Project for a Healthy American Future

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Project for a Healthy American Future

The way forward on health care reform in 2010

By Steve Benen






About 16 years ago, William Kristol crafted a lengthy strategy memo for congressional Republicans, advising them on how best to deal with then-President Clinton's health care reform initiative. At the time, a variety of Republican offices had every intention of presenting alternative reform plans — in part to help shape the debate, and in part to demonstrate the GOP's interest in addressing a chronic national problem.

Kristol, however, noticed that his party lacked direction, and offered his vision as a way forward. His memo offered a simple and clear response: the GOP had to kill the Clinton reform plan at all costs. The merit of the reform proposal and its ability to improve the lives of Americans was deemed largely irrelevant — Kristol argued that a successful reform effort would position Democrats as the "protector of middle-class interests," a fate the GOP could not allow. The Republicans' principal goal, Kristol added, should be to focus on handing the White House a "monumental setback." (He declined to use the word "Waterloo," but the sentiment was hardly vague.)

The memo became the basis for the GOP strategy in 1994 — it remains the guiding principle of the Republican Party today — and was integral in killing what was thought to be the best chance at passing meaningful reform since the days of Truman. Clinton's approval ratings suffered dramatically; Democrats developed a reputation for being unable to deliver on their own agenda; and less than a year later, Democrats lost their congressional majority. Republicans, far from being punished for their obstructionism, reaped the rewards of health care reform's demise. (Indeed, the public blamed the White House and the Democrats for overreaching, grinding on for months, and having little to show for it — a task made easier when Democrats blamed each other in ways that played into the Republican narrative.)

As the health care system worsened, the issue of comprehensive reform became toxic for Democrats, and it would be nearly two decades before a president with an impressive electoral mandate, working alongside huge Democratic congressional majorities, chose to take on the domestic policy challenge that has burdened the United States for generations.

After grueling, often thankless work, and overcoming seemingly-insurmountable hurdles, the task of fulfilling the promise of reform was all but complete less than two weeks ago. The door that appeared locked forever was finally open, with Democrats poised to make history by crossing the threshold.

As is now well known, there have been recent setbacks that make taking the next step difficult. Some may see the value in leaving the door ajar, or perhaps coming back to it at a later time. Opponents would have lawmakers believe we'd all be better off if they just closed the door and walked away.

It is imperative for the country, the economy, the party, and the Obama presidency that Democrats resist the temptation to let this rare opportunity slip by. The most effective path forward is also the most obvious: the House should approve the legislation that has already passed the Senate, and the Senate should extend assurances to the House on pursuing improvements through the budget reconciliation process.


I. The need for reform is overwhelming — and growing more intense every day.

The reasons that made health care reform an absolute necessity two weeks ago were not changed by a narrow majority of special-election voters in Massachusetts — many of whose Republican and independent voters support their own state's version of what congressional Democrats seek to do.

For all the media interest in political strategies, polls, and attack ads, the health care system remains badly broken. The reform package approved in December by the Senate would not only be the most important domestic policy breakthrough in decades, it would quite literally save American lives.

As anyone even passively familiar with the debate surely knows, the tens of millions of Americans with no coverage are struggling with a burden unseen in other major democracies. Thousands more join the ranks of the uninsured every day. Tens of thousands of Americans die every year because they have no insurance. Hundreds of thousands of others fall into medical bankruptcy — and most of these medical bankruptcies involve people who have insurance, but whose coverage proves inadequate.

To come up short now, or to pass a half-measure intended to respond to shifting political winds, would be more than just a political fiasco. It would be genuinely cruel.

The circumstances are incontrovertible. We pay too much and get too little. The system is bankrupting families, undermining businesses, hurting wages, and placing crushing burdens on government at every level. If reform falters right now, every easily-identified problem will get considerably worse. The current course is simply unsustainable for a country that hopes to have a fiscally responsible, competitive, and healthy future.


II. The political climate is inhospitable, but can be improved.

Any fair observer of the current political landscape recognizes that public support for reform waned as the legislative process unfolded. Some critics are on the left, hoping for an even more ambitious remedy, though most of the proposal's detractors have come to accept as true the often-false attacks waged by the insurance industry, the Republican Party, and right-wing activist/lobbying organizations.

To believe, however, that the attacks have done irreparable harm, and that far-right distortions are already too pervasive, is a mistake.



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