Health Care


Talk of changing the nation's health-care system is giving some people in Washington a sense of deja vu. Back in 1993, a new president came to town, and his own party held the House and Senate. Tens of millions of people had no health insurance and high hopes for change. That reform effort crashed. Today, the experts involved in that effort say the Obama team will have to do things differently if they want to be successful this time. NPR's Joanne Silberner reports.

JOANNE SILBERNER: In 1993, Sheila Burke was the top aide to the minority leader of the Senate, Republican Bob Dole. She says bad timing was one of the prime reasons for the failure of the Clinton health plan.

Ms. SHEILA BURKE (Former Chief of Staff for Senator Bob Dole): The Clintons had made this issue a critical one in the course of the campaign, talking about health reform, but then essentially let a year go by while their task force pulled things together. And in the course of that, you lost the attention of the American public in many respects, and you also allowed the opponents to essentially mount a campaign.

SILBERNER: Another problem: The Clintons came up with a 1,300-page bill and asked Congress to pass it. Burke says the health reform effort would have fared better...

Ms. BURKE: Had the president simply created a framework, given us a set of expectations and goals, and then allowed the Congress to essentially work through all the issues it had to work through in order to put something together that could pass legislatively.

SILBERNER: Then, she says, there was the complexity of the bill. Chris Jennings sees that as a problem, too. Jennings was the White House senior health policy adviser throughout the Clinton years. He says the Clinton team learned that people fear change that they don't understand.

Mr. CHRIS JENNINGS (Former White House Senior Health Policy Adviser): People aren't happy with their current health-care system, but they aren't willing to trade up or down for anything until they know exactly what it is.

SILBERNER: From what Jennings can see, Obama's campaign promises were the right ones, that people could keep what they have, it would be more secure and less expensive, and there'd be more choice. Obama didn't get bogged down in detail, says Jennings. And so far, he's not pushing a lot of confusing mandates.

Mr. JENNINGS: You don't hear about price controls or premium caps, or you don't talk about new government agencies.

SILBERNER: Both Burke and Jennings are optimistic that this time around, something will happen. Burke says that's in no small part because health insurance costs more, and more people are uninsured than in 1993.

Mr. JENNINGS: 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. So it's hard to imagine from a policy standpoint not addressing this issue.

SILBERNER: 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. Daschle, they say, knows how to get legislation through after his stint as Senate majority leader. And he knows health care because it's been one of his issues since his time as a Democratic senator.

Daschle and Obama will have to pacify some powerful interests: insurers, doctors, hospitals, patient groups. And they're facing a skeptical public worried about losing what they have. Burke says the public has to prepare itself.

Ms. BURKE: I think they have to anticipate that things will change.

SILBERNER: Among the changes Obama has been calling for: Employers would have to offer insurance or pay some kind of fine; insurers would have to cover pre-existing conditions; the government would offer a health plan anyone could join. 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 onboard until there's legislation ready to sign. Joanne Silberner, NPR News, Washington.

Copyright © 2009 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.



Please keep your community civil. All comments must follow the Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

NPR thanks our sponsors

Become an NPR sponsor

Support comes from