Lessons of 93
In 1993-94, then Senate Minority Leader Bob Dole, a Kansas Republican who had presidential ambitions and a hankering to regain his position as Senate Majority Leader, helped kill President Bill Clinton's health reform initiative.
"I want this to pass," he said. "I don't agree with everything Obama is presenting, but we've got to do something." He added that he expected to see a Rose Garden signing ceremony within months.
Dole joins a lengthening parade of prominent Republicans, including Bill Frist, in endorsing health reform. (They may not change many minds in a polarized Congress, but might be a help to centrists in both parties. Having Frist and Dole on board would make it easier for someone like Republican Olympia Snowe to vote yes... and harder for a moderate Democrat like Ben Nelson to vote no.)
Harry and Louise are back! And, as we've mentioned before, they're pro-reform this time.
As you may recall, Harry and Louise were the face of the anti-reform movement when Bill Clinton attempted to reform the health care system in the early nineties. During their time in the national spotlight in 1994, they were a focal point for the public fear that health reform would hurt, rather than help, the American people. The original Harry and Louise ads featured a middle class couple sitting at their kitchen table, discussing their fears that "Sometime In The Future," faceless government bureaucrats were going to take away their health care choices. "Having choices we don't like is not choice at all," Louise lamented.
Next week the U.S. Census Bureau will release its updated estimate of the number of uninsured people—now officially at 47 million. David Colby at the Robert Wood Johnson Foundation helpfully assembled some accessible foundation-backed papers and issue briefs on who the uninsured are, what being uninsured means, what the federal environment for change looks like now, and how the states have or have not stepped up. Here's the link to the series "The State of Research on the Uninsured: Putting Census Estimates in Perspective" and we're providing a few of the summaries and abstracts below. We'll post a similar brief guide to some of our own issue briefs and papers on the uninsured before the Census numbers come out.
We've all done a lot of looking back to the lessons of 1993-94, and the long list of reasons the highly complex, ill-timed and politically-polarizing Clinton health care plan failed. But today the journal Health Affairs published an essay looking back not just at the failures of the Clinton plan but at the successful passage of two major health reform initiatives--the truly bipartisan State Children's Health Insurance Program (SCHIP) and the Medicare Modernization Act, which added prescription drug coverage for seniors.
We hear lots of talk about health care reform and the presidential campaign, and certainly it registers in the polls. But is it resonating enough to make a difference in November—and will the next president, whoever that is, put the issue front and center if voters don't demand it?
As John Whitesides of Reuters wrote the other day:
"The sharply contrasting health care visions of Republican John McCain and his Democratic presidential rivals offer the promise of a grand campaign debate—if the candidates find room on a crowded agenda.
While health care reform ranks as the second-biggest domestic issue after the economy in most national opinion polls, it will compete with the Iraq war, taxes, high gas prices, and other topics for a prime-time spot in the campaign."
We caught Tom Daschle, the former Senate Majority Leader and newly-minted health wonk, discussing his new book "Critical" today. We were delighted to hear him take issue with the too-common refrain that "America has the best health care in the world." Politicians in both parties say that, and it was an effective slogan against the Clinton health care reform in the early 1990s. It drives us nuts. Yes, we have great doctors and great research and great medical schools and great technology but no, we don't have the best health care in the world available on a consistent basis to all Americans. Daschle's phrase was that we have "islands of excellence in a sea of mediocrity." Like Daschle, we believe that any initiative to expand coverage also requires us to acknowledge our quality gaps and address spending that doesn't buy value.