Why 2009 Is the Year for Universal Health Care: It's Not 1994 All over Again. the Next President Can Get the Reforms That Harry Truman and Bill Clinton Couldn't

Article excerpt

In the best of circumstances, presidential libraries are a strange combination of leftover campaign literature and newfound architectural ambition. Even so, the Clinton Presidential Library, in Little Rock, Arkansas, is notable for approaching its subject with all the depth of a coloring book. Eight years of presidential policies, political battles, and world events are sorted into 20-odd "policy alcoves," all of which come complete with titles right from the campaign. The first, for instance, is "Putting People First." Here, behind reinforced glass tattooed with inspirational excerpts from Bill Clinton's speeches, the administration's entire record on social policy is condensed into a couple of blow-up photos and capsule summaries. And right there, between "caring for children" and "welfare reform," is the library's exhibit on the 1994 health-care battle. It gets 144 words.

Uncharitable observers might sneer that this is all it deserves. They would be wrong. The 1994 health-reform fight was a tremendous, courageous undertaking that the nascent Clinton administration approached seriously, substantively, and stupidly. Its defeat, which preceded an election in which the Democrats lost 52 House seats and control of Congress, inflicted enormous psychic trauma on every level of the Democratic establishment--the politicians, the political consultants, the advocacy community, and the hundreds of wonks and experts who participated in the plan's creation. It taught many that health care is simply too big, too complicated, too dangerous to touch. Since the drubbing, Democrats have been afraid, as former Sen. Bill Bradley put it, "to go back into that room where that bad thing happened."

But Democrats need to return to that room--and bipartisan universal health-care campaigns in Massachusetts, California, Wisconsin, and many other states have opened the door. In the Congress, Sen. Ron Wyden's Healthy Americans Act has attracted 10 co-sponsors, six of them Republican. In the presidential campaign, all of the major Democrats proposed comprehensive plans. Talk of reform once again floats through Washington.

But as the Clinton Library display attests, the moment has looked propitious for change before, and failure has been all the harsher for it. Health care, which now comprises a full one-seventh of the economy, is hard to reform. Harry Truman failed, as did Richard Nixon and Bill Clinton. Franklin D. Roosevelt didn't even try, believing any attempt would not only fail but take down Social Security, too. And the system has only grown larger and more entrenched in the years since. Health care is now a multi-trillion dollar industry that generates billions in profit streams for all manner of powerful actors. Medical coverage and its attendant costs are a source of acute anxiety for Americans. About 84 percent of the population has health insurance, and, crucially, 94 percent of voters do, but they are deeply afraid of losing what they already possess.

In 1994, reformers were hampered by the belief that the rules of bipartisanship were still in effect and a collection of public-minded senators would eventually come together to enact reform. They weren't prepared for a Republican Party animated by William Kristol's famous memo, "Defeating President Clinton's Health Care Proposal," which darkly warned that a Democratic victory would save Clinton's political career, revive the politics of the welfare state, and ensure Democratic majorities far into the future. "Any Republican urge to negotiate a 'least bad' compromise with the Democrats," wrote Kristol, "... should also be resisted." Today, the basic arithmetic of the Senate remains unfriendly, with a 60-vote supermajority still required to move major legislation.

Even so, every major Democrat running for president has promised to make health-care reform the top domestic priority of their first term. And they will do so atop a community of advocates, analysts, organizers, and congressmen who are more battle-hardened than they, or their counterparts, were in 1994. …