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Revision as of 21:11, 18 September 2007 by Mwlin1 (talk | contribs) (→Controversy in retrospect and perspective: copy edit)(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)The Clinton health care plan, sometimes called "Hillarycare" by opponents, was a 1993 healthcare reform package proposed by the administration of Bill Clinton, then sitting President of the United States.
Background
Clinton had campaigned heavily on health care in the 1992 election, and he quickly set up the Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, to come up with a comprehensive plan to provide universal health care for all Americans, which was to be a cornerstone of the administration's first-term agenda. A major health care speech was delivered by Clinton to a joint session of Congress on September 22 1993, with an overwhelmingly positive response. In that speech, President Clinton explained the problem as follows:
Millions of Americans are just a pink slip away from losing their health insurance, and one serious illness away from losing all their savings. Millions more are locked into the jobs they have now just because they or someone in their family has once been sick and they have what is called the preexisting condition. And on any given day, over 37 million Americans -- most of them working people and their little children -- have no health insurance at all. And in spite of all this, our medical bills are growing at over twice the rate of inflation, and the United States spends over a third more of its income on health care than any other nation on Earth.
Hillary Rodham Clinton's leading role in this project was unprecedented for a presidential spouse. This unusual decision by President Clinton to put his wife in charge of the project has been attributed to several factors, including the President's desire to emphasize his personal commitment to the enterprise, and more controversially including a quid pro quo in which she would "defend him from sex-related charges."
Although the United States has never had a universal health care system, it does have certain publicly funded health care programs that help to provide for the elderly and disabled (via Medicare), military service families and veterans (via the Veterans Health Administration), and the poor (via Medicaid). Additionally, federal law guarantees public access to emergency services regardless of ability to pay.
Debate
Starting on September 28, 1993, Hillary Clinton appeared for several days of testimony before five congressional committees on health care. Opponents of the bill organized against it before it was presented to the Democratic-controlled Congress on November 20, 1993. The bill was a complex proposal running more than 1,000 pages, the core element of which was an enforced mandate for employers to provide health insurance coverage to all of their employees through competitive but closely-regulated health maintenance organizations (HMOs). The full text of the November 20 bill (the "Health Security Act") is available online.
Conservatives, libertarians, and the insurance industry staged a campaign against the "Health Security" plan and criticized it as being overly bureaucratic and restrictive of patient choice. The effort included extensive advertising criticizing the plan, including the famous Harry and Louise ad paid for by the Health Insurance Association of America, which depicted a middle-class couple despairing over the plan's supposed complex, bureaucratic nature. Time, CBS News, CNN, the Wall Street Journal and the Christian Science Monitor ran stories questioning whether there really was a health-care crisis. Op-eds were written against it, including one in The Washington Post by University of Virginia Professor Martha Derthick that said:
In many years of studying American social policy, I have never read an official document that seemed so suffused with coercion and political naivete ... with its drastic prescriptions for controlling the conduct of state governments, employers, drug manufacturers, doctors, hospitals and you and me.
U.S. Senator Daniel Patrick Moynihan qualified his agreement that "there is no health care crisis" by stating "there is an insurance crisis" but also indicated "anyone who thinks can work in the real world as presently written isn't living in it." Meanwhile, Democrats, instead of uniting behind the President's original proposal, offered a number of competing plans of their own. Some criticized the plan from the left, preferring a Canadian-style single payer system.
The First Lady's role in the secret proceedings of the Health Care Task Force also sparked litigation in the U.S. Court of Appeals for the D.C. Circuit, in relation to the Federal Advisory Committee Act (FACA) which requires openness in government. The Clinton White House argued that the Recommendation Clause in Article II of the U.S. Constitution would make it unconstitutional to apply the procedural requirements of FACA to Hillary's participation in the meetings of the Task Force. Some constitutional experts argued to the court that such a legal theory was not supported by the text, history, or structure of the Constitution. Ultimately, Hillary Clinton won the litigation when the D.C. Circuit ruled narrowly that the First Lady of the United States can be deemed a government official (and not a mere private citizen) for purposes of not having to comply with the procedural requirements of FACA.
