We Hope Third Time is the Charm

"I shall propose a sweeping new program that will assure comprehensive health-insurance protection to millions of Americans who cannot now obtain it or afford it, with vastly improved protection against catastrophic illnesses.”
- President Richard Nixon – State of the Union Speech 1974

Sounds familiar, doesn’t it?

Nixon’s 1974 plan contained provisions for employer mandates to buy worker’s health insurance, a broader use of HMO’s as a cost control measure, and States contracting with private insurance companies to provide coverage for the poor and unemployed. Unfortunately his 1974 plan sank under the waves of Watergate. The AFL-CIO killed the plan, in hopes of getting a better deal after the 1976 election. A serious discussion of health care was put off for another 20 years.

In 1993 -94, President and Hillary Clinton tried again. The Clinton plan also relied on a mix of employer purchased health insurance, cost cutting, and State assistance for the poor and unemployed to buy health insurance. Similar in concept to Nixon’s, it was significantly more complex.

But in the 10 months it took them to create the proposal, the impetus for health care reform subsided. Furthermore, since Congress was not allowed to participate in the plan’s design, no one on the Hill had a stake in its success and it died without a vote.

Now, once again the window of opportunity is open. Obama is proposing a plan that relies on employer mandates, cost cutting, and States supporting the purchase of health insurance. Its broad outlines are similar to both Nixon’s and Clinton’s proposals.

What are the differences that will help Obama succeed where others have failed?
One difference is the political climate. When Nixon proposed his plan he was 8 months from resignation. His ability to lead was rapidly draining away and he faced a congress controlled by the opposition that was preparing to impeach him. The Democrats had every reason to believe that they could either get a better plan from a weak President Ford, or the 1976 election would tighten their control over Congress and put a Democrat in the White House. They killed Nixon’s plan with confidence that one way or the other they would get a better deal. It didn’t work that way.

Clinton didn’t move fast enough. Economic fear help put him in the White House. The 1992 recession was unusual in its reach. Suddenly white collar voters who had felt safe in past downturns were afraid of losing their health insurance at layoff time. By the time Clinton actually proposed his plan the recession had eased and as had economic people’s fears. The political drive for reform waned.

The Clinton proposal might still had survived except they made a fatal mistake. The White House developed and presented a complete health care plan without consulting Congress. Consequently no one on Capitol Hill felt any ownership for the Clinton plan or had any stake in its success.

To make matters worse there was no strong Democratic leadership to guide it through. Rep. Dan Rostenkowski, Chair of the House Ways and Means Committee, was under a cloud of scandal. Senator Lloyd Bentsen left his post as Chair of Senate Finance to join the Clinton cabinet. With no one to take ownership, fend off endless revision, and steer it through Congress the Clinton plan was ripped to shreds and died without a vote.

Obama’s situation is different. Unlike Nixon he has strong support from the voters and political capital to spend. His party is in control of both houses of Congress. In Ted Kennedy he has at least one strong player on his side in the Senate, and a House of Representatives run with a firm hand by Nancy Pelosi.

Obama is also letting Congress get into the act of drawing up the proposals. People on Capitol Hill will have a stake in the success or failure of any reform plan they develop. It will be created with legislative compromises that will make passage politically possible. So he is already ahead of where Nixon and Clinton started.

But Nixon and Clinton both let the opposition define the debate over their health reform plans, and that helped kill both proposals. Now opponents are already taking parts of Obama’s health care plan out of context and exaggerating its effects. The President can’t approach this like he did the stimulus package, where he let Congress work out the details but he left the dialog to the Republicans. Obama didn’t get involved in selling the stimulus package until it was almost too late.

Obama must start hammering away in clear broad terms on what his proposals actually do. He must constantly remind the American people what he is actually trying to achieve and not let his opponents govern the debate. If he does, there is a good chance Americans will finally have health care reform. If he doesn’t, his proposals will join line of failure stretching back to 1974.

He must not fail because we can’t afford to wait another 35 years.