What Hillary Knew—In 1993
Twenty years ago, Clinton's health care plan was on to something. But you wouldn't know it from Democratic policy since then.
By GOV. BOBBY JINDAL
May 13, 2014
Former White House press secretary Robert Gibbs’ recent comments doubting that Obamacare’s employer mandate will ever be implemented—he called it “one of the first things to go”—likely caused heartburn among his onetime West Wing colleagues. But there’s one former Obama administration official whom Gibbs must have terrified more than most.
Years ago, that famous figure testified publicly that if Congress were to pass legislation with an individual mandate to purchase insurance, “we worry that the numbers of people who currently are insured through their employment will decrease because there will no longer be any reason for many employers” to offer coverage, when individuals can receive government subsidies instead.
That figure’s name is Hillary Clinton.
It is a well-known fact that Clinton came to strenuously support an individual health insurance mandate in her 2008 primary campaign against Barack Obama. Less well-remembered, however, is that Clinton considered an employer mandate—not an individual mandate—the best way to achieve “universal coverage” in her health care task force’s ill-fated 1993 proposal, put forth while she was first lady.
Back then, both Hillary and President Bill Clinton believed that placing responsibility primarily on individuals, as opposed to employers, to obtain coverage could cause employers to drop their existing plans. Little wonder that after millions of Americans had their health plans canceled last fall, Bill Clinton criticized President Obama’s “if you like your health care plan” promise; in fact, the Clinton White House knew that pledge was dubious two decades before Politifact finally named it the “lie of the year.”
The Clintons were onto something at the time, but the health policies they and their party have since advocated have not only failed to solve our nation’s health care problems—in some cases, they’ve made them worse. Read two decades later, Clinton’s 1993 congressional testimony reinforces both what has changed and what has not.
Consider another truth the Hillary Clinton of 1993 could tell Obama today. “If we subsidize individuals below a certain income level,” she noted in her testimony before Congress, “there would be pressure on employers to keep wages below the subsidy level so that they [health insurance premiums] would continue to be paid for by the government.” That sounds a lot like what the Congressional Budget Office concluded in February: that Obamacare will reduce the labor force by the equivalent of 2.3 million workers, because employers will not raise wages and individuals will choose not to work in order to retain access to government insurance subsidies.
Clinton’s statements demonstrate the colossal failures not just of the Obama administration but of two decades of government planning in health policy. For instance, before the House Ways and Means Committee in September 1993, Clinton testified, “We have 70 percent specialists, 30 percent primary care physicians. We need to move toward 50-50.” Today, more than two-thirds of practicing physicians remain specialists, and a June 2013 study found that only one-quarter of new doctors go into primary care. The Department of Health and Human Services predicts a shortage of 20,400 primary care physicians by 2020, while outside estimates are more than double that figure. All this despite dozens of government education and training programs for health care professionals; just in fiscal year 2012, four federal departments administered 91 separate programs, to the tune of $14.2 billion, many of which had been expanded under Obamacare.
Clinton’s testimony is also replete with data regarding geographic variations in health costs. Like Obama in 2009, both Clintons argued in 1993 that reducing these variations would lower health care costs on balance, while improving quality of care. But the Clinton administration utterly failed to address this concern: The CBO has found that variations in Medicare spending actually increased during the Clinton years. And in fact, an Institute of Medicine report released in June found that high-spending regions in 1992 remained high-spending regions in 2010. What does it say about the Clinton administration—and, so far, the Obama administration too—that for two decades liberal policymakers have utterly failed to “fix” one of the supposed rationales for proposing Hillarycare in the first place?
The left continues to argue that the next new program, the next new bureaucracy or the next new tweak to Medicare’s more than 7,000 reimbursement codes will finally provide the magic elixir needed to fix all that’s wrong with the U.S. health care system. But none has worked. In health care, as in many things, the Clintons were the future—once. But after 20 years of false hope and undelivered promises, their vision, as eventually implemented in Obamacare, looks more dystopian than utopian. With apologies to Lincoln Steffens, we have seen the past, and it didn’t work—then or now.
There is a better way—and it involves promoting freedom and choice to control rising health costs. The America Next health plan I unveiled last month empowers both states and individuals, not federal bureaucrats, giving states new incentives to reform their insurance markets and health systems and providing more insurance options for individuals. And it focuses on reducing health costs—the CBO concluded that a proposal similar to the America Next plan would reduce individual health insurance premiums by thousands of dollars per family.
The question neither Hillary Clinton nor Barack Obama will want to answer is why the problems outlined by Clinton in her testimony two decades ago remain unsolved. The reason is that the left keeps coming up with the same wrong answers; it brings to mind that insanity is sometimes defined as doing the same thing over and over again, hoping for a better result. It’s time for conservatives to propose better solutions—and the America Next health plan is a big step in that direction.