Hillarycare Redux? A Review of “The System”

A young president promising hope and change takes over the White House. Immediately embarking upon a major health-care initiative, he becomes trapped amidst warring factions in his party in Congress, bickering interest groups, and an angry public, all laying the groundwork for a resounding electoral defeat.

Barack Obama, circa 2009-10? Most definitely. But the same story also applies to Bill Clinton’s first two years in office, a period marked by a health-care debate in 1993-94 that paved the way for the Republican takeover of both houses of Congress.

In their seminal work “The System,” Haynes Johnson and David Broder recount the events of 1993-94 in detail—explaining not just how the Clinton health initiative failed, but also why. Anyone following the debate on Obamacare repeal should take time over the holidays to read “The System” to better understand what may await Congress and Washington next year. After all, why spend time arguing with your in-laws at the holiday table when you can read about people arguing in Congress two decades ago?

Echoes of History

For those following events of the past few years, the Clinton health debate as profiled in “The System” provides interesting echoes between past and present. Here is Karen Ignani of the AFL-CIO, viewed as a single-payer supporter and complaining that insurance companies could still “game the system” under some proposed reforms. Ironic sentiments indeed, as Ignani went on to chair the health insurance industry’s trade association during the Obamacare debate.

There are references to health care becoming a president’s Waterloo—Johnson and Broder attribute that quote to Grover Norquist, years before Sen. Jim DeMint uttered it in 2009. Max Baucus makes an appearance—he opposed in 1994 the employer mandate he included in Obamacare in 2009—as do raucous rallies in the summer of 1994, presaging the Obamacare town halls 15 years later.

Then there are the bigger lessons and themes that helped define the larger debate:

“Events, Dear Boy, Events:” The axiom attributed to Harold Macmillan about leaders being cast adrift by crises out of their control applied to the Clintons’ health-care debate. Foreign crises in Somalia (see “Black Hawk Down”) and Haiti sapped time on the presidential calendar and press attention, and distracted messaging. During the second half of 2009, Obama spent most of his time and energy focused on health care, leading some to conclude he had turned away from solving the economic crisis.

Old Bulls and Power Centers: “The System” spends much more time profiling the chairs of the respective congressional committees—including Dan Rostenkowski at House Ways and Means, John Dingell at House Energy and Commerce, and Patrick Moynihan at Senate Finance—than would have been warranted in 2009-10. While committee chairs held great power in the early 1990s, 15 years later House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid called most of the legislative shots from their leadership offices.

Whereas the House marked up three very different versions of health-care legislation in 1993-94, all three committees started from the same chairman’s mark in 2009. With Speaker Paul Ryan, like John Boehner before him, running a much more diffuse leadership operation than Pelosi’s tightly controlled ship, it remains to be seen whether congressional leaders can drive consensus on both policy strategy and legislative tactics.

The Filibuster: At the beginning of the legislative debate in 1993, Robert Byrd—a guardian of Senate rules and procedures—pleaded for Democrats not to try and enact their health agenda using budget reconciliation procedures to avoid a filibuster. Democrats (begrudgingly) followed his advice in 1993, only to ignore his pleadings 16 years later, using reconciliation to ram through changes to Obamacare. Likewise, what and how Republicans use reconciliation, and Democrats use the filibuster, on health care will doubtless define next year’s Senate debate.

Many Obama White House operatives such as Rahm Emanuel, having lived through the Clinton debate, followed the exact opposite playbook to pass Obamacare.

They used the time between 1993 and 2009 to narrow their policy differences as a party. Rather than debating between a single-payer system and managed competition, most of the political wrangling focused on the narrower issue of a government-run “public option.” Rather than writing a massive, 1,300-page bill and dropping it on Capitol Hill’s lap, they deferred to congressional leaders early on. Rather than bashing special interest groups publicly, they cut “rock-solid deals” behind closed doors to win industry support. While their strategy ultimately led to legislative success, the electoral consequences proved eerily similar.

Lack of Institutional Knowledge

The example of Team Obama aside, Washington and Washingtonians sometimes have short memories. Recently a reporter e-mailed asking me if I knew of someone who used to work on health care issues for Vice President-elect Mike Pence. (Um, have you read my bio…?) Likewise, reporters consider “longtime advisers” those who have worked the issue since the last presidential election. While there is no substitute for experience itself, a robust knowledge of history would come in a close second.

Those who underestimate the task facing congressional Republicans would do well to read “The System.” Having read it for the first time the week of President Obama’s 2009 inauguration, I was less surprised by how that year played out on Capitol Hill than I was surprised by the eerie similarities.

