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Deja Vu on Health Care? Maybe Not.

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By Ruth Marcus
Wednesday, June 24, 2009

Congressional Democrats warn that the president's ambitious plans to overhaul the nation's health-care system may be in danger. Sensing political opportunity, Republicans ramp up their criticism, warning of a government takeover of health care. Business groups balk at the notion of an employer mandate.

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Is this health-care deja vu all over again, the Clinton disaster of 1993-94 revisited?

When it comes to the prognosis for overhauling health care, pessimism is a safe bet, and there's been ample basis recently for that gloomy assessment. The Congressional Budget Office put the price tag of one proposal at $1.6 trillion. The Senate Finance Committee, reeling from the sticker shock, postponed action.

"I don't know that he has the votes right now," California Democratic Sen. Dianne Feinstein said of President Obama. "Health-care reform is on life support," warned Tennessee Democratic Rep. Jim Cooper.

So the whole effort could well fall apart once again. But my money is on the side of a significant legislative accomplishment -- something short of immediate universal coverage but more than cosmetic change. In conversations with veterans of the Clinton effort, all said the turbulence was expected, inevitable and almost certainly not the last buckle-your-seatbelt moment. But most were cautiously optimistic about the final outcome.

Their reasoning was threefold: This administration has learned from the multiple mistakes of the Clinton years. Congressional Democrats are more committed to getting something passed than they were 15 years ago. The interest groups -- insurers, pharmaceutical companies, doctors, hospitals -- are no less self-interested, but some have concluded that their self-interest may be better served by forging change to their liking than sticking with an unsustainable status quo.

The Clinton administration's errors on health care were, literally, start to finish. At this point in the Clinton administration, the plan was being written in secret; the stone tablets weren't handed down until September. Obama smartly let lawmakers work through the complicated details from the start. At the same time, he has not locked himself into an unwinnable endgame as Clinton did, waving his pen and vowing to veto anything short of universal coverage. By contrast, White House Chief of Staff Rahm Emanuel has decreed that "the only non-negotiable principle here is success."

Even Robert Reischauer, CBO director during the Clinton years and the most pessimistic of the bunch, gave the Obama administration high marks. "The way they've been going about doing this has raised the probability, in my mind, from zero to about 33, 40 percent," he said.

In Congress, key lawmakers have been preparing for this moment and are determined not to squander it. Montana Democrat Max Baucus, chairman of the Senate Finance Committee, is no Daniel Patrick Moynihan, but that may be a good thing in this circumstance: Moynihan as chairman was openly skeptical of comprehensive reform, while Baucus has doggedly been working through the details alongside the ranking Republican, Iowan Chuck Grassley.

Getting more than a few Republicans on board will be difficult but not impossible: The proof is in the bipartisan bill crafted by Oregon Democrat Ron Wyden and Utah Republican Bob Bennett. Without being ghoulish, the Ted Kennedy factor is also at play. Although the effort has suffered to some extent because of the Massachusetts senator's absence from the negotiating scene, his illness provides powerful emotional leverage for passage.

"I know some people are trying to turn this into '93-94, and people on the right wing and people on the left wing are practically starting the recrimination hour already," said Wyden, optimistic Tigger to Reischauer's gloomy Eeyore. "There is much more to work with today than there was in '93. Republicans have moved dramatically and Democrats have said that we want to meet them halfway."

Meantime, the coalition of interest groups that coalesced to kill health-care reform last time is in a more accommodating frame of mind. Insurers are willing to subject themselves to strict rules if they don't face crippling competition from a public plan and if individuals are required to purchase coverage. Pharmaceutical companies are running ads in support of health reform; Monday's announcement that the industry will ante up $80 billion in savings was short on details but still suggests how far the calculus in favor of cooperation has changed.

Not that getting there will be easy. "If you think every day is going to be a good day," said Chris Jennings, a member of Clinton's health-care team, "then you haven't been through health reform."

marcusr@washpost.com


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