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Comprehensive health care reform (then)
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The more things change, the more they stay the same.
The current flurry of activity—which seeks to achieve a sweeping reform of the health care system—is reminiscent of the health care reform wars of the 1990’s in the nation’s capitol.
An excellent paper by Derek Bok of Harvard University reviews the politics of what happened during the “HillaryCare” effort. http://www.upenn.edu/pnc/ptbok.html The Clintons undertook this challenge early in President Bill Clinton’s brand new presidency. Then-First Lady Hillary Clinton headed up a task force which worked behind closed doors at The White House; that group produced a plan that was comprehensive and massive.
It was 1993. The time had seemed right to take on a massive overhaul of the health care system in the United States. The (arguably) most powerful country in the world was being severely crippled by the cost, yet resultant lack of quality, of its health care system. Americans were dismayed at health care coverage options which were quickly becoming unaffordable. The new president was riding high on a wave of public approval—64% in late ‘93-early ‘94, according to a poll conducted by The Roper Center at the University of Connecticut. www.ropercenter.uconn.edu Portions of the medical provider community were ripe for change, some even seeking it; and there was the enticing promise of lower-cost insurance coverage that would be provided to even the most difficult-to-reach of the uninsured population.
All this, and the health care reform effort failed.
How? There were as many opponents of the huge legislative proposal put forth by the Clintons as there were proponents. For example, the “Harry and Louise” advertising campaign by the health insurance industry played a big role in scuttling the extensive effort in 1993-4. http://www.youtube.com/watch?v=Dt31nhleeCg While the insurance companies were—and are—concerned about their fiscal health, they were not the only aspect of the health care community to have stood in opposition to government-run health care. That list was extensive: everyone from the big pharmaceutical companies, that would have been subjected to government price controls (in the form of the “blacklisting” of new drugs considered to be priced inappropriately); to employers, small and large, who would have faced mandates; to the American Medical Association. Furthermore, it was opposed by the American Association of Physicians and Surgeons, who, along with several other groups, filed a lawsuit against Hillary Clinton and then-Secretary of Health and Human Services Donna Shalala for their secretive proposal-development process, to find out who the participants at the table had been.
While initially supportive of the general idea of reforming the health care system, the devil is always in the details. The insurance industry and others took a hard-line in opposition when they saw the “fine print” in the 1,000+ page proposal from Mrs. Clinton’s secret task force. The proposal was heavy on regulation and light on market-based competition (at a time when market-based competition held more appeal.) http://tech.mit.edu/V113/N44/health.44w.txt.html
The result of the extensive months of debate on “HillaryCare” was passage of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA (known “back-in-the-day” as Kennedy-Kassebaum—though technically it was the Kassebaum-Kennedy bill) grew out of the ashes of “HillaryCare.” It was a series of compromises; it contained essentially the provisions that could garner bi-partisan support in the aftermath of the visceral debate on the huge, encompassing legislation that drove people—politicians, industry representatives, Americans—into different corners.
HIPAA was designed to reward individuals who have done the “right” thing—maintaining health insurance, avoiding “significant breaks” in coverage (going more than 63 days uninsured)—by prohibiting health insurance companies from discriminating against them, such as not covering “pre-existing conditions.” At the same time, it does not allow Americans to “game” the system—going uninsured while healthy, and then seeking to get into the insurance market should they become ill.
More can certainly be done with this compromise of 16 years ago. Even in today’s debate, “Obama and Democrats who control Congress are pushing bills to limit insurers' ability to deny coverage. Some legislation being discussed also would force more insurance competition by setting up exchanges, purchasing pools or nonprofit cooperatives.” http://www.chicagotribune.com/business/chi-tc-biz-healthcare-0618-0619-jun19,0,3512484.story
HIPAA certainly did not solve all of the problems in the health care system in the United States. It was merely a step in the right direction, but it was derived honestly and correctly; it was action that was supported widely across the political spectrum and was intended to move protections forward. HIPAA did provide some progress against the problems of the day—which is really all that we can hope for from the government, and other reforms were achieved during President Clinton’s Administration. These included the Family and Medical Leave Act and the Children’s Health Insurance Program, though Mr. Clinton failed to gain consensus on efforts such as his attempt to expand Medicare eligibility.
According to Dictionary.com, compromise mean “a settlement of differences by mutual concessions; an agreement reached by adjustment of conflicting or opposing claims, principles, etc., by reciprocal modification of demands.” Read: one cannot get everything, every time.
This discussion will be continued.
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