The Washington Post

Why did Obama promise people could keep their health insurance? Blame Bill Clinton.

The irony of Bill Clinton coming out to advise that Obamacare be changed — somehow — to let everyone keep their current plans is that he's the reason Obama made the disastrous promise in the first place.

Who's laughing now? (AP) Who's laughing now? (AP)

Veterans of the effort to pass Clinton's health-care plan believed that their core mistake was producing a plan that upended the insurance arrangements of almost every American.

Where the 1990-1991 recession left most Americans terrified that they could lose the health care they had, the Clinton bill promised they would lose that care. The sort of comforting lines reformers offer today — "if you like your current care, nothing will change," or "you'll get the same health care members of Congress have" — couldn't be uttered because they weren't true. The line the Clinton campaign did use, "health security that can never be taken away," foundered because, before the plan offered that security, the health security that Americans currently trusted would be taken away.

In this, the plan violated the fundamental paradox of health-care polling, which is that even though most Americans believe the health-care system is a mess, they're reasonably happy with the insurance they have.

In the aftermath of Clinton's failure, health-care reformers swung far to the other side. Rather than building a plan in which almost everyone lost their insurance, they began trying to build plans in which almost no one lost their insurance — and selling them under the promise that literally no one would.

That promise, as the Obama administration is now learning, went too far. Saying "everyone who likes their health insurance can keep it" is very different from saying "95 percent of people who like their health insurance can keep it."

But it's a bit rich for Clinton to argue for a plan that leaves everyone's insurance unchanged. When he managed this policy process, he believed the optimum policy upended almost everything. He knows that it's functionally impossible to reform the health-care market if you upend nothing. This is the kind of argument that, in another context, Clinton would be delighting in explaining, carefully and persuasively, why it's so very wrong.



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Lydia DePillis · November 12, 2013

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