As President-elect Barack Obama prepares to take office and confront the problems with the nation's health care system, some people in Washington are feeling a sense of deja vu.
In 1993, Bill Clinton had just become president, and his party was in the majority in both the House and Senate. There were tens of millions of people without health insurance and high hopes for change.
That health reform effort crashed. The policy experts involved in that initiative say the Obama team will have to do things differently if they want to make change this time.
Sheila Burke, who in 1993 was the top aide to Senate Minority Leader Bob Dole, says bad timing was one of the prime reasons why the Clinton health plan failed.
"The Clintons had made this issue a critical one in the course of the campaign, talking about health reform," Burke says. "But then [they] essentially let a year go by while their task force pulled things together. ... You lost the attention of the American public, and you also allowed the opponents to essentially mount a campaign."
Setting Clear Goals
Another problem was that Bill and Hillary Clinton came up with a 1,300-page bill and asked Congress to pass it. Burke says the health reform effort would have fared better if "the president simply created a framework, given us a set of expectations and goals, and then allowed the Congress to do its business — allowed the Congress to essentially work through all the issues it had to work through in order to put through something that could pass legislatively."
The complexity of the bill didn't help matters either, says Chris Jennings, who was the White House Senior Health Policy adviser during the Clinton years. He says the Clinton team learned that people fear change they don't understand.
"People aren't happy with their current health care system. They aren't certainly happy with the costs, but they aren't willing to trade up or down for anything until they know exactly what it is," Jennings says.
Keeping It Simple
From what Jennings can see, Obama's campaign promises were the right ones. Obama said people could keep what they have, that his health care reform would be more secure and less expensive, and that there would be more choice.
Obama didn't get bogged down in details, and so far he's not pushing a lot of confusing mandates, Jennings notes.
"You don't hear about price controls or premium caps; you don't talk about new government agencies," he says.
A Time For Change
Both Burke and Jennings are optimistic that something will happen this time around — in no small part, Burke says, because health insurance costs more, and more people are uninsured than in 1993.
"People are increasingly frightened, and their economic situation has grown worse. But as a result, they are losing their coverage, they are getting sicker, they are more costly to care for," she says. "So it's hard to imagine from a policy standpoint not addressing this issue, because it is so central to the country, to people, so central to our economy."
Both Burke and Jennings are encouraged by the President-elect's pick of Tom Daschle to lead the Department of Health and Human Services, and the health reform effort. The former Senate majority leader knows how to get legislation through, they say. And health care was one of Daschle's issues as a leading Democratic senator.
Obama and Daschle will have to pacify some powerful interests, says Burke, including insurers, doctors, hospitals and patient groups.
"And they're facing a skeptical public worried about losing what they have," says Burke. The public has to prepare itself for change.
Among the changes Obama has been calling for: The government would offer a health plan anyone could join, employers would have to offer insurance or pay some kind of fine, and insurers would have to cover pre-existing conditions.
That's a lot simpler than the 1993 plan, but it's destined to get a lot more complicated as the details get worked out. The challenge will be to keep the public involved and on board until there's legislation ready to sign.