HILLARYCARE AND HISTORY (is she lying in wait?)

EXCERPT--CIRCA 2008---Jim Cooper, the conservative Democrat from Tennessee. Cooper has a genuine and long-standing interest in health care reform. During the 1993-94 fight, he quickly worked his way into the conversation by proposing a centrist bill designed to attract the support of Republicans as well as Democrats.

In this, he succeeded. His bill, which called for partially restructruing the insurance market and offering subsidies to the uninsured, eventually won over 26 Republicans and 32 Democrats. Over in the Senate, Senators John Breaux and Daniel Patrick Moynihan co-sponsored it.

But the bill was not nearly as comprehensive as Clinton's. Most notably, it didn't require employers to put up money for their workers' insurance -- a key feature of the Clinton plan. As a result, it wouldn't have covered everybody.

Cooper and his supporters admitted as much. They simply figured that such a piecemeal reform -- one designed to reach some of the uninsured, though not all -- was preferable to the complete overhaul Clinton had in mind. This wasn't just a political judgment; it was, for many of them, a policy preference at well. They simply weren't comfortable with the such an intrusion into the marketplace.

Hillary Clinton didn't see things that way. And, as Brooks explains today, she made those feelings quite clear:

On June 15, 1993, Cooper met with Clinton to discuss their differences. Clinton was “ice cold” at the meeting, Cooper recalls. “It was the coldest reception of my life. I was excoriated.”

Cooper told her that she was getting pulled too far to the left. He warned that her plan would never get through Congress. Clinton’s response, Cooper now says, was: “We’ll crush you. You’ll wish you never mentioned this to me.”

This account is consistent with others, including ones provided in The System (the authoritative history of the Clinton health care battle written by David Broder and Haynes Johnson). Joshua Green's exhaustive look at Hillary Clinton, which the Atlantic published in November, 2006, recounts a similar episode that apparently happened a few months after the one Brooks describes.

And, as we all now know, things didn't quite work out as Hillary predicted. The Clinton plan died a quiet death in the fall of 1994. Former administration officials and allies have since criticized Hillary, in particular, for being so inflexible. And they've wondered, on more than one occasion, whether they should have taken Cooper's bill -- or something like it -- when it was still a viable option.

It's a good question -- but not such an easy one to answer. The Cooper bill never got the same scrutiny the Clinton proposal did; if it had, huge flaws would have become apparent. Nor is it clear that all of those Republcian co-sponsors were serious about embracing even modest reforms. As a 1994 National Journal article by Julie Kosterlitz noted,

The more visible the Cooper and Chafee bills become, the more questions arise about their technical and political feasibility. Many supporters of the two bills, when pressed, confess that they have misgivings about some key features and hint that they have signed onto them mainly for tactical reasons.

It's also important to remember that the administration did try -- albeit somewhat unsuccessfully -- to keep an open line of communication with the sponsor of a different centrist measure, the one sponsored by the late Rhode Island Senator John Chafee. Chafee's bill, although also flawed in the specifics, did try to cover everybody. (In fact, it bears more than a passing simliarity Clinton has proposed this year.) But, in the end, Republicans weren't that excited about his approach, either.

This does't mean Hillary couldn't have been more accommodating, both stylistically and substantively (although Paul Starr, who was part of the Clinton health care brain trust, has argued she had less influence over the decisions at that time than many people suspect). But Clinton has also said she learned from that episode. And in this year's campaign, she's shown signs that she means it. Among other things, she's promised to let Congress write the details of the plan, rather than hand them a 1,200 page bill. (Rest assured, when Congress is done, it will still be plenty long. It's unavoidable when you're contempating something this ambitious.)

At the same time, Clinton has also indicated -- both in speeches and interviews -- that she is still committed to getting universal coverage if she can. She'll compromise on the means, not the ends. The style is different, but the underlying commitment to universal coverage is still there.

At the end of the day, does that mean she's better positioned to deliver universal health care than Barack Obama is? That's a tough call, particularly when you consider his political strengths -- which, frankly, look more formidable by the day. It's not yet clear whether the support for universal coverage actually exists. If it doesn't, I imagine he has more ability to move public opinion -- and build up trust among skeptics -- than she does. Plus there's his history in Illinois, where liberal advocates for health care reform had only good things to say about him.

Then again, it's not clear whether Barack Obama is as committed to the goal of universal coverage as she is. That is is one reason Paul Krugman, among others, keeps raising questions about his candidacy.

Either way, I think it's wrong to say Clinton got everything wrong last time around. And I'm glad to see that she seems to think the same thing.

Hillary came to Philadelphia to tout the benefits for her plan and they had all of these planted questioners lobbing softball questions to her:
Example:
- Q: “My child has had xxxxx disease and it’s been a struggle xxxx ... I don’t work and have never held a job .. will they be covered fully?”
- A: Of course, all their bills will be covered and it will actually save money because of the inefficiencies that will be removed from the system .. and so on.

So I got in line and asked a different sort of question:
Q: There have been recent Medicare scandals where the CBO faulted the agency for being overly bureacratic and inefficient and also stated that fraud constituted significant portion of the dollars spent. My question has two parts:
- Since the federal government already controls a significant portion of the healthcare market via Medicare, how will your plan be any more efficient and less fraudulent than Medicare
- For every person that has already asked you a question, your answer has been that all their ailments will be covered, and they’ll pay less than they are paying now, or will pay nothing if they can’t afford to make payments. I’m skeptical that there will be anywhere near the level of savings in your plan that you are promising and I fear that your plan will lead to an explosion of our debt, unless care is rationed. Since you seem so confident in the savings, will you include language in your plan that the amount that is spent on your program cannot exceed the amount that is budgeted and that the budgeted amount cannot add to our debt?

Hillary stammered for a few minutes and then C. Everett Koop (the quaker oats guy) told me I shouldn’t be so concerned about the money and the cost and should be focused on the more altruistic parts of the plan.

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