Pacifying Republicans is only one of the things Hillary has to worry about. After more than a month of meetings, speeches and visits to Capitol Hill, the broadest outlines of the First Lady’s health-care plan are coming into view-but her new job has become more complicated than even she may have imagined. She is barnstorming the country, building support for the idea of national health-care reform-while refereeing fights over policy among staffers back in Washington. She is girding the White House for a fierce lobbying battle over the biggest piece of social legislation the country has seen since the New Deal. And she is doing it while the whole world is watching to see if Bill Clinton blew it by giving her that much responsibility.
Hillary Rodham Clinton is the kind of person who can will herself to do almost anything. Yet even she is daunted by the challenge of creating a health-care plan in a hundred days. As the May 3 deadline looms, Hillary is showing signs of stress. Trundling from one meeting to another last week, she confessed to “worrying, worrying, worrying about all this.”
Being in charge of 500 policy wonks is Hillary heaven. But hammering out consensus is hell: hundreds of decisions have yet to be made. Some critics are asking what’s the rush: why can’t the administration take its time to both work out the details and line up legislative support? But Clinton aides believe they must move fast to pre-empt the interest groups. There have already been so many leaks from the 34 working groups that White House communications aide David Dreyer jokingly opened an umbrella in a meeting last week. The leaks suggest a plan based on two concepts: managed competition, where businesses form large networks to better bargain for coverage, and global budgeting, a Big Brotherish idea that sets ceilings on what can be spent.
Within the White House, there is tension between those who want to move quickly toward universal coverage and those who think cost-cutting should be the primary goal. A longtime social activist, Hillary would like to be in the first camp. But she is a realist. If Bill Clinton fails to curb health-care costs, he will lose the benefits of deficit reduction in his economic plan. For now, say White House insiders, it looks like the deficit hawks are winning. It is likely that universal coverage will be phased in over several years, while cost controls will be slapped on immediately.
Hillary must also listen patiently to all the interest groups clamoring for a seat at the table. To satisfy federal “sunshine” laws, she will hold a public meeting of her task force this month. Most of the big-name groups are making a public show of how much they support reform. The American Medical Association, which for decades has fought government intervention, has adopted the slogan “A time for new partnership.” The Pharmaceutical Manufacturers Association has joined with consumer advocates to urge speedy universal coverage. But once the plan is announced, and the groups have some specifics to shoot at, the pleasantries will end. “They say they support 95 percent of what we’re for,” says a Democratic aide. “But how many millions will they spend to defeat the other 5 percent?” Opponents of sin taxes aren’t waiting for the fine print. The public-relations firm of Fleishman-Hillard, representing the beer giant Anheuser-Busch, had the idea of recruiting organizers from the Clinton-Gore campaign to rally support against an expected tax on beer. But Hillary can play rough, too. The White House is putting out the word that those who sign on will be writing their death warrant in Democratic politics.
Hillary is mounting a campaign of her own to counter the often phony grass-roots opposition ginned up by special-interest groups. The model is her husband’s presidential race. Campaign manager Celia Fischer, a disciple of James Carville, Clinton’s colorful presidential strategist, is already at work. Fischer placed a sign on her door that reads: NO POLICY WONKS, JUST ORGANIZERS. Plans call for a nationwide push to educate the public about what’s in it for them. Videos will promote the plan, and there will be 800-numbers to call for information. The Clintons know that Congress, already on the spot to vote some $300 billion in new revenues under the Clinton economic plan, will not vote for a second round of taxes without significant public pressure. (The Clintons are avoiding naming a price tag, but the minimum is likely to be $30 billion.) Building the army for reform is made easier if Hillary is widely seen as a citizens’ advocate, the role she has sought to create as she travels the country.
The interest groups hit by the plan will inevitably charge that reform is a code word for less health care than the middle class is getting under the current system. The right to choose your own doctor could become a rallying cry against a plan that will inevitably restrict choice. The specter of rationing will be invoked. The White House will combat these arguments by creating demons on the other side-greedy doctors and insurance companies. Clinton’s defenders will argue that for a large chunk of the population, there is no doctor choice under the current system, while rationing is already dictated by ability to pay.
Having Hillary Clinton head the health-care task force makes it even more of a lightning rod. And yet she has managed to conduct most of her business beneath the media radar. She glides from meeting to meeting on Capitol Hill, her presence no longer considered worth remarking upon. And with only the perfunctory photo op, she rarely says anything that makes news. Once the plan is introduced, Hillary will let her husband take over as the main salesperson. She’ll still be out there, but in a secondary role. “You’ll never see a joint address,” says an adviser. It will be his health-care plan, for better or worse.
Oppose price controls and rigid global budgets that impose penalties for spending above a set level. Want a system that preserves Patient choice of physicians and permits a fee-for-service option.
Oppose extension of Medicare payment system to everyone. Oppose tinkering with prices or reimbursement without restructuring health care into networks that include both doctors and hospitals.
Oppose mandatory price controls but seek an antitrust waiver so companies can come up with voluntary price-increase restraints. Want to see drug coverage as part of the basic package of benefits.
Oppose plans that would mandate a single regional purchaser of health insurance. Oppose premium caps; in setting premiums, want some allowances for variances such as age and sex.
