« The Hillary Plan | Main | A Very Bad Column »

September 18, 2007

Does 1994 Help Clinton Or Hurt Her?

With Clinton's health care plan released, and only a shade different than Edwards, the argument on health care moves over to who can git 'er done. Which is, theoretically, Clinton's stronger ground. But Edwards and Obama are hoping that memories of 1993 to will undermine that claim to competency.

Obama released a press statement that ended, "I was able to pass health care reform in Illinois that covered an additional 150,000 children and their parents, and that's how we'll prevent the drug and insurance industry from defeating our reform efforts like they did in 1994." Edwards gave a speech telling Clinton -- who he called "the architect of the 1993 reforms" -- that "the cost of failure 14 years ago isn't anybody's scars or political fortune, it's the millions of Americans who have now gone without health care for more than 14 years and the millions more still crushed by the costs." But according to a new poll, the voters may not be receptive to this line of attack:

“Registered voters see Clinton's experience with a failed health care proposal as an asset rather than a liability. Sixty-six percent of all voters, and 77 percent on Democratic primary voters, say her past experience will help her to reform health care if she becomes president. … Just 25 percent of all voters, and 15 percent of Democratic primary voters, say that experience will hurt her. Fifty-two percent of registered voters say the lack of health care reform in the 1990s was beyond Clinton's control. Only 5 percent say she was ‘mostly responsible’ for the lack of reform, while 39 percent say they do not know enough to have an opinion. In a CBS poll in 1994, 43 percent said Clinton's involvement was one reason health care reform did not pass, while 49 percent disagreed.”

As one smart observer e-mailed, "There's not enough difference on the substance among the Dems to matter, which is deliberate. I thought HRC did a good job on avoiding the 94 landmines. Now this is no longer an argument over who has the best plan, but rather who is the one who could get it done." If you buy that the Democratic primary is a tug-of-war between whether "change" -- benefitting Obama/Edwards -- or "experience" -- benefitting Hillary -- will triumph, Hillary's plan, which offers more change than Obama's and is barely distinguishable from Edwards, does quite a bit to ensure the conversation remains focused on practical experience. Edwards may be able to get some traction by detailing the lavish amounts of money Clinton has taken from the medical industry -- including insurance companies -- but that's about all her opponents have left, and it's not an attack that's gained much purchase in the last month or two.

September 18, 2007 | Permalink

Comments

I don't suppose you've noticed that the only blogger who is agreeing with you on this is Kevin fucking Drum. The same Kevin Drum who shits his pants every time someone suggests the Democrats grow a pair. A cowardly old man who is too traumatized from the politics of his youth to have anything like courage, ambition, or hope.

Do you really have a better explanation as to why you think you're right and everyone else is wrong?

Posted by: soullite | Sep 18, 2007 9:21:11 AM

Who are these other bloggers, and what are their arguments?

As best as I can tell, no one has noted a stark difference between Edwards' and Clinton's plans. Some people have called for straight single payer, but that's an argument against Edwards as much as against Clinton.

Posted by: DivGuy | Sep 18, 2007 9:32:37 AM

Amazing how Ezra shifts from 'THIS IS A GREAT PLAN!!!1!!!" to "this plan is a great political manuever, and will sap the other candidates of their manly juices!" as soon as it becomes apparent that nobody really agrees with his initial offering.

Posted by: soullite | Sep 18, 2007 9:33:35 AM

Div, it's not really my job to read blogs for you, it's not like reviews of her proposal are archaic and difficult to find. She released them yesterday, find a blog, hit up it's link sections, and scroll down.

It's really that easy. Well, except for the fact that many blogs simply haven't talked about this at all. I can't say I blame them, This is a plan designed to pass, not to help anyone.

Posted by: soullite | Sep 18, 2007 9:45:28 AM

That's crazed. I can't speak to what blogs you read, Soullite, but the idea that Clinton's plan is being roundly criticized isn't even credible. It's the same damn plan that Edwards offered -- the same Edwards who, you so determinedly support. It's weird how I've not seen you in the threads where I lauded his plan, attacking me for the misjudgement...

Posted by: Ezra | Sep 18, 2007 9:50:46 AM

Was the polling conducted before her UHC proposal was out? Because I suspect what voters are really saying is that they want Health Care reform, and being associated with it in the past is an asset.