Defeat
In August of 1994, Democratic Senate Majority Leader George J. Mitchell introduced a compromise proposal that would have delayed requirements of employers until 2002, and exempted small businesses. However, "Even with Mitchell’s bill, there were not enough Democratic Senators behind a single proposal to pass a bill, let alone stop a filibuster."
A few weeks later, Mitchell announced that his compromise plan was dead, and that health care reform would have to wait at least until the next Congress. The defeat weakened Clinton politically, emboldened Republicans, and contributed to the notion that Hillary Clinton was a "big-government liberal" as decried by conservative opponents.
The 1994 mid-term election became a "referendum on big government — Hillary Clinton had launched a massive health-care reform plan that wound up strangled by its own red tape." In that 1994 election, the Republican revolution led by Newt Gingrich gave the GOP control of the House of Representatives, and the Senate too, ending prospects for a Clinton-sponsored health care overhaul. Comprehensive reform aimed at creating universal health care in the United States has not been seriously considered by Congress since.
Controversy in retrospect and perspective
In 2004, as a U.S. senator from New York, Hillary Clinton argued in the The New York Times that the current health care system is unsustainable, and she offered several solutions. Her article also mentioned areas of agreement with one-time opponent Newt Gingrich, and likewise Gingrich has expressed agreement with Senator Clinton on some aspects of health care, including a bill to modernize medical record keeping.
In 2005, referring to her previous efforts at health care reform, Hillary Clinton said "I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done." Again in 2007, she reflected on her role in 1993-1994: "I think that both the process and the plan were flawed. We were trying to do something that was very hard to do, and we made a lot of mistakes."
Hillary Clinton received hundreds of thousands of dollars in campaign contributions from doctors, hospitals, drug companies, and insurance companies for her 2006 re-election in the Senate, including several insurance companies that were members of the Health Insurance Association of America that helped defeat the Clinton Health Plan in 1994. Charles N. Kahn III, a Republican who was executive vice president of the Health Insurance Association in 1993 and 1994, refers to his previous battles with Clinton as "ancient history," and says "she is extremely knowledgeable about health care and has become a Congressional leader on the issue."
In the years since the Clinton effort of 1993-1994, a combination of factors have kept health care off the top of the agenda. For example, politicians have not been eager to confront the forces that successfully frustrated the Clinton effort, and health maintenance organizations have been able to limit cost increases to some extent.
The Clinton health care plan remains the most prominent national proposal associated with Hillary Clinton, and may influence her prospects in the 2008 presidential election. There are some similarities between the Clinton Health Plan and Republican Mitt Romney's health care plan that has been implemented in Massachusetts.
Current estimates put US healthcare spending at approximately 15% of gross domestic product, which is the highest in the world, and government spending (including tax benefits) accounts for more than 44.6% of total health spending in the United States. Still, only an estimated 84.3% of citizens have some form of health insurance coverage, either through their employer or purchased individually, and Americans apparently continue to have a relatively low life expectancy compared to other industrialized nations such as Australia, the United Kingdom, Canada, and Sweden. Infant mortality rates also appear to be higher in the United States, despite declines in recent decades. However, health statistics may have less to do with the quality of health care than with variations in the way countries collect their data.
On September 14, 2007, a former Clinton Administration senior health policy advisor Paul Starr published an article named The Hillarycare Mythology, where he asserted that Hillary Clinton was actually just a spokesperson for the plan, that she in fact knew nothing about it, and when it failed her husband actually used her to distance himself from it.
Many analysts believe that life expectancy in the United States could be best addressed by decreasing obesity rates, and former President Clinton has made tackling childhood obesity a major priority of his, in recent years. In 1997, during President Clinton's second term, Congress enacted a health insurance program that was intended to improve coverage for children (the SCHIP program).
References
- i.e. Gratzer, David. "The Return of HillaryCare" ]. 05/23/2005, Volume 010, Issue 34. Retrieved 2007-August-07.
- Clinton, Bill. Address to Joint Session of Congress as Delivered (2003-09-22).
- ^ "Events leading up to Clinton's Healthcare Address to Congress," Timeline from PBS's The System. Accessed June 10, 2007.
- ^ Cohn, Jonathan. "Hillary was Right - The health care plan that dares not speak its name," The New Republic, June 5, 2007. Accessed June 8, 2007.
