The Politics of Health-Care Reform

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Clinton Legacy

Politicians have also taken to heart the lesson of 1993-94, when then-First Lady Hillary Clinton led the last national effort to reform health care. It ended in disaster, amid charges the Clinton Administration was trying to impose socialized medicine on Americans. As a result, candidates now believe the more detailed a health-care reform plan they put forward, the more political problems they will have. This may explain why Senator Clinton (D-N.Y.) herself, the Democratic front-runner, was that last of the major candidates from her party to to issue a detailed health-care proposal, laying our her proposal on Sept. 17.

Clinton's plan is far less complex than the effort she tried to push through with her husband in the prior decade, but it does go further than that of chief rival Sen Barack Obama by mandating that everyone buy insurance. It also takes on the insurers that were instrumental in scuttling that first effort. Under Clinton's new proposal, all Americans would be required to carry insurance, either through their employers, through an expanded version of the insurance available to federal employees, or a new government-run Medicare style plan. There would be tax subsidies and credits to cover the premiums, and no one could be turned down by an insurer for a pre-existing condition or other health issues. "You'll never again have to worry about finding afforable coverage," Clinton said at a campaign stop in Iowa where she unveiled her plan. "If you pay your premiums and follow the rules, your insuranc company will be required to renew at a price you can afford."

On the campaign trail, Clinton is often questioned about health-care reform and her earlier failure. In an interesting twist, she is trying to turn that failure to her advantage. At the recent meeting of the AARP, Clinton admitted she blew it 14 years ago, but says she learned from that experience how to negotiate the Washington process.

Now she says she is both ready and able to take on the insurance and drug companies that lobbied so hard against the 1994 effort. Her strongest statement to date on that point came Sept. 12 at a Democratic candidates' debate sponsored by the online magazine Slate. "I intend to dramatically rein in the influence of the insurance companies, because frankly I think they have worked to the detriment of our economy and of our health-care system," Clinton said.

For Some, a Centerpiece

So far, polls show Clinton leading with the voters on health care, precisely because they see her as the most experienced of the candidates on this issue. That perception has caused considerable grousing from staffers on Barack Obama's campaign. They find it particularly galling because Senator Obama (D-Ill.) has issued a position paper on health care with far more detail than anything Clinton has provided. An Obama adviser was recently quoted in The New Yorker as saying: "I'm sure George Bush learned how not to invade Iraq. Should we then trust him to invade Iran?"

Obama is not alone in spelling out exactly what he has in mind for health care. John Edwards and New Mexico Governor Bill Richardson have both made it a centerpiece of their campaigns in an effort to appeal to a Democratic base that is more concerned about such matters than are Republican voters. As a result, GOP candidates have been far more circumspect: Republican front-runner Rudy Giuliani doesn't have a health-care issue statement on his campaign Web site, and Fred Thompson, who entered the race in early September, has yet to take a position.

Ultimately, though, political consultants say the details of any reform plan may not matter to the electorate as much as the candidate's commitment to make a change—that and the number of uninsured in the Census Bureau report due out next August, two-and-a-half months before the election.

Check out the BusinessWeek.com slide show for a review of the candidates' views on health-care reform.

Arnst is a senior writer for BusinessWeek in New York .