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Ruth Marcus

Deja vu on health care? Maybe not

Congressional Democrats warn that the president's ambitious plans to overhaul the nation's health care system may be in danger. Sensing political opportunity, Republicans ramp up their criticism, warning of a government takeover of health care. Business groups balk at the notion of an employer mandate.

Is this health care deja vu all over again, the Clinton disaster of 1993-94 revisited?

My money is on the side of a significant legislative accomplishment — something short of immediate universal coverage but more than cosmetic change. In conversations with veterans of the Clinton effort, all said the turbulence was expected. But most were cautiously optimistic about the outcome.

Their reasoning was threefold: This administration has learned from the mistakes of the Clinton years. Democrats are more committed to getting something passed than they were 15 years ago. The array of interest groups — insurers, pharmaceutical companies, doctors, hospitals — is no less self-interested, but some have concluded that their self-interest may be better served by forging change to their liking than sticking with an unsustainable status quo.

At this point in the Clinton administration, the plan was being written in secret. Obama smartly let lawmakers work through the complicated details from the start. At the same time, he has not locked himself into an unwinnable endgame as Clinton did, waving his pen and vowing to veto anything short of universal coverage.

In Congress, key lawmakers have been preparing for this moment and are determined not to squander it. Montana Democrat Max Baucus, the chairman of the Senate Finance Committee, has doggedly been working through the details alongside the ranking Republican, Iowan Chuck Grassley.

Getting more than a few Republicans on board will be difficult but not impossible: The proof is in the bipartisan bill crafted by Oregon Democrat Ron Wyden and Utah Republican Bob Bennett.

Meantime, the coalition of interest groups that coalesced to kill health care reform last time is in a more accommodating frame of mind. Insurers are willing to subject themselves to strict rules if they don't face crippling competition from a public plan, and individuals are required to purchase coverage. Pharmaceutical companies are running ads in support of health reform.

Not that getting there will be easy. "If you think every day is going to be a good day," said Chris Jennings, a member of Clinton's health care team, "then you haven't been through health reform."

© 2009 Washington Post Writers Group

Deja vu on health care? Maybe not 06/25/09 [Last modified: Thursday, June 25, 2009 9:32pm]
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