Columns » John Brummett

It’s 1993 all over again



Democratic health care reform advocates, reeling from soaring new cost estimates and subsequent Republican rhetorical gains, found buoyancy from a New York Times/CBS poll released over the weekend.

They shouldn't have.

The poll showed a solid majority of 895 respondents nationwide favoring major health care reform including higher taxes if necessary to extend coverage to the uninsured. Respondents also favored a government-operated insurer to reduce costs.

But on the other hand — and there's always another hand when you try to figure out what Americans are thinking — three in four respondents said they were satisfied or somewhat satisfied with their own current health insurance.

Then, as it happened, I picked up a recent copy of The New Republic and saw a piece from Stanley Greenberg, a pollster for Bill Clinton in 1993 when Clinton and wife Hillary tried and failed to reform health care.

To summarize what Greenberg wrote: His polls in ‘93 showed Americans favoring health care reform and willing even to pay higher taxes, though most were satisfied, if not what you'd call happy, with their own health insurance.

Sound familiar?

He wrote that, in the end, he and everyone else in the Clinton administration misread the findings.

Yes, decisive American majorities thought uninsured people ought to have insurance. Yes, they were willing to pay taxes to extend that insurance. But here's the key point: Americans were not willing to pay higher taxes for someone else's coverage if they realized no health care cost savings themselves.

In the end, Greenberg wrote, the political debate turned on what reform meant to every-day Americans. And in the end, he wrote, increased government costs to extend health insurance through Hillary's proposed creation of complex “purchasing alliances” would not be embraced by the family working hard to stay insured and not seeing how it would benefit.

The Obama administration understood that. That's why it proposed a government component, meaning some kind of public health insurance corporation to enter the market and compete with private insurers.

The idea was to turn private health insurers into FedExes and United Parcel Services, working hard, metaphorically speaking, to get packages delivered quicker than the Postal Service and at competitive costs. It was to attack costs in the only way that would work semi-naturally, meaning not with price controls or government mandates, but by market forces, albeit with a market the government would artificially alter with a new entity.

Be aware that Medicare, while a frightful drain on our long-term treasury, is the only health benefit payer in the current marketplace with any significant record of success in limiting costs.

Republicans, fighting to protect the status quo and the private health insurance industry, miscast this public option as the conspiratorial first phase toward a single-payer system of national health insurance. They called it socialism, which is nonsense. We have public entities competing with private ones all the time. Our economy is a mix-and-match.

Republicans and a few centrist Democrats warn that a government-backed insurer might run private insurers out of business, as if, as columnist Paul Krugman lamented Monday, the prevailing idea was to shore up private insurers rather than help the common man.

It appears now, then, that Democrats are going to abandon the public component and advocate some kind of “private cooperative” alternative, which, alas, is starting to look like the overly complex Hillary plan that failed to connect with every-day Americans looking for a break in their own health care expenses.

Here's something else Greenberg wrote: In 1993 Clinton didn't enjoy the backing of a key constituency, seniors, because they, with Medicare, couldn't figure out exactly what was in it for them.

So now the Congressional Budget Office has scared Democrats by assigning a $1.6 trillion cost estimate to proposed reforms. So now Democrats are trying to figure ways to save money.

On Friday, Blanche Lincoln, a key member of the key Senate Finance Committee, told me one place to find savings was to trim “around the edges” of Medicare.

Oh? We're going to try to extend insurance to some by nibbling at older folks' Medicare?

Alas, we're fast wending our way back to the same futile conversation we had in 1993.

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