Attacks on Obama plan mirror Clinton health debate

Former President Bill Clinton ran for president in 1992 with health care reform as a key part of his domestic platform. It seemed then that the time was right for comprehensive reform.

The number of uninsured people had already climbed to 40 million. The Democrats were in control of the White House and Congress. A large majority of the public rated health care reform as an urgent priority and voiced support for a universal insurance plan.

In 1993, shortly after taking office, Clinton set up the President’s Task Force on National Health Reform. Hillary Rodham Clinton was asked to head the task force and prepare health reform legislation for submission to Congress within the first 100 days of the administration. This was initially viewed as the administration’s signal to Congress and the media that health care was a top priority.

Yet when the task force was hastily disbanded on May 31, without having submitted a plan to Congress, this was an early warning sign that the emerging details of the reform plan had failed on two fronts. The insurance industry and right-wing Republicans, who sought to stop any health reform legislation, were not appeased by the plan’s concessions.

Union activists, progressive health care advocates and the uninsured were not energized by a weak plan chock full of industry giveaways and loopholes.

Managed competition, not working-class reform

The Clinton administration claimed that its overriding goal was quality universal health coverage. But rather than eliminate the biggest obstacle to real reform—the profit-driven private insurance industry—the administration proposed a market-oriented plan based upon the principles of managed competition.

The plan sought to develop financial incentives for consumers to choose health care plans based on price and perceived quality. Regional alliances would be established to restructure the health insurance market by serving as the group purchaser for people not receiving Medicare and would offer local residents—employed and unemployed—their choice of health plans. Large companies could act as their own corporate alliance.

A 1994 article in the Journal of the American Medical Association titled “A Better-Quality Alternative: Single-Payer National Health System Reform” provided a contemporary critique of the Clinton plan:

“A managed competition strategy, such as that proposed by the Clinton administration and debated in Congress, while designed to provide universal access, has not demonstrated an ability to contain cost and creates a complex structure with separate and unequal multitiered care. Eschewing the easily enforceable budgetary constraints of the single-payer approach necessitates relianceon potentially damaging financial incentives, wasteful micromanagement, and complicated budgetary regulation to minimize spending. ... No amount of regulation and oversight can breathe quality into a system that is not based on caring professionals working for patients.”

Health care reform, the Democratic déjà vu

Despite Obama’s best efforts to avoid a repeat of the Clinton health reform debacle, the similarities between the push for health care reform in 1993 and now are striking.

Bill Clinton rode a wave of economic anxiety and dissatisfaction over former President George H.W. Bush’s first term to win the 1992 presidential election. Clinton’s general election victory was solid; he won 370 electoral votes and took states generally outside of the Democrats’ reach, such as Georgia, Louisiana and Kentucky.

Fast-forward 16 years and the resemblance is glaring. President Barack Obama rode a wave of economic anxiety and dissatisfaction over the presidency of George W. Bush, son of the defeated 1992 incumbent, to win the 2008 presidential election. Obama’s general election victory was stunning in light of his status as the first Black president of the United States. Obama was able to secure 365 electoral votes as he also took states generally outside the Democrats’ reach, such as Indiana, Virginia and North Carolina.

Health care reform was named the top domestic priority both by President Clinton during his first year in 1993 and by President Obama during his first months in 2009. Both administrations had solid Democratic Party majorities in the House and Senate at the time they made their respective efforts to push a reform bill through Congress.

Yet both Clinton and Obama backed flawed health reform plans that failed to challenge the private insurance industry, fell short of voter expectations, and ultimately would leave the lives of millions in the hands of corporate bureaucrats. The bill in 1993 went down to a stunning defeat. There are still signs of life for Obama’s proposal, although its final form and outcome are undecided.

The 1993 and 2009 Democratic Party’s reform efforts have more in common than just the failure of the Democrats to fight for meaningful health reform. Both efforts were the focus of organized attacks by the health insurance industry and an extreme right wing, eager to whip up anti-Obama racism today and sexism against Hillary Rodham Clinton earlier.

President Obama has been the focus of racist attacks, from incendiary comments by conservative radio and television talk show commentators to the appearance of hostile forces at town hall forums, some flagrantly displaying guns.

The intentions of the attacks faced by Obama are similar to those underlying the sexism targeted at Hillary Rodham Clinton when she led the Clinton administration’s campaign. The right wing’s misogynist slanders toward her, which were repeated by the media, were meant to stop passage of any health care reform legislation.

The health care reform experiences of 1993 and 2009 should serve as an important lesson to organized labor and other progressive backers of the Democrats. Democratic Party concessions do not appease the opponents of reform, nor do they provide a path to victory for universal health care.

Next: 2003 Medicare changes— corporate giveaway in the name of reform.

• Part 1: The urgency of reform
• Part 2: Cold War politics forced Truman’s hand
• Part 3: Soviet medicine—a workers’ health plan
• Part 4: Radical movements create context for 1960s health care reform
• Part 5: Cuban socialism builds model health system
• Part 6: Attacks on Obama plan mirror Clinton health debate
• Part 7: Corporate giveaway in the name of reform
• Part 8: The impact of technology on health delivery and access
• Part 9: The road to health care justice