How healthcare reform opponents prevailed in 1993-94:

Intransigence plus exploiting Hillary's cumbersome plan

Denial of health care to those in need would seem to be unnecessarily cruel, but it is viewed as politically essential by right-wing ideologues like William Kristol, now the editor of The Weekly Standard.

The same cruel calculus is visible in President George W. Bush's all-out battle against expansion of the S-CHIP program for covering the health needs of uninsured children. (See below).

As we approach the latest round of America's on-again, off-again drive for healthcare, we must understand more clearly how the clever, if demented, elements of the Right blocked enactment of a universal healthcare program in 1993-94 when there appeared to be overwhelming momentum for such a plan. For example, a Wall St. Journal poll in 1993 showed 69% for a Canadian-style single-payer plan.

But Kristol managed to rally the Right, arguing that Republicans' had a critical political imperative to destroy any health plan that might emerge during the Clinton administration. Give the devil his due: Kristol assembled the then-despondent Right at a time when ultra-conservatives were feeling a national health plan was inevitable.

Kristol recognized that if the Democrats "delivered" on such a fundamental need as healthcare, the Deems would recapture the loyalty of their wavering base--and a chunk of the Republicans'-- for decades to come.

Moreover, a successful health plan would demonstrate several inconvenient truths: That government can take the side of the people against the powerful; that government can be a constructive tool for extending democracy and improving people's lives; and finally, that government can be far more efficient than the bureaucracy-ridden, profit-driven insurance companies who impose such huge costs on the US health system.

Thus, Kristol came to this bald conclusion in a memo widely disseminated on the Right: "Sight unseen, the Republicans should oppose it."

Enactment of a successful national health plan, he warned, would "re-reinitiate middle-class dependence for 'security on government spending and regulation" and "revive the reputation of the…Democrats as the protector of middle-class interests."

Kristol's strategy called for raising doubts about reform proposals, trying to suggest that they valued efficiency over quality and would erode personal relationships between the doctor and patient.

Two additional factors intervened to help Kristol and his allies:

1) NAFTA DEMORALIZES POTENTIAL ACTIVISTS Bill Clinton's all-out push for the job-exporting, corporate-supremacy NAFTA severely alienated the rank and file of labor and its retiree groups, who saw it as an unprecedented sell-out of their interests. When Clinton prevailed on NAFTA in November, 1993, it took the wind out of the sails of working people. They felt that they had been betrayed by a Democrat who won passage of a reactionary measure sending jobs to low-wage, high-repression Mexico that no Republican could have possibly won.

2) SINGLEPAYER BLOWN OFF BY CLINTONS Second, Bill and Hillary Clinton dismissed without consideration the single-payer healthcare plan that has been so successful from Canada to Taiwan. Instead, the Clintons opted for a plan that would keep large insurers at the wheel of our healthcare system, assuring their support for the healthcare plan as well as huge campaign contributions (that is, until control of Congress switched to the Republicans in 1994.

The incredibly complex and secretive process around the Hillarycare plan, plus the cumbersome final product calling for "managed care," gave the Right a huge, slow-moving dirigible that was easy to shoot down.

Americans' experience with "managed care" up to that point had been far from positive, and was often perceived as "mangled care": HMOs denied free choice of doctors, blocked additional testing, refused to authorize needed operations, and took other ruthless cost-cutting steps.

The infamous "Harry and Louise" ads launched by medium and small insurers--cut out by the Clinton plan--coupled with relentless Rush Limbaugh-style talk radio attacks--completed the task of blasting the managed care blimp out of the sky.

(I discuss some lessons of the lost HillaryCare opportunity of 1993-94 in the July 11 issue of Progressive Populist at http://www.populist.com/07.11.bybee.html)

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The S-CHIPS are down: Bush battles child health program while fighting to subsidize insurers

All the chips are down, as President Bush is waging an all-out hold crusade against the expansion of the S-Chip program to provide healthcare to uninsured American children.

Bush claims that this battle is over "philosophy," reflecting his belief that healthcare must include a substantial rake-off for the insurance companies as parasitic middlemen. (Bush is fighting this same battle in still-ravaged New Orleans, where he is pushing the sale of private insurance policies rather than rebuilding a charity hospital that could provide far more medical coverage for the same money. (See my July 25 post below).

Even the drug industry's lobbying arm, PHRMA--always eager to polish its sordid image among the American public-- and ultra-conservatives like Sens. Orrin Hatch and Charles Grassley are deserting Bush on this issue and pushing for S-CHIP's expansion. No wonder they're backing away:  both a poll by Republican public-opinion research firm and a recent Georgetown University survey show 86%-90% support for S-CHIP expansion, including 83 percent of self-identified Republicans.

As Paul Krugman astutely observes in his New York Times column 7/30/31,

It [the conflict] must be about philosophy, because it surely isn’t about cost. One of the plans Mr. Bush opposes, the one approved by an overwhelming bipartisan majority in the Senate Finance Committee, would cost less over the next five years than we’ll spend in Iraq in the next four months. And it would be fully paid for by an increase in tobacco taxes.

The House plan, which would cover more children, is more expensive, but it offsets S-CHIP costs by reducing subsidies to Medicare Advantage — a privatization scheme that pays insurance companies to provide coverage, and costs taxpayers 12 percent more per beneficiary than traditional Medicare.

Strange to say, however, the administration, although determined to prevent any expansion of children’s health care, is also dead set against any cut in Medicare Advantage payments.

So what kind of philosophy says that it’s O.K. to subsidize insurance companies, but not to provide health care to children?

To be blunt, Bush's brand of philosophy is willing to accept chronic illnesses and reduced life-chances for children due to preventable conditions if two overriding concerns are at stake:

1) The health system retains a central, guiding role for private interests despite their proven record of inefficiency, as the private insurers most surely do Total administrative costs in the US are 31%; in Canada it is 16.7%, according to a study published in the New England Journal of Medicine.

2) It prevents the spread of the dangerous example of government acting positively in behalf of ordinary people. The possibility of the government acting as the public's democratic voice, expressed in policy that actually gets implemented efficiently, could easily re-kindle the expectations that fueled the New Deal and Great Society. Thus, much of current right-wing propaganda is devoted to extinguishing the very notion that it is possible for government to ever act effectively. (See for example Daniel Popeo's ludicrous argument in the 7/30/07 NY Times, placed by the Washington Legal Defense Fund on the op/ed page)

Thus, the Bush administration's shameful performance around Katrina is attributed to the inherent flaws of government inefficiency, not the fact that this particular government was stacked with pet poodles of corporate power in the agencies that matter to Bush and filled with utterly inexperienced and uncaring incompetents in agencies that don't count with Bush, like FEMA.

But not content with re-fighting the battle of Katrina, Bush and his dwindling band of bitter-end allies are now choosing to risk a lot of political chips in their war against S-CHIPS.