June 10, 2006


Wounds Salved, Clinton Returns to Health Care (ROBIN TONER and ANNE E. KORNBLUT, 6/10/06, NY Times)

Today, her plans to expand coverage are tempered and incremental. Her first major goal appears to be universal health coverage for children, which she hopes to advance by expanding the State Children's Health Insurance Program, or Schip, an existing federal program up for review in 2007. [...]

Mrs. Clinton is quick to admit errors and thereby distance herself from the old plan. "I think that both the process and the plan were flawed," she said in the interview. "We were trying to do something that was very hard to do, and we made a lot of mistakes."

But some analysts say the old vulnerability — the memory of what conservatives scornfully called "Hillarycare" — remains, and could be revived in the heat of a presidential campaign. Moreover, the history puts Mrs. Clinton in a peculiar box.

"On the Democratic side, people will hunger for a major proposal," said Robert J. Blendon, a Harvard professor and expert on public opinion and health. "But she's extremely vulnerable to Republicans saying, the minute she articulates something, 'Here we go again, a major expansion of government plans and plans that hurt business.' "

The woman who was sharply criticized a decade ago for a lack of political realism is now steeped in it. If her cardinal sin in 1993-94 was overestimating the public's appetite for change, as many analysts contend, she seems intent on not repeating the error. When employers complain to her about the need for federal action on health care, she said, "I say back to them, 'Fine, what are you going to do to help us create the consensus that has to develop in order to move the political system?' "

In her own search for consensus, Mrs. Clinton hired as her domestic policy adviser Laurie Rubiner, a health policy expert who for many years worked for Senator John H. Chafee, the moderate Rhode Island Republican, until his death in 1999. That has fueled suspicions on the left that Mrs. Clinton is growing too cautious and moving to the center on health care.

She encounters that perception on many issues these days; on health care it has been reinforced by her work alongside prominent Republicans like Newt Gingrich and Senator Bill Frist on goals like upgrading medical information technology.

Still, that cautious and occasionally bipartisan approach could help lighten the ideological baggage of 1993-94, when she ended up in a ferocious battle with small businesses, the insurance industry and the drug companies.

Mrs. Clinton often frames the problem today as one of economics as much as social justice. She asserts that soaring health costs are weighing down American corporations and hindering their ability to compete in a global marketplace, against countries with government-financed health benefits or no expectation of health coverage at all.

If she got together with the moderate Democrats in the Senate, Bill Frist, the President, and a couple big-time businessmen (Jack Welch, Bill Gates, Paul O'Neill, Robert Rubin types) to offer universal health coverage centered around lifetime HSAs with taxpayer subsidies for poor children, mandatory employer contributions, and the like she'd not only be able to get historic social legislation through Congress but establish herself as the kind of Third Way candidate who could actually be elected president if the GOP fails to nominate a McCain or Guiliani.

Posted by Orrin Judd at June 10, 2006 10:00 AM


What makes you think she's interested in the "3rd way?" (or any other rational policy)

H. Clinton is in unapologetic socialist who won't be happy until people like you and me are silenced and/or "re-educated."

Posted by: Bruno at June 10, 2006 11:04 AM

Plus, she clearly doesn't want to achieve a new health care plan until after '08.

Posted by: David Cohen at June 10, 2006 12:05 PM

She's interested in being president, which means she has to adopt the Third Way.

Posted by: oj at June 10, 2006 12:29 PM

Yes, but she can't be elected without proving she's changed.

Posted by: oj at June 10, 2006 12:33 PM

I suspect part of the problem with health care reform is similar to the problem with education reform: lots of people think lots of other people need it, but don't want their coverage/school screwed up by meddling politicians. Thus school vouchers get voted down by the suburbs, in fear that their good schools will be overrun by students escaping bad schools.

HillaryCare got defeated the first time because it would basically have made private health care illegal: it would have been the federal government system or nothing. The left thought it would be perfect, but everyone else ran for the hills. So the trick for her this time is to come up with a system that is universal enough to please the left, but not so socialist it spooks everyone else. In theory she could do it with libertarian---oh excuse me, "Third Way" solutions like HSAs, but I doubt if she or the left would stand for building such freedom into their proposal.

Posted by: PapayaSF at June 10, 2006 1:10 PM

Why should the rich get subsidized health care?

Posted by: Sandy P at June 10, 2006 1:13 PM

If she really wants to be forward-looking - start w/Congress and change theirs.

Posted by: Sandy P at June 10, 2006 1:13 PM

No, folks actually do want health coverage for the poor because they figure it won't harm their own. They oppose school reform because it might bring black kids to junior's class.

Posted by: oj at June 10, 2006 1:16 PM


Isnm't that what Democrats propose--giving everyone the plan Congreess gets?

Posted by: oj at June 10, 2006 1:17 PM

HSAs don't address the problem, so I doubt Clinton will incorporate them; and one of the motivating factors in universal health care is decoupling health care from employment. When health care is tied to employment, many people can't get access to it, and employers that do provide it are less competitive because of the costs.

The business community is gradually coming around to UHC, since it's patently in their interests, and Clinton's emphasis on economic efficiency will play to that.

Posted by: jpe at June 10, 2006 6:44 PM

They are the only thing that addresses the problem by making people consumers again. You can't argue for efficiency and against HSAs.

Posted by: oj at June 10, 2006 6:56 PM

With HSAs, you pay out of pocket - there's a strong incentive to underconsume medical care and not take care of things that can be far more expensive down the road.

HSAs have some use, but it's not insurance, and can't be substituted for insurance.

Posted by: jpe at June 10, 2006 7:31 PM

Exactly. If you aren't the one paying you have no incentive to shop.

Posted by: oj at June 10, 2006 8:47 PM

HSAs won't empower consumer choice, will they? We'll still be insured, and our choices will still be made for us by the insurance network.

Posted by: jpe at June 10, 2006 10:32 PM

No, that's quite wrong.

Posted by: oj at June 10, 2006 10:46 PM

jpe: HSAs are generally used with insurance, and aren't coupled to employment.

Posted by: PapayaSF at June 10, 2006 10:56 PM

HSAs are generally used with insurance, and aren't coupled to employment.

Exactly - HSAs are no substitute for insurance. Medical bills are expensive, and there's no way anyone could pay for those bills w/o insurance.

Posted by: jpe at June 11, 2006 12:43 PM

They are a substitute for comprehensive insurance which almost no one needs but everyone wastes money on. Medical bills are more expensive because of insurance.

Posted by: oj at June 11, 2006 12:58 PM

Yes. Then why are we blathering non-stop about health insurance?

Medicare paid our local hospital and the rehab facility where they sent here over $40,000 for approx. five weeks during which she received no treatment other than to be kept comfortable. They sent her to an ALF where we paid almost $10,000 for 32 days and received a posthumous bill from their pharmacy for medication totaling $800.00 for the month following her death.

Posted by: erp at June 11, 2006 5:37 PM

Sorry. I am referring of course my recently deceased mother.

Posted by: erp at June 11, 2006 5:58 PM