1993 Clinton health care plan

The Clinton health care plan, sometimes called "Hillarycare" by opponents, was a 1993 healthcare reform package proposed by the administration of Bill Clinton, then sitting President of the United States, and created and chaired by the First Lady of the United States, attorney Hillary Rodham Clinton. Now a candidate for President in 2008, Hillary Clinton has begun to outline a new health care proposal that she will push to enact if she becomes President in 2009.

Background
William Jefferson Clinton had campaigned heavily on health care in the 1992 election, and he quickly set up the Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, to come up with a comprehensive plan to provide universal health care for all Americans, which was to be a cornerstone of the administration's first-term agenda. A major health care speech was delivered by Clinton to a joint session of Congress on September 22 1993, with an overwhelmingly positive response. In that speech, President Clinton explained the problem as follows:

Millions of Americans are just a pink slip away from losing their health insurance, and one serious illness away from losing all their savings. Millions more are locked into the jobs they have now just because they or someone in their family has once been sick and they have what is called the preexisting condition. And on any given day, over 37 million Americans -- most of them working people and their little children -- have no health insurance at all. And in spite of all this, our medical bills are growing at over twice the rate of inflation, and the United States spends over a third more of its income on health care than any other nation on Earth.

Hillary Clinton's leading role in this project was unprecedented for a presidential spouse. This unusual decision by President Clinton to put his wife in charge of the project has been attributed to several factors, including the President's desire to emphasize his personal commitment to the enterprise; more controversial speculation suggests a quid pro quo in which she would "defend him from sex-related charges."

Although the United States has never had a universal health care system, it does have certain publicly funded health care programs that help to provide for the elderly and disabled (via Medicare), military service families and veterans (via the Veterans Health Administration), and the poor (via Medicaid). Additionally, federal law guarantees public access to emergency services regardless of ability to pay.

Debate
Starting on September 28, 1993, Hillary Clinton appeared for several days of testimony before five congressional committees on health care. Opponents of the bill organized against it before it was presented to the Democratic-controlled Congress on November 20, 1993. The bill was a complex proposal running more than 1,000 pages, the core element of which was an enforced mandate for employers to provide health insurance coverage to all of their employees through competitive but closely-regulated health maintenance organizations (HMOs). The full text of the November 20 bill (the "Health Security Act") is available online. Conservatives, libertarians, and the insurance industry staged a campaign against the "Health Security" plan and criticized it as being overly bureaucratic and restrictive of patient choice. The effort included extensive advertising criticizing the plan, including the famous Harry and Louise ad paid for by the Health Insurance Association of America, which depicted a middle-class couple despairing over the plan's supposed complex, bureaucratic nature. Time, CBS News, CNN, the Wall Street Journal and the Christian Science Monitor ran stories questioning whether there really was a health-care crisis. Op-eds were written against it, including one in The Washington Post by University of Virginia Professor Martha Derthick that said: In many years of studying American social policy, I have never read an official document that seemed so suffused with coercion and political naivete ... with its drastic prescriptions for controlling the conduct of state governments, employers, drug manufacturers, doctors, hospitals and you and me. U.S. Senator Daniel Patrick Moynihan qualified his agreement that "there is no health care crisis" by stating "there is an insurance crisis" but also indicated "anyone who thinks [the Clinton health care plan] can work in the real world as presently written isn't living in it." Meanwhile, Democrats, instead of uniting behind the President's original proposal, offered a number of competing plans of their own. Some criticized the plan from the left, preferring a Canadian-style single payer system.

The First Lady's role in the secret proceedings of the Health Care Task Force also sparked litigation in the U.S. Court of Appeals for the D.C. Circuit, in relation to the Federal Advisory Committee Act (FACA) which requires openness in government. The Clinton White House argued that the Recommendation Clause in Article II of the U.S. Constitution would make it unconstitutional to apply the procedural requirements of FACA to Hillary's participation in the meetings of the Task Force. Some constitutional experts argued to the court that such a legal theory was not supported by the text, history, or structure of the Constitution. Ultimately, Hillary Clinton won the litigation when the D.C. Circuit ruled narrowly that the First Lady of the United States can be deemed a government official (and not a mere private citizen) for purposes of not having to comply with the procedural requirements of FACA.

Defeat
In August of 1994, Democratic Senate Majority Leader George J. Mitchell introduced a compromise proposal that would have delayed requirements of employers until 2002, and exempted small businesses. However, "Even with Mitchell’s bill, there were not enough Democratic Senators behind a single proposal to pass a bill, let alone stop a filibuster."