- Hodgson, Godfrey. The Gentleman from New York: Daniel Patrick Moynihan : a Biography, page 349 (2000): "Hillary Clinton was out in front on this project to a degree unprecedented among presidential wives."
- ^ Bok, Derek. "Political Leadership in the Great Health Care Debate of 1993-1994" in Public Discourse in America: Conversation and Community in the Twenty-First Century by Stephen P. Steinberg, Judith Rodin, page 96 (2003): "the President took the unprecedented step of naming his wife."
- Phillips, Kevin. "All in the Family; Two books attempt to get at the real Hillary Clinton", Washington Post (2007-06-10):
Hillary's influence over policy and personnel peaked when her husband needed her to defend him from sex-related charges, especially in 1992, 1993, 1998 and 1999. Dick Morris and historian Doris Kearns Goodwin both confirm the chronology. This helps to explain how Ms. Clinton could race ahead, unbridled, in 1993-94 with her disastrous health reform program.
Philips was reviewing a book by Carl Bernstein titled, A Woman in Charge. See also Dick Morris, Rewriting History (2004).
- Centers for Medicare & Medicaid Services. CMS Programs & Information. Retrieved August 30, 2006.
- Centers for Medicare & Medicaid Services. Emergency Medical Treatment & Labor Act. Retrieved August 30, 2006.
- H.R. 3600, Health Security Act (1993-11-20).
- Moffit, Robert. "A Guide to the Clinton Health Plan", Heritage Foundation (1993-11-19):
he Clinton Administration is imposing a top-down, command-and-control system of global budgets and premium caps, a superintending National Health Board and a vast system of government sponsored regional alliances, along with a panoply of advisory boards, panels, and councils, interlaced with the expanded operations of the agencies of Department of Health and Human Services and the Department of Labor, issuing innumerable rules, regulations, guidelines, and standards.
- ^ Hernandez, Raymond and Pear, Robert. "Once an Enemy, Health Industry Warms to Clinton," The New York Times, July 12, 2006. Accessed June 9, 2007.
- "The Rise and Fall of the Political Catchphrase," Time, February 14, 1994. Traces the origins of the Republican counter-argument "there is no health care crisis." Accessed June 8, 2007.
- Will, George. "Inoculated for Exuberance?" The Washington Post, November 10, 2006. Accessed June 9, 2006.
- Kramer, Michael. "The Political Interest," Time, January 31, 1994. "Slowly but surely, Bill Clinton's health-care plan is headed for the triage unit." Accessed June 8, 2007.
- Sidak, J Gregory (1993). "Amicus Brief of J. Gregory Sidak in Association of American Physicians & Surgeons v. Hillary Rodham Clinton". Social Science Research Network. Retrieved 2007-08-21.
{{cite web}}: Check date values in:|date=(help) - Association of American Physicians and Surgeons, Inc. v. Hillary Rodham Clinton, 997 F.2d 898 (D.C. Cir. 1993).
- Pantel, Kant and Rushefsky, Mark. Politics, Power, and Policy Making: The Case of Health Care Reform in the 1990s (1997).
- ^ "The Evolution of Hillary Clinton," New York Times, July 13, 2005. Accessed June 8, 2007.
- Thomas, Evan. "Decline and Fall", Newsweek. {2006-11-20).
- Clinton, Hillary Rodham. "Now Can We Talk About Health Care?" The New York Times, April 18, 2004. Accessed June 8, 2007.
- "Gingrich, Clinton Collaborate on Health Care Bill," Associated Press in the Washington Post, May 12, 2005. Accessed June 10, 2007.
- Milbank, Dana. "The Reformer and the Gadfly Agree on Health Care," Washington Post, July 22, 2005. Accessed June 10, 2007.
- Toner, Robin and Kornblut, Anne. "Wounds Salved, Clinton Returns to Health Care," The New York Times, June 10, 2006. Accessed June 8, 2007.
- ^ Krugman, Paul, and Wells, Robin. "The Health Care Crisis and What to Do About It", New York Review of Books, March 23, 2006.
- Cannon, Michael. "What Mitt and Hillary Have in Common," The National Review Online, June 5, 2007. Accessed June 8, 2007.