George Santayana’s saying that “Those who cannot remember the past are condemned to repeat it” bears more than a grain of truth. History may not repeat itself exactly, but it does run in cycles. Those who read “The System” now will better understand the cycle about to unfold before us in the year ahead.

This post was originally published at The Federalist.

AARP: On the Wrong Side of History–Again

What Happened the Last Time the Organization Put Its Own Interests Before Seniors’

 

 

Even as Speaker Pelosi and President Obama attempt to trump the endorsement of purported seniors’ advocacy organization AARP for the Pelosi health care bill as a monumental achievement, a look at past health care bill shows the AARP’s “seal of approval” has often functioned as the “kiss of death” for proposals unpopular with the American people. Just as disturbing lies the fact that AARP’s endorsements of legislation often coincides with special favors being bestowed in those very bills:

  • In 1988, AARP endorsed the Medicare Catastrophic Coverage Act (P.L. 100-360)—so unpopular that it was repealed the following year. As Haynes Johnson and David Broder write in their analysis of the Clinton health care debate, The System, “AARP had been badly burned by the failure of the Medicare catastrophic insurance legislation…It endorsed that bill early, saw it become law, and then watched rival organizations of senior citizens lead the battle to have it repealed.”
  • What Johnson and Broder refer to as the Medicare catastrophic “fiasco” occurred as the bill fell “victim [to] a loud protest from the very people it was supposed to help.” While AARP claimed the catastrophic bill would help seniors—just as AARP alleges the Pelosi bill will provide untold benefits to Medicare beneficiaries—its own members did not agree. Perhaps most worrisome for Democrats, the bill’s higher taxes began immediately, while the benefits did not take effect for several years—prompting rapid outcries from seniors that led to the bill’s repeal. The exact same scenario faces the Pelosi health care bill.
  • The Medicare catastrophic debacle contains other parallels to the Pelosi bill 20 years later—out-of-touch politicians being accosted by angry constituents seeking to hold Members accountable for not representing their interests. Most famously, then-House Ways and Means Committee Chairman Dan Rostenkowski (D-IL) was—despite his protests to the contrary—chased out of a meeting by angry seniors, who promptly surrounded his car as he attempted to escape. The contrast between Rostenkowski and his constituents was stark; the latter shouted, “He’s supposed to represent the people—not himself!” while the Chairman alleged, “I don’t think they understand what the government’s trying to do for them…
  • Despite the cautionary tale of the Medicare catastrophic debacle, five years later Democrats waded back into health care, with another scheme to expand government-run insurance—this time to all Americans as part of President Clinton’s “reform” effort. Despite the fact that the proposed new entitlement to government-run health care was financed by reductions in seniors’ Medicare benefits—as is the case today—AARP endorsed legislation written by then-Senate Majority Leader George Mitchell (D-ME).
  • The AARP-endorsed legislation also happened to contain provisions benefiting the organization. For instance, one news article from 1994—headlined “AARP Endorsement of Reform May Be Financially Motivated”—pointed out that the Mitchell bill exempted mail-order pharmaceuticals from price controls imposed on Medicare prescription drugs—and “not coincidentally, AARP currently owns a stake in one of America’s oldest and largest mail-order prescription drug companies.” As the article noted, “If the Mitchell bill becomes law, this clause could mean extra wealth for what’s already become a cash cow for America’s largest advocacy group.”
  • Similarly, passing the Pelosi health care bill would likely provide a significant benefit to AARP’s financial interests. The Pelosi bill contains strict restrictions on all other forms of health insurance—banning pre-existing condition exclusions and limiting “excessive” price increases—except Medigap supplemental insurance plans purchased by seniors. Perhaps not coincidentally, AARP plans dominate the Medigap market—meaning that under the Pelosi bill, AARP could continue its current practice of denying access to individuals with pre-existing conditions in order to increase its own “royalty fees.” Indeed, AARP could benefit further from the Pelosi bill, by obtaining new Medigap customers when the legislation’s cuts to Medicare Advantage cause millions of seniors to lose their current coverage.

Even as the month of August demonstrated seniors’ concern about the impact of the Pelosi health care bill on them, AARP officials showed the same kind of disdain for their members’ concerns that Chairman Rostenkowski demonstrated to his constituents twenty years ago—attempting to quiet its members by telling them, “You are not running the meeting,” then running out of the meeting when members continued to raise concerns about Democrats’ government takeover of health care. Both the organization’s past history and its present behavior raise questions about the entity’s very character and nature: How many more times will AARP need to support failed health care legislation before understanding that its members do not support a government takeover of health care? And when will the organization stop endorsing legislation that benefits its financial interests rather than those of seniors?