A few weeks later, Mitchell announced that his compromise plan was dead, and that health care reform would have to wait at least until the next Congress. The defeat weakened Clinton politically, emboldened Republicans, and contributed to the notion that Hillary Clinton was a "big-government liberal" as decried by conservative opponents.

The 1994 mid-term election became a "referendum on big government — Hillary Clinton had launched a massive health-care reform plan that wound up strangled by its own red tape." In that 1994 election, the Republican revolution led by Newt Gingrich gave the GOP control of the House of Representatives, and the Senate too, ending prospects for a Clinton-sponsored health care overhaul. Comprehensive reform aimed at creating universal health care in the United States has not been seriously considered by Congress since.

In 1997, during President Clinton's second term, Congress did enact a health insurance program established by Senator Ted Kennedy and Hillary Rodham Clinton,SCHIP, that was intended to improve coverage for children.

Controversy in retrospect and perspective
In 2004, as a U.S. senator from New York, Hillary Clinton argued in the The New York Times that the current health care system is unsustainable, and she offered several solutions. Her article also mentioned areas of agreement with one-time opponent Newt Gingrich, and likewise Gingrich has expressed agreement with Senator Clinton on some aspects of health care, including a bill to modernize medical record keeping.

In 2005, referring to her previous efforts at health care reform, Hillary Clinton said "I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done." Again in 2007, she reflected on her role in 1993-1994: "I think that both the process and the plan were flawed. We were trying to do something that was very hard to do, and we made a lot of mistakes."

Hillary Clinton received hundreds of thousands of dollars in campaign contributions from doctors, hospitals, drug companies, and insurance companies for her 2006 re-election in the Senate, including several insurance companies that were members of the Health Insurance Association of America that helped defeat the Clinton Health Plan in 1994. Charles N. Kahn III, a Republican who was executive vice president of the Health Insurance Association in 1993 and 1994, refers to his previous battles with Clinton as "ancient history," and says "she is extremely knowledgeable about health care and has become a Congressional leader on the issue."

In the years since the Clinton effort of 1993-1994, a combination of factors have kept health care off the top of the agenda. For example, politicians have not been eager to confront the forces that successfully frustrated the Clinton effort, and health maintenance organizations have been able to limit cost increases to some extent.

The Clinton health care plan remains the most prominent national proposal associated with Hillary Clinton, and may influence her prospects in the 2008 presidential election. There are some similarities between the Clinton Health Plan and Republican Mitt Romney's health care plan that has been implemented in Massachusetts, though Romney has since distanced himself from Clinton on the issue, in particular arguing that his plan calls for more control at the state level, and not from the federal government. According to Bill Maher, Clinton's attempts to distance herself from the original plan (stating in one debate, "We tried that in '93, and I've got the scars to prove it") are unwise because, in his view, she should be reminding other candidates of such similarities: And Hillary Clinton – I’ve heard her recently say, "Oh, yeah, we made a lot of mistakes back when I was doing health care; oh, I shouldn't have done this." [...] Instead of saying, "You know what? I kind of had it right back then, and you idiots went along with 'Harry and Louise', which were ads bought by the insurance companies." [...] And if you look at the plans that the other people have come up with, they're basically the same plan that she proposed. [...] And she's giving life to the lie.

Current estimates put US healthcare spending at approximately 15% of gross domestic product, which is the highest in the world, and government spending (including tax benefits) accounts for more than 44.6% of total health spending in the United States. Still, only an estimated 84.3% of citizens have some form of health insurance coverage, either through their employer or purchased individually, and U.S. citizens continue to have a relatively low life expectancy compared to people from other industrialized nations such as Australia, the United Kingdom, Canada, and Sweden. Infant mortality rates also appear to be higher in the United States, despite declines in recent decades.

In September 2007, former Clinton Administration senior health policy advisor Paul Starr published an article named "The Hillarycare Mythology", where he asserted that Bill Clinton, not Hillary Clinton, was the driving force behind the plan at all stages of its origination and development; that the task force headed by Hillary Clinton quickly became useless and was not the primary force behind formulating the proposed policy; and that "Not only did the fiction of Hillary's personal responsibility for the health plan fail to protect the president at the time, it has also now come back to haunt her in her own quest for the presidency."

Many analysts believe that life expectancy in the United States could be best addressed by decreasing obesity rates, and former President Clinton has made tackling childhood obesity a major priority of his, in recent years.