Posted by: Anthony Damiani | Sep 18, 2007 10:41:01 AM

Ezra,

Too much on the horse race, not enough on the substance. (We got enough of the DC MSM doing that stuff, you're supposed to provide something different!)

Obama's claiming that HRC's plan is weaker on cost control. Given the importance of that issue, how about a post on that rather than this stuff?

Posted by: wisewon | Sep 18, 2007 10:43:38 AM

I'll state it differently:

I don't see how this plan changes the health care cost growth between now and 2050.

None of the three plans do, but instead seem to hit other progressive wants: 1) UHC 2) a public option as an incremental approach to single-payer.

Here was what you said in May:

If given a choice between passing mediocre health reform and strong cost control measures, I'd go with the latter, saving universality for another day and not discrediting the goal by wrapping it in a plan that's likely to fall apart. I haven't spent enough time looking into her proposal to decide whether it's strong enough on controlling costs, but it's an interesting approach, and a strain of incrementalism I could actually imagine getting behind. More later, as they say.

I guess later is now-- so what you do you have to say?

Posted by: wisewon | Sep 18, 2007 10:49:50 AM

You have a peculiar habit of reading each post I write as I've never written another one. I've argued many, many times that the road to cost control requires a more integrated system, a public option that can keep the private insurers in check, much more data on wghich drugs are and are not cost effective, and the sort of increased regulation that can serve as a precursor to more substantial national bargaining power. I've written on all these aspects of Hillary's plan. Extrapolate, my good man!

Posted by: Ezra | Sep 18, 2007 10:57:00 AM

I don't think anything you wrote above will substantially change the cost issue.

Policy experts in the US have pretty strong alignment that the largest driver of cost growth is utilization of new medical technologies. Of your list above-- only one of those touches on that issue (cost-effectiveness of drugs, which is only 10% of the pie- a lot of technologies exist outside of drugs) and it merely provides data-- not utilization controls.

At the end of the day-- you need either a NICE-style control or greater cost-shifting to consumer to scale back demand. HRC's plan has neither, that's my concern. (In other words you've personally written on the need for an expert panel, which sounds like a NICE-style approach. Its not here. The other stuff is nice, but really isn't going to change the growth curve in a meaningful way.)

Posted by: wisewon | Sep 18, 2007 11:11:31 AM

sorry, I am going to have to agree with wisewon. This post was mostly process, and I've been seeing that else where more than actual talk about "is the plan good?" too many blogs have given up on actually challenging our candidates, and that worries me a lot. You were suppose to be more than just score keepers.

Posted by: akaison | Sep 18, 2007 11:16:11 AM

I think Edwards is taking on the 1994 experience narrative in a much more direct way than you outiline. He 's saying explicitly that she has learned the wrong lessons from her experience. She's decided to be a back room dealer type and hope to mollify the interests, he's chosen to take them on directly.

Overall, it's the same argument he's making against her, which is a more direct 'outsider' vs 'insider' line. That has a better shot, I think, than 'change' vs 'experience' of making a dent in Clinton, as she'll have a harder time trying to be both on that one. Not that she won't try.

Posted by: AJ | Sep 18, 2007 11:21:18 AM

Yes, but you're not going to get any serious cost control in the first go around. It's too painful, and too politically impossible. You need to move towards a system where it's more achievable so that when there's finally enough pressure for it, you can actually enact some serious measures. That requires further integration. But if you're looking for cost control in the first generation of reform, well, good luck.

Posted by: Ezra | Sep 18, 2007 11:23:25 AM

I figured you'd say that.

Here's my point.

You say today:

Yes, but you're not going to get any serious cost control in the first go around.

Here's what you said in May:

If given a choice between passing mediocre health reform and strong cost control measures, I'd go with the latter, saving universality for another day and not discrediting the goal by wrapping it in a plan that's likely to fall apart.

I agree with the "May" Ezra. I'm concerned that the "chits"/political dynamic for health care reform are being used to push through UHC and public option at the expense of cost control. I agree that you can't get everything in one bill. Like you, I was impressed when Clinton started her discussions in May with a focus on costs-- this is the most difficult and most pressing issue. In the end, she's punted this issue down the road, and given the nature of political issue cycles, it'll be another 15-20 years before this degree of focus on health care will enable the tough decisions to be made on cost control.

People are anxious about health care "not working"-- we could be using this dynamic to push through serious cost control measures, but instead we have plans that focus on different priorities.

