Sickness & struggle, part 6
Attacks on Obama plan mirror Clinton health debate
Published Oct 1, 2009 9:09 PM
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
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
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.
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