Living History, by Hillary Rodham Clinton: on Health Care

Al Franken: 1994: Wrote spoof ads for Hillary defending health reforms

For the Gridiron Dinner, comedian Al Franken wrote a script.

Bill and I were seated on a sofa, examining a massive sheaf of papers.

Me: I've just read the Clinton health security plan.

Bill: Health care reform sounds like a great idea to me.

Me: Well, I know, but some of these details sure scare the heck out of me.

Bill: Like what?

Me: Like for example, it says here on page 3,764 that under the Clinton health security plan, we could get sick.

Bill: That's terrible.

Me: Well, I know. And look at this, it gets worse. On page 12,743--no, I get that wrong--on page 27,655, it says that eventually we're all going to die.

Bill: You mean after Bill & Hillary put all those bureaucrats and taxes on us, we're still going to die?

Together: There's got to be a better way.

Announcer: "Paid for by the Coalition to Scare Your Pants Off."

Bill Clinton: 1992 campaign: “It’s the economy, stupid” but healthcare too

Bill and expert advisers began developing ideas about how to tackle health care. Bill previewed those plans in a campaign book entitled Putting People First and in a speech. The reforms he outlined included controlling spiraling health care costs, reducing paperwork and insurance industry red tape, making prescriptions more affordable to those in need, and, most important, guaranteeing that all Americans had health insurance. We knew that trying to fix the health care system would be a huge political challenge. But we believed that if voters chose Bill Clinton on Nov. 3, it meant that change was what they wanted.

Bill Clinton: OpEd: Opposition to reform are "theologically-held" opinions

The historical odds were against Bill because attitudes about health care reform were diverse, even among Democrats. As one expert put it, opinions are "theologically held"--this impervious to reason, evidence or argument. But Bill felt he had to show the public and the Congress that he had the political will to move forward and make good on his campaign promise to take immediate action on health care. Reform was not only good public policy that would help millions of Americans. It also was inextricably tied to reducing the deficit.

Bill Clinton: Allowing patients to choose doctors is non-negotiable

The best model was the Federal Employees Health Benefit Plan, which covered nine million federal employees and offered an array of insurance options to its members. Prices and quality were monitored by the plan's administrators.

Under managed competition, hospitals and doctors would no longer bear the expense of treating patients who weren't covered because everyone would be insured through Medicare, Medicaid, the veterans and military health care plans or one of the purchasing groups.

Perhaps most important, the system would allow patients to choose their own doctors, a non-negotiable item in Bill's view.

Bill Clinton: Despite reform failure, smaller reforms helped millions

On balance I think we made the right decision to try to reform the whole system. By 2002, with the economy in trouble again and the financial savings of managed care in the 90s having leveled out, health insurance costs were again rising, the number of people without insurance was going up and seniors on Medicare still didn't have prescription drug coverage. Someday we will fix the system. When we do it, it will be the result of more than 50 years of efforts by Richard Nixon, Jimmy Carter and Bill and me.

Hillary Clinton: 1990s reform called “secretive” but had 600 in working group

In addition to the President’s Task Force, we organized a giant working group of experts that would consider every aspect of health care. This group, comprising as many as 600 people, met regularly to debate and review specific parts of the plan in detail.

On February 24, we were dealt a blow that none anticipated. Groups affiliated with the health care industry sued the task force over its composition, claiming that because I was not a government employee, I was not allowed to chair or attend closed task force meetings.

It was a deft political move, designed to disrupt our work and foster an impression with the public and the media that we were conducting secret meetings.

We were trying to move too quickly on a bill that would fundamentally alter social and economic policy for years to come.

Hillary Clinton: Millions uninsured is source of America's healthcare crisis

Rising health care costs were sapping the nation's economy, undermining American competitiveness, eroding workers' wages, increasing personal bankruptcies & inflating the national budget deficit. As a nation, we were spending more on health care-- 14% of our GDP--that any other industrialized country.