Posted by: wisewon | Sep 18, 2007 11:33:45 AM

Like you, I was impressed when Clinton started her discussions in May with a focus on costs-- this is the most difficult and most pressing issue.

You're crazy. The most pressing issue is that millions of people suffer bodily because they do not have health care. UHC goes a long way towards producing better lives for people living in suffering. Cost control is important, but jeez, a little moral perspective.

I think you're misreading Ezra's notion of "mediocre health care reform" - he was thinking of, in the context of that post, non-universal plans to expand coverage a bit, or mild attempts at regulation of industry. Hillary's and Edwards' plans are not mediocre - they're excellent universal plans with public options that ease the way to single payer.

Ezra did not say he preferred cost control to a plan like Hillary's or Edwards' - that's clearly not what he means by "mediocre" in the post you cite.

Posted by: DivGuy | Sep 18, 2007 11:54:14 AM

Policy experts in the US have pretty strong alignment that the largest driver of cost growth is utilization of new medical technologies. Of your list above-- only one of those touches on that issue (cost-effectiveness of drugs, which is only 10% of the pie- a lot of technologies exist outside of drugs) and it merely provides data-- not utilization controls.

I'm actually in the process of writing a research paper on increasing medical costs around the world. And I can tell you that the actual research is inconclusive regarding increasing medical costs. Even the research that does attribute technology increases to increased spending says that it doesn't account for a predominant amount.

No doubt that techonology accounts for a decent amount of the pie but it is by no means the only aspect of it.


Also I agree with Ezra that its convient that people on this site start critisizing plans once Hillary's plan comes out even though all of these arguments apply to all plans

Posted by: Phil | Sep 18, 2007 12:11:18 PM

would you have preferred people criticize before all the plans were out ?

Posted by: akaison | Sep 18, 2007 12:15:34 PM

It seems like the actual contents of the three Dem. plans is coming to have less weight among progressives than some not-so-visible belief that projects Hillary as being more industry-submissive or less driven to actual reform than Edwards (or Obama) - and that also seems to be the Edwards/Obama response as well.

Frankly, the powers of the opposition will be deployed against any of the 3 Dem. plans, and they will exploit the intra-Dem. fighting.

In my optimum world, Hillary, Edwards and Obama would serve the nation and the party best by spending a weekend together (with some key Congressional and health-care leaders as well) and coming up with one unified plan - in effect saying this is what the Dems will do, not one of the candidates.

The Dems are not going to choose a candidate based on their health care plans (since they are so similar), so there is no advantage there in separate plans. The argument, if any, on health care should be on who can get the Dem. plan put into law and on what schedule.

I'm not pro any candidate yet, and it is clear to me that other non-health-care issues should be the basis of choice.

We are missing the chance for a unified Dem. party message against what will likely be a Republican message that clearly won't produce universal coverage and other needed features. Let the GOP candidates fight against a unified Dem. party program on health care, and then let the country choose between the ultimate GOP and Dem. candidates.

Posted by: JimPortlandOR | Sep 18, 2007 12:31:44 PM

the problem with that theory is that not everyone is interested in running a substantive campaign as much as they are interested in scoring points and deflecting any attention from their strategy. i will leave it to you do do the research as to is doing what, when and how.

Posted by: akaison | Sep 18, 2007 12:59:31 PM

You're crazy. The most pressing issue is that millions of people suffer bodily because they do not have health care. UHC goes a long way towards producing better lives for people living in suffering. Cost control is important, but jeez, a little moral perspective.

Bingo.

My attitude is, universal health care, by any means necessary. There a number of issues that need to be dealt with, but they don't have to all be dealt with at the same time, and trying to do so seems likely to make doing anything more difficult. "Cost control first" sounds to my ears like something the Republicans would use as a slogan.

Posted by: Jasper | Sep 18, 2007 1:01:33 PM

Wisewon,

I disagree with you on this one. I think Senator Clinton is actually on the right track, and costs will be easier to attack once universal coverage is achieved. Politicians will have an incentive to pursue cost control because there are other worthwhile priorities that they want to pursue, and they know there is a limit to how far they can push the tax burden on both middle class and upper income taxpayers. Private employers, for their part, can push their cost control ideas without the distraction of how to provide coverage for the uninsured.

