Hillary Care Cometh

Pay no attention to the details of Sen. Hillary Clinton's health care plan, which will be announced later today in Iowa. That's for wonks (like me). What really matters is the rhetoric, which reflects what her campaigns managers -- the best in the business -- want average Americans to hear.

Here's what I think she's going to say:

* I'm for a plan that provides health insurance for every American, but doesn't take away the coverage anyone has now.

* I'm for holding down costs through prevention, and I will create a separate trust fund to ensure that every American gets the preventive care they need.

* The employer-based insurance system is the American Way, and we should do nothing to undermine it. But too many employers don't provide their workers any coverage at all, and some only bare-bones plans. So we're going to require that every employer who doesn't provide coverage pay into a fund to cover the uninsured.

* Since privagte insurance will remain the backbone of the system, we have to make sure that insurance companies are unable to deny people coverage because of pre-existing conditions or their overall health status. We'll pass a law that forbids them from only insuring the healthiest people.

* We're going to help doctors and patients hold down costs by giving them solid information about what works best. Widely disseminated comparative effectiveness information will allow insurers and patients to know that they're not paying for overpriced and unnecessary care.

There's a few devils in the details of those bromides. Will the default plan for the uninsured be government-run or will it be provided by health insurance companies? This is the ideological bellwether of how she plans to pursue universal care. Will she appeal to the grass roots activists who support "Medicare for all"? Or will she try to triangulate away insurance industry opposition to universal coverage by turning the default plan for the uninsured over to the insurance industry?

In making employers "pay or play," will she make the "pay" high enough to cover all the uninsured, or will she call for additional taxes to support a universal system? Again, its a base vs. triangulation decision that will tell us lots about how the Democratic frontrunner plans to run the rest of her campaign.

I will have more to say tomorrow after the plan comes out, but allow me to recommend some essential reading for those following the health care reform debate. Paul Starr, a Princeton University professor, co-editor of The American Prospect magazine, and a close adviser to President-Elect and President Bill Clinton on health care, recounts Hillary's role in the 1993-94 health care reform fiasco in the cover story of the latest issue of the magazine. He effectively counters the conventional wisdom that the then First Lady was the architect of that failure. "Bill Clinton actually never gave up control of the policy-making process, and the work fell to a small team of advisors and analysts that (Ira) Magaziner directed," he writes.

Her gifts complemented Magaziner's. Besides her quick intelligence, she had the personal tact and ease in communicating with the public that would make her an ideal ambassador for the initiative, while he had organizational skills, command of detail, and imaginative boldness necessary for mastering an ambitious and complex reform. The overall direction of policy was not Hillary's choice.

That rings true. The current cover story in The Atlantic Magazine has a fawning profile of Bill Clinton's efforts to remake aid and charity efforts in the developing world. Architect of this plan? Ira Magaziner.

This revisionist history of Health Care Reform War I is not a flattering portrait. Hillary as spokesman and not architect? That isn't an image that that someone who claims she has the experience to lead free world wants to see.

But in fairness to her, that was then, and this is now. I know from personal contact that she has surrounded herself with some of the smartest minds in Washington on the issue of health care reform. There are going to be some extraordinarily far-sighted elements in her health care plan that deserve enthusiastic support no matter who becomes the Democratic standard bearer. Her emphasis on prevention and on financing comparative effectiveness research shows that she and her advisers -- more than any other group in the race -- have a firm grasp on what it will take to finally get health care costs under control.

But I doubt those far-sighted elements will get much coverage on tonight's evening news or in tomorrow's papers. The political reporters will want to know whether she is aiming her appeal to the special interests in health care -- the doctors, the hospitals, the drug companies, the insurance industry -- with a proposal carefully crafted to buy off their opposition -- a classic Clintonian triangulation gambit? Or will she appeal to the Democratic Party base by going after the insurance industry, drug companies and irresponsible employers with a populist plan to provide coverage for all?

Like I said. That was then. This is now. I'm betting on the latter.

Posted by gooznews at September 17, 2007 12:01 AM