Top Clinton Health Care Aide Talks About Lessons Learned From HillaryCare’s Failure

Spiritual Progessives Weigh in on Health Care Reform & Pound Dems

John P. Geyman has written an article titled “Missing the Boat on Health Care?” for Tikkun, a website that creates a network for spiritual progressives. The article is very well-written and is insightful about the political opportunity for health care reform. The website describes the network as a “New Bottom Line of love, kindness, generosity, ethical and ecological sensitivity, peace, social justice, non-violence, and awe, wonder and radical amazement at the grandeur of the universe. Recognizing that our own well being depends on the well being of everyone on the planet and of the planet itself, we at NSP [New Spiritual Network] will do our best to spread this consciousness and build a world that embodies these ideals.”

The answer to the nation’s health care problems, according to Geyman, is national health insurance, government run health care, socialized medicine, a single payer system — or whatever name you prefer.

Some may wonder why this article is important. This article lays out the position of the pro-Canadian style health care system wing of the Democratic Party’s governing coalition, and because the Democratic Party controls both the U.S. House and U.S. Senate, and could control the White House as well in 2009, Geyman’s view is now politically relevant. The extended quote below gives you a sense of his position:

“Although we spend far more than any other country in the world on health care, we have little to show for it except high prices, decreasing access, variable quality, underuse of essential care by vulnerable populations, and a significant amount of unnecessary and inappropriate care for those who can pay for it. Our enormous private health insurance industry of 1,300 insurers competes to cover healthier and lower-risk enrollees with more limited policies each year, while denying coverage of sicker individuals or raising premiums to unaffordable levels. That shifts the burden of the more costly care of sicker people to the public sector, defeating the whole principle of insurance: to spread risk broadly. Meanwhile, as the private insurance industry no longer finds growth in the employer-sponsored and individual markets, it has been shifting its sights to privatized public programs, including Medicare and Medicaid. Here it has found generous subsidies and little oversight from friendly conservatives in government.

“Now would be the ideal time for leading Democrats to advance a progressive agenda for health care, such as Teddy Roosevelt did as a Progressive, with his call for national health insurance in 1912. The Republicans have been weakened by scandals, cronyism and incompetence, and have no new or credible ideas for health care reform. They still offer up only warmed-over ideas such as tax credits, health savings accounts, and how the competitive market can fix our problems, while limiting government’s responsibility for care of the poor—blatant social Darwinism. As William Greider recently observed in the Nation, “Democrats have a splendid opening to be substantive and political and righteous for working folks,all at once.”

“But so far, with only one exception, the Democratic presidential candidates have been disappointing, if not derelict, in reforming the system. In their misguided efforts to avoid too much controversy and to build a “centrist consensus,” they are completely missing the target even before starting. Although Democrats in Congress united behind reauthorization of an expanded State Children’s Health Insurance Program (SCHIP), that effort has diverted them from the real challenge—how to reform the system to make accessible and comprehensive health care affordable for all Americans. That would require taking on powerful stakeholders, especially the insurance and drug industries, in the medical-industrial complex, now one-sixth of our economy. All but one of the Democratic presidential contenders shy away from that battle, usually with the limp excuse that real reform is not politically feasible.”

What is especially interesting is his attack on the idea of building a “centrist consensus” which rejects out of hand one of the main points of consensus on health care reform: small, incremental reforms will actually be enacted into law, whereas wholesale system changes will spool up so much opposition, nothing will get done — just as it happened with Hillary Clinton’s health care reform push in the ’90s.

Geyman concludes with a rejection of the mainstream Democratic health plans:

The leading Democrats’ health care plans, if enacted, are a prescription for failure by giving the private insurance industry another bonanza: a carte blanche opportunity to sell more limited benefit policies to healthy people and prevent a structural health care fix. They would further raise costs, increase bureaucracy, enrich market stakeholders at the expense of patients, families, and taxpayers, and perpetuate markets treating health care as just another commodity to be bought and sold. Wall Street would prosper as Main Street hurts.”

At my last count, there are 87 cosponsors of the Medicare for All Act (H.R. 676) in the U.S. House, not an insignificant number of U.S. Representatives. The number of U.S. Representatives after the 2008 elections that hold this position on health care reform, will have a significant influence on the outcome of the next President’s health care reform plan.

For those who want to enact health care reform, it would be interesting to look back and see what went wrong with Hillary Clinton’s effort in the 1990s, and what needs to change in order for the next health care reform effort to result in a bill being signed into law by the next President. Fortunately, the next item (below) discusses an interview with President Clinton’s top health care aide during the famed HillaryCare debate, wherein he discusses what went wrong, and what needs to happen in order to succeed the next time a serious health care reform effort is mounted.

Top Clinton Health Care Aide Talks About Lessons Learned From HillaryCare’s Failure

Chris Jennings, former White House Senior Health Care Adviser, was the main health care policy advisor to President Clinton during their effort to pass Hillary Clinton’s health care reform plan in the 1990s. Jennings, visiting family in Ohio, met with the Athen News for an interview about his years in the Clinton White House, and what went wrong with their reform effort. The Health Security Act (HSA) was the bill’s title, and Jennings said that there were two primary mis-steps they made: the first was the closed (secret) task force meetings were resented by all those who were not included, or as Jennings put it:

“There were many mistakes made by us that we’re culpable for,” he said. One was setting up a task force to study the issue interminably behind closed doors – a move that alienated press, public, and all the people who didn’t get appointed to the task force and thought they should have been. “That was a process mistake,” he admitted.

Another mistake was dictating to Congress what they were to do, instead of allowing Congress to do what they could, or were able to do. Quoting the Athens News:

“Another was having the White House introduce its own complex bill, rather than telling Congress what it wanted and letting them draft a bill – the approach current President Bush took with prescription drug reform.”

It is surprising to hear from such a senior former Clinton aide, that there were specific strategic reasons in President Bush’s approach to health care reform, that allowed him to succeed where President Clinton failed.

As the Athens News reports, Jennings also said that there were other factors in the failure of the Clinton health care plan:

“A constituency for reform that included single-payer zealots, universal-coverage backers not wedded to single-care, and those wanting more of a market component; plus all the other ambitious legislative plans of the Clinton White House; plus the need for deficit reduction…”

Geyman, in his rejection of the “centrist consensus,” may be helping to stop the next Democratic attempt at health care reform, by contributing to the political difficulties that a new Democratic President would have to deal with inside the Democratic political coalition. Jennings specifically states what he believes will work, and how it needs to be done:

“The first step, he suggested, should probably be getting some kind of health insurance coverage for everyone, without insisting on a pure single-payer system. And to accomplish that, he argued, Clinton’s experience, relationships with legislators and stakeholders, and pragmatic approach may be just the right prescription.”

“If you want to do the heavy stuff, the hard stuff… that requires leadership, and it requires relationships, and it requires, ultimately, bi-partisanship,” he said.

There is a certain maturity in Jennings’ view of what needs to be done, and how to do it, to actually succeed in enacting change — whereas Geyman’s approach is going to make any health care reform harder, and will certainly fail.

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