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Barack Obama Economics Health care Politics

The Lesson of 1993/1994

[digg-reddit-me]Like a lingering odor, the failure of Hillarycare in 1993 is hanging over this perilous moment in Obama’s presidency. It’s true that Clinton’s health care plan never got this far legislatively.  By presenting a complicated plan to Congress and trying to bully it through, the Clinton administration made a huge tactical blunder. But it is clear that both sides sense that this is the moment when health care reform could be derailed. While the Democrats and Obama have long been planning on pushing through health care, what is going on now is pure political blood sport. This is a zero sum game. This is a Democratic attempt to prove that they can accomplish something that is popular and helps the middle class and which they have been trying for sixty years with only moderate success to enact. This is the Republican attempt to protect the status quo and to slingshot their way back to power as they did in 1994.

Bill Kristol has said that this is the week to stop health care reform – to not worry about being obstructionist or trying to appear constructive:

There will be a tendency to want to let the Democrats’ plans sink of their own weight, to emphasize that the critics have been pushing sound reform ideas all along and suggest it’s not too late for a bipartisan compromise over the next couple of weeks or months.

My advice, for what it’s worth: Resist the temptation. This is no time to pull punches. Go for the kill.

Beneath the veneer of policy disagreement that Kristol is using, it’s clear he is advocating pure obstructionism. He senses opportunity. Which is why he and many other Republicans are now all repeating the same talking points: Obama’s health care reform is an “experiment” with your health; it will ration health care; you will lose the insurance you have now; the government will impose itself between you and your doctor; socialism! These rather familiar refrains are being thrown about for one purpose – and it has little to do with health care.

As Senator Jim DeMint rather infamously declared in a secret call to anti-reform advocates:

If we’re able to stop Obama on this it will be his Waterloo. It will break him.

Newt Gingrich echoed this point:

This could be the bill that drags his whole presidency down and they look back on it and suddenly the whole thing is unraveled.

And the Democrats seem to agree – as the former Organizing for America sent out DeMint’s statements to rally supporters – and Mark Kleiman, a Democratic blogger said, “This bill is make or break for the Democratic Party.”

The Republicans are trying to break the Obama presidency – as they did Clinton’s. Clinton came back, but he never had the same political support.

Meanwhile, moderates play an interesting role in this political blood sport. They decry both sides for being mean – and suggest everyone get along. They talk about bipartisanship, suggest the Democrats move slowly, and they feel queasy at the prospect that the Democrats – by actually governing and doing what they promised they would do – might be overreaching. Matt Yglesias ably responded to this point:

It’s not as if what happened in 1994 was the congress passed Bill Clinton’s big health reform package, then the public didn’t like it, then in revulsion they turned against Democrats. Nor did congress pass the proposed BTU tax, then the public didn’t like it, and then in revulsion they turned against Democrats. The noteworthy thing about the first two years of the Clinton administration was the lack of ambitious progressive programs put in place. And you could say the same about Jimmy Carter. Whatever it is people reacted against in 1978, 1980, and 1994 it wasn’t actually existing left-wing governance.

Ezra Klein – on the same theme – explained the lesson one of the key architect’s of Obama’s strategy learned from 1993:

Emanuel has carried that lesson with him into the Obama White House. “The only thing that’s not negotiable is success,” he likes to say. The worst outcome for the party — in part because it’s the worst outcome for its marginal members – is defeat. Voters punish defeat.

If the Democrats succeed – as Bill Kristol explained in 1993:

It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle-class by restraining the growth of government.

Despite this moment of peril, Obama’s strategy to get health care through is still intact. His administration has learned the lessons of 1993- 1994 well – perhaps too well.

But make no mistake as you see the charges thrown about by both sides in these next few weeks. This battle is no longer about policy for either the White House or the Republican Party. (Though the right policies will be essential to its long-term success.) Right now this is political blood sport – it is about whether or not the Obama administration will be broken by obstructionist elements. The short-term success of the administration will be determined by whether or not they succeed in the next few weeks to pass something substantial; their long-term success will depend on the policies they are able to include.

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102 replies on “The Lesson of 1993/1994”

Of course the Republicans are being obstructionist at this crossroads – if the bill passes, there’s no going back. Republicans can’t campaign on “we’re going to take your health care coverage away.” Democrats, however, when the plan ends up exploding health care costs, CAN campaign on the promise “to reduce out of control costs”. Then we get to choose between: meaningful reduction in cost which = steady erosion in the quality of care, or alternatively, costs don’t get controlled until it’s too late. We often assume that if government oversteps, we can just ‘get the republican reformers back in there.’ In the case of healthcare, with the baby boomers aging now, we may not have time for reform before we do irreversible economic harm (ie – set in motion massive inflation or the destruction of our currency).

Everyone agrees that we need to cut costs to ‘bend the curve’ (hence reform is “necessary”.. has to “get done”). But what Obama refuses to acknowledge, is that the question whether we create a ‘public option’ and add millions to the rolls is an entirely separate issue. He creates a sense of urgency by referencing the need to cut costs, but then mixes in a couple sob stories about uninsured people and pre-existing conditions and hopes nobody notices that he’s really just passing the largest welfare program in history. (And, hopefully, creating an enormous Democrat power-grab in the process.)

@O’Neil:

It seems you start out with the presumption that our health care market is efficient. I’m not sure how else to interpret this:

meaningful reduction in cost which = steady erosion in the quality of care

The stats don’t bear this out. Every other country in the world spends much less than we do – and many nations have better quality of care, whether measures by outcomes, number of doctors to the population, life expectancy, infant mortality, etc.

