Avoiding Clinton’s Mistakes on Health Care

Barack Obama is determined to avoid the mistakes made by Bill in Hillary Clinton in their ineptly managed attempts at health care reform in the 1990’s. The Boston Globe reports:

The Obama team is determined to avoid the mistakes of the early 1990s, when the Clinton White House created a healthcare policy team that had more than 500 members and spent months secretly developing a 1,342-page proposal with minimal input from Congress. A lack of investment among congressional leaders helped doom the bill, which never even went to a vote.

Obama and his team – headed by former Senate majority leader Tom Daschle, who will serve as a bridge to Congress – have already begun privately engaging with congressional leaders and have emphasized that they intend to work more collaboratively on healthcare than the Clintons did, said the two leading Democratic senators on healthcare reform.

“Congress did not want to be told what to do,” said Max Baucus, the Senate Finance Committee chairman, whose committee will determine whether a healthcare overhaul is fiscally feasible. “They’re very cognizant of that and they don’t want to make the same mistake.”

“The only way for this to work is to have both ends of Pennsylvania Avenue working hand-in-glove,” Senator Edward M. Kennedy, chairman of the Health, Education, Labor and Pensions Committee, said in a statement. “And all signs are that’s how it will proceed. It’s not Congress or the White House, it’s both together.”

Consideration of the fact that we have both an Executive and Legislative Branch would provide a welcome change from the attitude of both the Clinton administration on health care and the Bush administration on virtually everything. This addresses some of the problems of the Clinton approach but not all.

HillaryCare died not simply because of Harry and Louise ads from the insurance industry but because a majority of Americans felt it was a bad plan being imposed upon them from above. This meant not only that it was a plan developed in secret by the Clinton White House, but was also was a reaction to the type of plan developed. The plan was overly complex and overly regimented.

Many Americans are uninsured or under-insured and desire assistance in obtaining affordable health care. Many others are perfectly happy as they are and do not want the government to be any more involved in their lives. A successful plan must consider both views–as Obama often has when discussing his plans for change.

A health care plan must be kept as simple as possible (considering the complexity of health care). This means simple for the individual–not the government. In many ways it would be simpler for the government for a plan to have mandates, avoiding all the problems of individuals who choose to postpone purchasing health care. This complicates things for writers of a health care plan but is not an insolvable problem. The otherwise faulty Medicare D Plan has managed to overcome this problem by having the rates adjusted based upon when someone joins the  plan. Even the Medicare B plan is voluntary. Besides, mandates make it far too easy for politicians to claim to have provided health care for all even if it means requiring everyone to participate in a bad plan. Freedom of choice provides a necessary safety valve to ensure that the plans are truly beneficial.

The question of mandates arose during the 2008 nomination battle between Obama and Clinton. Mandates, along with the manner in which the plan was developed, were only a portion of the problems with Hillary Clinton’s approach to health care. The plan was overly complex, such as in its demands for creations of regional alliances of health care providers with vast government regulation.

The reaction against such an unnecessary over-expansion of government led to Republican dominance of government for years afterwards. Subsequently we have seen more modest attempts at government involvement to expand access to health care, such as in the plans promoted by John Kerry in 2004 and Barack Obama in 2008. Hopefully Congress, along with the Obama administration, remember all the lessons of the failure of HillaryCare in working on health care legislation.

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