This terrible cycle of escalating costs and declining coverage was largely the result of a growing number of uninsured Americans. Patients without insurance seldom could afford to pay for their medical expenses out-of-pocket, so their costs were absorbed by the doctors and hospitals that treated them. Doctors and hospitals, in turn, raised their rates to cover the expense of caring for patients who weren't covered or couldn't pay.

Hillary Clinton: Recommended "managed competition"; not single-payer system

Bill and other Democrats rejected the single-payer and Medicare models, preferring a quasi-private system called "managed competition" that relied on private market forces to drive down costs through competition. The government would have a smaller role, including setting standards for benefit packages and helping to organize purchasing cooperatives. The cooperatives were groups of individuals and businesses forget for the purpose of purchasing insurance. Together, they could bargain with insurance companies for better benefits and prices and use their leverage to assure high-quality care.

Hillary Clinton: 1994 "Harry & Louise" ads exploited consumer fears

For the Gridiron Dinner, Bill and I decided to stage a parody of the insurance lobby's TV spot, with Bill playing "Harry" and me playing "Louise." It would give us a chance to expose the scare tactics employed by our opponents and have some fun:

Me: On page 3,764 that under the Clinton health security plan, we could get sick.

Bill: That's terrible.

Announcer: "Paid for by the Coalition to Scare Your Pants Off."

Our videotaped performance was widely covered, even replayed on several Sunday morning new shows.

Hillary Clinton: When last Republican backed out, HillaryCare died

Health care faded with barley a whimper. I still think that was the wrong call. Giving up without one last public fight demoralized Democrats and let the opposition rewrite history.

Hillary Clinton: Despite failure, glad she tried system-wide reform

That said, I still believe we were right to try. Our work in 1993 and 1994 paved the way for what several economists dubbed the "Hillary Factor," the purposeful restraint on price increases during the 1990s. It also helped to create the ideas and political will that led to important smaller reforms in the years following.

On balance I think we made the right decision to try to reform the whole system. Someday we will fix the system. When we do it, it will be the result of more than fifty years of efforts by Harry Truman, Richard Nixon, Jimmy Carter and Bill and me. Yes, I'm still glad we tried.

Hillary Clinton: Low-tech low-cost water treatment for developing world

Newt Gingrich: 1994: Declined gov't insurance but gov't paid 75% anyway

Richard Nixon: 1970s: first proposed "employer mandate"

Pres. Nixon recognized the draining effects of health costs on the economy and proposed a system of universal health care based on what's known as an "employer mandate": all employees would be required to pay for limited benefits for their employees. Although as many as 20 different health care proposals were introduced in Congress during the Nixon Administration, no proposal for universal coverage got a majority vote from a congressional committee until 1994.

Presidents Ford and Carter also pursued reform in the 1970s, but they ran into the same political obstacles that had blocked change for most of the 20th century. Over several decades, the health insurance industry had grown increasingly powerful. The historical odds were against Bill.

Rush Limbaugh: 1994: Whitewater is about health care

One afternoon in Seattle at the end of July 1994, I pulled into town as part of the Health Security Express. Inspired by the Freedom Riders who traveled by bus across the South in the early sixties to spread the message of desegregation, health reform advocates organized this nationwide but tour in the summer of 1994.

Local and national radio hosts had been inciting protestors all week. One of them had urged listeners to come down and "show Hillary" what they thought of me. At least half of the 4,500 people who came to my speech in Seattle were protesters.

The protests were openly sponsored by a group called Citizens for a Sound Economy (CSE). Reporters eventually discovered and disclosed the fact that CSE worked in concert with Newt Gingrich's office.

Ted Kennedy: Acknowledged expert on healthcare issues

This knowledge gap became apparent to me one day at a meeting with a group of Senators. Ted Kennedy, one of the true experts on healthcare, listened to question after question posed by his colleagues. Finally he barked out, "If you would just look at page 34 of the briefing material you'll find the answer to that question." He knew every detail--including page numbers--off the top of his head.