What is pretty clear to many health care economists is that there are massive inefficiencies in this market – and the various Democratic plans attempt to address many of them to make up costs – from an organization that conducts and promulgates comparative effectiveness studies to electronic records to a re-focus of incentives to outcomes instead of tests.

In terms of separating out the issues of the uninsured and the rising costs: first, depending on one’s interpretation of events, they share a root cause. Second, Obama himself has been pretty honest in separating the issues I’ve found – for example:

And I think it’s important for us to bend the cost curve, separate and apart from coverage issues, just because the system we have right now is unsustainable and hugely inefficient and uncompetitive.

I guess theoretically, you could just work on bending the cost curve without providing additional coverage. I actually think that you lose some of the benefits of getting universal coverage. For one thing, all the issues of uncompensated care would still be coming up. You potentially would lose the benefits of buy-in from insurance companies and drug companies and hospitals and others who feel that, okay, at least if we have an individual mandate and everybody has bought into the system, then we have more consumers, and we are more willing then to wring out insufficiencies in providing — insufficiencies per patient, essentially.

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072202522_pf.html

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Es la mejor manera absoluta de encontrar personas que no sólo quieren trabajar para usted, sino que desea también! La mayoría de los candidatos que obtiene de la publicación de trabajos en lugares como monstruo o workopolis son absolutamente terribles.Venganza

Así que al final es ganar-ganar. Las empresas obtienen los empleados que buscan (y saben que es mucho más probable que el solicitante sea un empleado que buscan si están solicitando en cusec) y los delegados obtienen las oportunidades que han estado buscando.NegroPollon

Creo que las ferias de carrera son una buena cosa. No sólo reducen los costos, sino que dan mucha credibilidad a la conferencia. Por primera vez estuve al otro lado de la feria de la carrera.Disiarte

Es la mejor manera absoluta de encontrar personas que no sólo quieren trabajar para usted, sino que desea también! La mayoría de los candidatos que obtiene de la publicación de trabajos en lugares como monstruo o workopolis son absolutamente terribles.Venganza

Así que al final es ganar-ganar. Las empresas obtienen los empleados que buscan (y saben que es mucho más probable que el solicitante sea un empleado que buscan si están solicitando en cusec) y los delegados obtienen las oportunidades que han estado buscando.NegroPollon

Así que al final es ganar-ganar. Las empresas obtienen los empleados que buscan (y saben que es mucho más probable que el solicitante sea un empleado que buscan si están solicitando en cusec) y los delegados obtienen las oportunidades que han estado buscando.NegroPollon

Es la mejor manera absoluta de encontrar personas que no sólo quieren trabajar para usted, sino que desea también! La mayoría de los candidatos que obtiene de la publicación de trabajos en lugares como monstruo o workopolis son absolutamente terribles.Venganza

Creo que las ferias de carrera son una buena cosa. No sólo reducen los costos, sino que dan mucha credibilidad a la conferencia. Por primera vez estuve al otro lado de la feria de la carrera.Disiarte

Creo que las ferias de carrera son una buena cosa. No sólo reducen los costos, sino que dan mucha credibilidad a la conferencia. Por primera vez estuve al otro lado de la feria de la carrera.Disiarte

Así que al final es ganar-ganar. Las empresas obtienen los empleados que buscan (y saben que es mucho más probable que el solicitante sea un empleado que buscan si están solicitando en cusec) y los delegados obtienen las oportunidades que han estado buscando.NegroPollon

Es la mejor manera absoluta de encontrar personas que no sólo quieren trabajar para usted, sino que desea también! La mayoría de los candidatos que obtiene de la publicación de trabajos en lugares como monstruo o workopolis son absolutamente terribles.Venganza

Creo que las ferias de carrera son una buena cosa. No sólo reducen los costos, sino que dan mucha credibilidad a la conferencia. Por primera vez estuve al otro lado de la feria de la carrera.Disiarte

Es la mejor manera absoluta de encontrar personas que no sólo quieren trabajar para usted, sino que desea también! La mayoría de los candidatos que obtiene de la publicación de trabajos en lugares como monstruo o workopolis son absolutamente terribles.Venganza

Así que al final es ganar-ganar. Las empresas obtienen los empleados que buscan (y saben que es mucho más probable que el solicitante sea un empleado que buscan si están solicitando en cusec) y los delegados obtienen las oportunidades que han estado buscando.NegroPollon

Así que al final es ganar-ganar. Las empresas obtienen los empleados que buscan (y saben que es mucho más probable que el solicitante sea un empleado que buscan si están solicitando en cusec) y los delegados obtienen las oportunidades que han estado buscando.NegroPollon

Así que al final es ganar-ganar. Las empresas obtienen los empleados que buscan (y saben que es mucho más probable que el solicitante sea un empleado que buscan si están solicitando en cusec) y los delegados obtienen las oportunidades que han estado buscando.NegroPollon

Así que al final es ganar-ganar. Las empresas obtienen los empleados que buscan (y saben que es mucho más probable que el solicitante sea un empleado que buscan si están solicitando en cusec) y los delegados obtienen las oportunidades que han estado buscando.NegroPollon

Así que al final es ganar-ganar. Las empresas obtienen los empleados que buscan (y saben que es mucho más probable que el solicitante sea un empleado que buscan si están solicitando en cusec) y los delegados obtienen las oportunidades que han estado buscando.NegroPollon

Es la mejor manera absoluta de encontrar personas que no sólo quieren trabajar para usted, sino que desea también! La mayoría de los candidatos que obtiene de la publicación de trabajos en lugares como monstruo o workopolis son absolutamente terribles.Venganza

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