Clinton Presents Plan For Universal Coverage

Sen. Hillary Rodham Clinton greets a crowd in Des Moines, where she unveiled her plan for providing universal health care.
Sen. Hillary Rodham Clinton greets a crowd in Des Moines, where she unveiled her plan for providing universal health care. (By Michel Du Cille -- The Washington Post)
By Perry Bacon Jr. and Anne Kornblut
Washington Post Staff Writers
Tuesday, September 18, 2007

Sen. Hillary Rodham Clinton yesterday unveiled a proposal to provide health insurance to all Americans, placing herself at the center of an issue that provided perhaps the greatest setback of her political career.

In a speech in Des Moines, the Democratic front-runner said she would expand insurance to the 47 million people who do not already have coverage and would attempt to reduce costs for others without spawning a massive new bureaucracy. In a far different political environment than the one that turned her efforts to establish universal health care into a fiasco in her husband's first term, Clinton offered a more modest approach than she took as first lady and head of a White House task force in 1993.

"Today's plan is simple yet doable," Clinton said. ". . . This is not government-run. There will be no new bureaucracy."

Similar to proposals offered by her chief Democratic rivals, former senator John Edwards (N.C.) and Sen. Barack Obama (Ill.), Clinton's plan -- with an estimated $110 billion annual price tag -- would seek to build on the existing health-care system but would make it easier for adults without health insurance to buy it through tax credits.

Health care has emerged as the paramount domestic issue of the 2008 race, and all of the Democratic contenders are embracing aggressive approaches to broadening coverage. But for Clinton, it also is a reminder of some of the early lows of her husband's administration. While even Edwards and Obama agree that her travails in the health-care debate of the early 1990s give her a vast base of knowledge and experience on the issue, they point to the failure as an argument that the experience Clinton so often touts is not necessarily an asset.

"She's the candidate with the most expertise, but she's also the candidate with the most negative history," said Jonathan Gruber, a health-care expert and professor at the Massachusetts Institute of Technology who talked to all three leading Democratic campaigns about their plans. "Will the public be more swayed by her experience or her bad history?"

Clinton said she has learned from her failure on the issue. In an interview before unveiling her proposal, she stressed that she has a "better understanding of the relationship between the president and Congress" than she did 15 years ago. "Having worked on both ends of Pennsylvania Avenue now," she said, "I think I have a better chance of being successful with this legislation."

She added that "there is a much broader consensus on the need for reform now," as health-care costs have outstripped inflation and the growth of income in the past 15 years. "You see businesses and labor together on this, Republican and Democratic governors, and the fact that we are in a global market, where our health-care costs are a competitive disadvantage -- all of that is different."

Bill Clinton campaigned on the promise of expanded health care in the 1992 presidential race, but the "Health Security Act" crafted by Hillary Clinton and her task force was abandoned as congressional Democrats and the administration bickered over the details and Republicans and insurance companies adamantly opposed it.

Now, with states such as Massachusetts mandating universal care and even Republicans such as California Gov. Arnold Schwarzenegger pushing similar initiatives, Clinton's proposal is not as politically daunting as it might have been even four years ago. The labor unions being courted by the candidates have essentially demanded that candidates offer universal coverage, and the plans Edwards and Obama have offered are so expansive that there was little short-term risk to Clinton in offering an ambitious scheme.

"The race is advanced to the point where you can't sneak by with a plan without too much detail in it," said Erik Smith, a Democratic strategist and veteran of presidential politics.

Republican presidential candidates have offered much more limited ideas for reforming health care, eschewing proposals for universal health care and instead touting changes to the tax code that they say would make it easier for individuals to purchase private insurance but that would not expand coverage dramatically, as the Democrats propose. Eager to establish themselves as anti-Clinton, several were quick to take aim at her proposal yesterday.

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