Hillary Clinton knows a little something about health care reform. Namely, she knows how personal an insurance plan and the doctor/patient relationship are to Americans, which not only makes it hard to get reforms through Congress, it makes it nearly impossible to even discuss wholesale changes.
Clinton knows these things because she’s been in the trenches before, working on the Health Security Act, i.e. “Hillarycare,” in the early years of her husband’s presidency.
President Clinton made health care reform the immediate goal of his first term, thinking he had found an opportunity to complete what liberals considered to be the capstone to the New Deal. The push stalled almost immediately. The far-left elements of the Democratic party pushed for Medicare-for-all single-payer plan, the center of the party embraced the notion of a “pay or play” coverage mandate that would require employers to provide coverage or pay a tax, and the more conservative Blue Dogs wanted more market-centric reforms.
The disarray meant that Republicans, many of whom believed they couldn’t stand in the way of health care reform, didn’t have a plan they could focus on and negotiate around. For Democrats, it meant that party’s leaders couldn’t get enough votes to pass any one proposal, let alone stop a filibuster. And for the Clintons, that meant their overly bold reform ideas were dead (and so were their majorities in Congress)
So what does that mean for 2016? Ezra Klein writes for Vox:
[T]he lessons her team took away are clear and deeply held. When it comes to health reform, do not screw with what people already have.
The Clinton plan wasn’t single-payer, but it was a lot closer than what we have now. Her plan would have upended the insurance of virtually everyone in America. And it was eviscerated because of it. The fact that, on net, there would have been many more winners than losers didn’t matter. That much disruption is impossible to pass through the American political system. It set the cause of universal health care back a generation.
Clinton’s view is that anyone who actually cares about insuring the uninsured needs to grapple with the power of the status quo — and Sanders hasn’t come close. He hasn’t even released a real plan, which, quite fairly, drives Clinton nuts.
In fact, it has driven Clinton so completely bonkers that she’s set the notion of “primary politics” aside and launched a misguided, full-scale attack on Sanders’ single payer idea.
She first went after the finances of single payer. “There is no way that can be paid for without raising taxes on the middle class,” Clinton said. “The arithmetic doesn’t add up.”
She then accused him of turning over enforcement of the plan to the states, which could create a patchwork plan. “His plan would take Medicare and Medicaid and the Children’s Health Insurance Program, and the Affordable Care Act, and health-insurance and private employer health insurance, and he would take that all together and send health insurance to the states, turning over your and my health insurance to governors,” Clinton said in Iowa.
And then she sent used her daughter for her biggest attack. “Senator Sanders wants to dismantle Obamacare, dismantle the CHIP program, dismantle Medicare, and dismantle private insurance,” Chelsea Clinton warned.
The decision to attack a fellow Democrat, especially on an issue as sacred to the progressive mindset as single-payer, has not gone over well. Liberals are attacking her for being disingenuous about the details and for eroding their hopes of achieving the progressive Utopia of entitlements-for-all. And Republicans are keen to point out that Clinton’s decision to play offense coincides with a dramatic dip in the polls, making her seem desperate.
But none of those explanations seem to tell the whole story. What I see is a Clinton who takes health care reform very personally because she’s spent a lot of time and lost a lot of political capital trying to get it done. And she’s indignant at the idea that a former mayor, who has read about single-payer in textbooks, but has no sense of the real-world difficulties of pushing such a sweeping reform through Congress, has any authority to speak on the issue.
For once, she may be right. And she may have had the chance to give her unique perspective on the issue and its political contours if only she hadn’t fought to limit debates.