Health care returns as an issue
By Bill Schneider/CNN
October 4, 1999
Web posted at: 6:22 p.m. EDT (2222 GMT)
WASHINGTON -- The House of Representatives is about to debate health care reforms and health care has emerged as a major issue in the presidential campaign. Haven't we been here before?
In 1993, health care was a hot issue. But the current debate is different from six years ago. Then the country was just coming out of a brutal recession. Middle-class Americans were terrified by the threat of losing their health care coverage and the Clinton Administration spoke directly to those fears.
"Every one of us in this room, even if we have insurance today, because our country cannot guarantee you health care coverage, we cannot know that we will have health insurance this time next year," said first lady Hillary Rodham Clinton in 1993.
The Clinton Administration came up with a bold program to guarantee insurance to all Americans.
"We have to create a system of comprehensive benefits that are always there that can never be taken away,'' said President Bill Clinton in 1993.
But the administration's plan was derailed by critics who said it would create a massive government bureaucracy.
Polls showed that Americans were overwhelmingly satisfied with their medical care and their health insurance, they were just afraid of was losing it.
By 1994, when the administration's plan was presented to Congress, Americans were more concerned about what would happen to them if the plan passed than about losing their health insurance if it failed.
So now, with the economy booming, low inflation and job creation at an all-time record, the health care issue has moved back on the front burner because more and more Americans have moved into managed care. The issue now is not loss of coverage. It's loss of rights.
"Americans have the right to have their medical decisions made by them and their doctors, and not by those bureaucrats sitting behind a computer screen hundreds of miles away," said Vice President Al Gore this year.
Back in 1994, Americans in managed-care plans and in traditional fee-for-service plans were about equally likely to rate their health insurance coverage as `"very good."
By 1998, those in traditional plans were still satisfied, but not the people in managed-care plans. Today, managed care accounts for almost 90 percent of people whose health care is covered by their employers. They're unhappy and that is the current crisis. It's a middle-class problem.
But what about the growing number of Americans who don't have any health insurance? Many of them are poor people, including women coming off welfare, children and non-citizens.
The danger for reformers now is the same as it was in 1994: the insured and the uninsured have different interests. And presidential candidates like Gore and former New Jersey Sen. Bill Bradley are trying to package them together, as one crisis. That gives opponents an opening to depict the reforms not as protecting what the middle-class already has, but as taking it away.
A new 1999 Business Roundtable advertisement depicts a man and a woman that express fears of losing insurance over new government regulations. The organization is opposing health care bill of rights legislation in Congress, saying it would lead to increased costs.
It's the same story now as in 1994. Middle-class concerns over managed care are driving the issue politically. But the crisis of the uninsured is largely outside the middle class.
The lesson of 1994 is, if you want to reform the system, you have to figure out a way to do it that doesn't threaten the middle class.