Clinton-era Health Aides Push to Save Obamas Tactic
February 8th, 2010
Clinton | 
Aides who shaped Bill and Hillary Rodham Clintons 1990s plan to cover all Americans, then labored in vain to pass it into law, are adamant that the Democrats cant afford another health care disaster. But theyre divided on whether scaling down Obamas plan would be an acceptable solution.
The Clintonistas - now in think tanks, universities, serving in the Obama administration or lobbying - are a potent voice in the furious debate within the Democratic Party over how to salvage health care. Listened to because theyre the veterans of the last health care policy war, they carry the scars of intense striving reduced to utter futility.
“If Bill Clinton couldnt get it done, and Barack Obama cant do it, no Democrat will ever try again,” said economist Len Nichols, health policy director at the New America Foundation. A Clinton White House health budget aide, Nichols has been operating as an unofficial adviser to lawmakers and administration officials wrestling with details of the current legislation.
“History is written by the victors, not the vanquished,” said Chris Jennings, congressional liaison for then-first lady Hillary Clinton during the 1990s debate. “Failure would serve as the ultimate judgment as to whether this effort was worth doing.” Jennings, now a lobbyist, replaced Ira Magaziner, principal architect of the Clinton plan, as White House health policy adviser.
The former first lady, now secretary of state, says “its really hard” watching the travails of Obamas plan. Hillary Clinton has been giving advice, as requested, to lawmakers in Congress and administration officials, and says shes still hopeful. “Im not sure that this last chapter has been written,” she told CNNs “State of the Union” on Sunday.
For most of last year, the health care debate was among Democrats. Republicans were left heckling from the sidelines. That changed when Republican Scott Brown pulled off a Senate upset in Massachusetts, winning the seat held by the late Sen. Edward M. Kennedy and depriving Democrats of the 60-vote majority they were counting on in the final push.
“Many of us thought we were really at the 1-inch line, then literally it was like being hit by a freight train with about 10 seconds warning,” said Ken Thorpe, a senior Health and Human Services official during the Clinton-era debate. Now a health policy professor at Emory University in Atlanta, Thorpe has proposed a scaled-back alternative in case Obamas plan cant get unstuck.
The mere mention of settling for less is causing consternation among former Clinton aides. Obamas health care plan - denounced as a government power grab by critics - is already scaled back from the ambition of the Clinton years.
Clinton would have changed how people covered by large employers got health insurance; Obama does not. Clinton required all employers to contribute significantly to the cost of coverage; Obama exempts small businesses. Clinton aimed at insuring all; Obamas plan reaches around 95 percent of eligible Americans. Todays Senate bill - supported by Obama - resembles a plan drafted by a moderate Republican senator in the Clinton years.
“It takes too much work to figure out what scaled back means,” said Judy Feder, a former colleague of Thorpes at human services, now a health policy professor at Georgetown University in Washington. “You cant do insurance reforms alone without expanding coverage, and the expansion costs money. I dont see the politics coming together for scaling back.”
The Obama plan focuses on those who have the most trouble getting and keeping health insurance, small businesses and people who buy their own coverage. They would be able to buy private coverage in a new kind of regulated marketplace, with government subsidies for many. Insurers would be forbidden from turning down people with medical problems. Most Americans would be required to carry health insurance.
“We are using the private insurance market and private incentives, as opposed to command-and-control,” said Nichols. “As a policy matter, we are in the middle.”
The president has sent mixed signals. Early after the Massachusetts defeat, Obama raised the possibility of paring back his proposal. Then he insisted he still wants a comprehensive approach. Just last Thursday, he publicly raised the prospect that Congress might not act at all.
On Sunday, the president invited GOP and Democratic leaders to discuss possible compromises in a televised gathering later this month.
The Democrats reversal “is like a big body blow,” said Jennings. “You either stammer and fall down, or you stammer and regain your balance. What Americans respect are those people who can take a punch and come back.”