a director of the newly created White House Office of Health Reform. In other words, the former Senate majority leader has been tasked not merely with running the mammoth HHS on a day-to-day basis, but also with using his legislative skills to shepherd any health care package through Congress.
“Now, some may ask how at this moment of economic challenge we can afford to invest in reforming our health care system,” Obama said at the news conference in which he announced the Daschle appointment. “And I ask a different question. I ask: how can we afford not to?”
Rather than consider themselves hamstrung by the financial crisis, Obama and Daschle argued that now is the time to act, because cash-strapped businesses are struggling with health care costs and high unemployment is swelling the ranks of the uninsured. It’s similar to the way that Franklin D. Roosevelt exploited economic anxiety to pass the Social Security Act in 1935, even though the first checks didn’t start getting mailed until 1940.
“It’s not something that we can sort of put off because we’re in an emergency,” Obama said of health-care reform. “This is part of the emergency.”
Since losing his Senate seat in 2004, Daschle has developed a passion for the health care issue, and published a book on the topic last year, Critical: What We Can Do About the Health-Care Crisis. A large portion of the book is dedicated to the failure of HillaryCare in 1994. Daschle’s autopsy found that Clinton and her collaborator Ira Magaziner did not involve Congress enough in the drafting process and that her “Interagency Health Care Task Force”—composed of 630 people and broken down into 34 “working groups”—produced a highly technical, 1,342-page proposal that was impossible to explain to lawmakers, let alone the American public.
If his book is any indication, Daschle will be determined to produce a much more streamlined proposal and do a better job of involving key lawmakers on Capitol Hill in the process, as well as insurers, doctors, and business leaders. Since the election, it has also become evident that Daschle hopes to piggyback on the successful strategies Obama used to mobilize voters during the campaign to help build grassroots support for any health care effort. Even before being sworn into office, Obama’s transition website invited Americans to post their own suggestions to improve the health care system and to hold health care house parties that would also serve as brainstorming sessions.
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