If I were advising Sen. Clinton, I would be urging her to boast that her approach to health-care reform enjoys support from conservatives like the Heritage Foundation and Gov. Romney. If I were advising Gov. Romney, I would prescribe a severe case of amnesia and a health-care agenda that actually reduces the role of government.
- "The World Health Report 2006 - Working together for health."
- "Income, Poverty, and Health Insurance Coverage in the United States: 2004." U.S. Census Bureau. Issued August 2005.
- CIA World Factbook table of life expectancies by country.
- CIA World Factbook table of infant mortality by country.
- Hogberg, David. "Don't Fall Prey to Propaganda: Life Expectancy and Infant Mortality are Unreliable Measures for Comparing the U.S. Health Care System to Others", National Center for Public Policy Analysis. Retrieved August 08, 2007.
- The Hillarycare Mythology.
- Williams, Michelle. "America's Life Expectancy Lower than Other Nations; Smoking and Obesity are Making Americans Unhealthy", People's Media Company (2007-07-15). Retrieved August 08, 2007.
- Why Childhood Obesity? Childhood Obesity – A National Health Epidemic. William J. Clinton Foundation.
External links
- Derek Bok, "The Great Health Care Debate of 1993-1994" Public Talk, Accessed June 8, 2007.
- "Events leading up to Clinton's Healthcare Address to Congress," Timeline from PBS's The System. Accessed June 8, 2007.
- C-SPAN3 Programming from 1993-94 on the Clinton Health Care Plan C-SPAN, Accessed June 8, 2007.
- President Bill Clinton's 1993 State of the Union address C-SPAN, February 17, 1993. Accessed June 8, 2007.
- Robin Toner, " Clinton's Health Plan; Poll on Changes in Health Care Finds Support Amid Skepticism," New York Times, September 22, 1993. Accessed June 8, 2007.
- "The Clinton Health Care Plan: Fundamental or Incremental Reform?" Annals of Intern Med, 1993;119(9):945-947. Accessed June 8, 2007.
- Robert Pear, "10 Doctors' Groups Endorse Clinton's Health Plan," New York Times, December 17, 1993. Accessed June 8, 2007.
- William Kristol, "How to Oppose the Health Plan - and Why," Ashbrook Center, January 1994. Accessed June 8, 2007.
- "AAFP calls Clinton health care plan a 'starting point for reform," Findarticles.com reprinting American Family Physician, January 1994. Accessed June 8, 2007.
- Robert Pear, "Health Care Plan Isn't Cast in Stone," New York Times, January 22, 1994. Accessed June 8, 2007.
- Donna E. Shalala, "Let's Face It, There Is a Health Care Crisis," U.S. Department of Health and Human Services. Reprinted from The Washington Post, January 25, 1994. Accessed June 8, 2007.
- President Bill Clinton's 1994 State of the Union address C-SPAN, January 25, 1994. Accessed June 8, 2007.
- Adam Clymer, "Hillary Clinton Tells Doctors Crisis in Health Care Is Real," New York Times, January 29, 1994. Accessed June 8, 2007.
- Michael Kramer, "The Political Interest," Time, January 31, 1994. "Slowly but surely, Bill Clinton's health-care plan is headed for the triage unit." Accessed June 8, 2007.
- "The Rise and Fall of the Political Catchphrase," Time, February 14, 1994. Traces the origins of the Republican counter-argument "there is no health care crisis." Accessed June 8, 2007.
- Paul Starr, "What Happened to Health Care Reform?" The American Prospect no. 20 (Winter 1995): 20-31. Accessed June 8, 2007.
- Robin Toner and Anne Kornblut, "Wounds Salved, Clinton Returns to Health Care," The New York Times, June 10, 2006. Accessed June 8, 2007.
- Raymond Hernandez and Patrick Healy, "The Evolution of Hillary Clinton," New York Times, July 13, 2005. Accessed June 8, 2007.
- Raymond Hernandez and Robert Pear, "Once an Enemy, Health Industry Warms to Clinton," The New York Times, July 12, 2006. Accessed June 9, 2007.
- Jonathan Cohn, "Hillary was Right - The health care plan that dares not speak its name," The New Republic, June 5, 2007. Accessed June 8, 2007.
- Michael F. Cannon, "What Mitt and Hillary Have in Common," The National Review Online, June 5, 2007. Accessed June 8, 2007.,