We've talked about cost control strategies before, some of which could make a difference in the relatively short term, some in the medium term and some in the long term. They include: (1) robust price and quality transparency so PCP's can make more cost-effective referrals to specialists, imaging centers, labs, hospitals, etc., (2) more widespread use of living wills and advance directives to reduce futile and often unwanted care at the end of life, (3) specialized health courts to, over time, reduce defensive medicine, (4) adoption of interoperable electronic medical records, especially in hospitals, to reduce or eliminate duplicate testing and adverse drug interactions, (5) package pricing by hospitals for complete episodes of care for procedures that lend themselves to that approach, (6) paying PCP's enough to properly supervise care for nursing home patients to reduce therapies of dubious value to the patient that are often performed to drive revenue for the nursing home, and (7) lower administrative costs from streamlining of insurance offerings, elimination of medical underwriting and more consolidation within the industry. I'm sure there are plenty of other ideas as well, but we can bring a more laser like focus to the problem once universal coverage is achieved.

Posted by: BC | Sep 18, 2007 1:07:25 PM

DivGuy and others,

Here's the whole excerpt below, you can read for yourself and make your own conclusions-- I see DivGuy's point, but in the context of the rest of the paragraph, I don't think its the right interpretation. Ezra writes "her initial focus on cost control is actually quite smart." Why is it smart if he's now saying that "you're not going to get any serious cost control in the first go around." The only logic I see where DivGuy's logic holds, is that Ezra felt it was smart because he expected the rest of Clinton's plan to be "mediocre" hence "if given a choice between passing mediocre health reform and strong cost control measures, I'd go with the latter, saving universality for another day and not discrediting the goal by wrapping it in a plan that's likely to fall apart."

If that was the case-- so be it. Of course, it would be easiest for Ezra to clarify it himself rather than others speculating. Were you expecting Clinton's plan to be mediocre? If not, why was focusing on cost control "smart"?

While on the subject of Hillary, she's released her plans for cost control (though not, as of yet, her plans for coverage or quality). I've sort of been waiting for the whole proposal before diving into it, but those who want to go piece-by-piece should certainly do so. My snap reaction is that Hillary knows a helluva lot more about health care than any of the other candidates, and her initial focus on cost control is actually quite smart. If given a choice between passing mediocre health reform and strong cost control measures, I'd go with the latter, saving universality for another day and not discrediting the goal by wrapping it in a plan that's likely to fall apart. I haven't spent enough time looking into her proposal to decide whether it's strong enough on controlling costs, but it's an interesting approach, and a strain of incrementalism I could actually imagine getting behind. More later, as they say.

Posted by: wisewon | Sep 18, 2007 1:48:12 PM

Up until Clinton released her current plan, I think the basic consensus in left blogistan was that Edwards and Obama were going to constitute the left of the health care debate among Dem front-runners, while Clinton would stand to their right. Edwards and Obama would offer good solid UHC plans, while Clinton would go with technocracy, Mark Penn-approved microinitiatives. In that context, cost control proposals from Clinton are good because of the possibilities in technocratic reform - rather than wholesale reform - cost control is a good place to start.

I was certainly surprised that Hillary's plan is pretty excellent. My reading of the reactions to Hillary - though not on soullite's secret blogs - is that most people were pleasantly surprised.

Posted by: DivGuy | Sep 18, 2007 2:06:32 PM

It's fucking amazing. for 5 years, bloggers bitch and moan about the media and it's horserace coverage. Yet what do they turn to when a real discussion of the issues might hurt their eventual nominee? Why, horse race coverage. It no longer becomes important to look at the issues (except for healthcare, where Ezra asserts, blind to the contradictions, that All Plans Are The Same, and yet Hillary has The Best Plan Evar!!!!1!!). Instead, we only need to look at whether their fucked up plans are so bad that they prevent them from being electable.

Everyone in this society with even the smallest amount of power or influence is corrupt beyond all repair.

Posted by: soullite | Sep 19, 2007 9:38:45 AM

Div, FiredogLake is one, if you really need one. If you didn't find any, it's because you didn't want to look. Corrente is another. I'm sure that will put you on a good enough scent that if you ACTUALLY want to find them, you'll actually read some blogs. Instead of expecting everything to be spoon fed, you'll do some fucking research. This isn't exactly obscure shit, you're just too much of a lazy hack to actually read anything.

The only real positive reviews I've seen are the endless water carrying on this site, and the extremely (and unapologetically)pro-hillary TalkLeft.

Posted by: soullite | Sep 19, 2007 9:41:29 AM

The comments to this entry are closed.