Hillary Clinton's Health Care Inoculation Strategy
When it comes to health care, Hillary Clinton of all the presidential candidates faces a special burden. As her rivals left and right unveil their health care plans, Senator Clinton is moving cautiously, as if seeking a vaccine to protect her from a recurrence of her 1990's experience. Call it Hillary's Inoculation Strategy: go slow, go small, and go with your enemies.
No doubt, Hillary Clinton faces a daunting challenge over health care in the 2008 race. Her leadership of the failed Clinton health care initiative in 1993/94 has made her a lightning rod in both parties. Fair or not, "HillaryCare" became the signature issue behind the conservative "big government" caricature that helped fuel her staggeringly high disapproval numbers. It's with good reason Hillary Clinton is quick to acknowledge the "scars" of those 1990's battles.
Which is where the inoculation strategy comes in. While supporting the goal of universal coverage, Hillary Clinton seems to be taking great care not to get out front and to not go it alone.
The first ingredient is to create the veil of bipartisanship. Taking a cue from Michael Corleone, Hillary Clinton in 2004 began to keep her friends close and her enemies closer. Focusing on less controversial and seemingly non-partisan issues such as standardized medical records and expanded patient access to information, Hillary in August 2004 co-authored a milquetoast op-ed with then Senate Majority Leader, Doctor Bill Frist. Proclaiming an "emerging bi-partisan consensus" for "major, transformative change," Clinton and Frist discussed incremental reforms at the margins, primarily to spur market competition in a consumer-driven health care system.
A much more high-profile Clinton dalliance with former foes featured Newt Gingrich in May 2005. Their joint appearances featured a common technocratic approach to a small sphere of health care issues, again centering on medical technology, records and information sharing. Their Odd Couple act not only helped defuse some of the right-wing rage over the ambitious Bill Clinton health care plan Gingrich helped stonewall, but even earned Hillary some conservative cred on national defense. As the New York Times noted:
"I know it's a bit of an odd-fellow, or odd-woman, mix," she said. "But the speaker and I have been talking about health care and national security now for several years, and I find that he and I have a lot in common in the way we see the problem."
For his part, Mr. Gingrich, who helped lead the impeachment fight against President Bill Clinton, called Mrs. Clinton "very practical" and "very smart and very hard working," adding, "I have been very struck working with her."
"Unlike most members of the legislature, she has been in the White House," he said. "She's been consistently solid on the need to do the right thing on national defense."
While Mitt Romney may view Hillary Clinton as the reincarnation of Karl Marx, she clearly believes her efforts may yet pay dividends among others in his Republican Party.
The second pillar of Hillary's campaign prescription for health care is the resurrection of the micro-program. A hallmark of her husband's presidency, micro-programs are tightly-focused, small budget initiatives intended by design to be cumulative - and unobjectionable. Put another way, these projects are popular because they don't cost a lot of money and merely listing them seems to represent progress.
Senator Clinton's incrementalism is reflected in the proposals offered in her two health care addresses to date. In May, she articulated a series of steps to help cut costs, while comments she delivered in New Hampshire on Friday emphasized improving the quality of American health care. Compared to the $2 trillion the U.S. spends on health care (16% of GDP in 2005), Hillary's initiatives are small potatoes indeed. As CBS detailed, Clinton offered a laundry list of small fixes for everything from physician reimbursements and nursing improvements to expanded patient involvement in health care treatment plans:
To improve quality, Clinton said she would promote physician certification programs that help doctors keep up with the latest advancements, increasing Medicare reimbursements for doctors who participate in them. Nursing care would get a boost in the form of $300 million to expand enrollment in nursing schools, create mentoring programs for recent graduates and recruit more minorities into the profession.
The third and last facet of Hillary's inoculation strategy on health is to proceed slowly and with all deliberate speed. While her Democratic rivals Barack Obama and John Edwards revealed much more ambitious plans centered on employer mandates and a subsidized national insurance pool (Obama) and universal coverage through mandatory insurance (Edwards) all funded by reversing the top tier of the Bush tax cuts, Clinton to date has held her fire.
Promising a major address on universal health care coverage in September, Senator Clinton describes her seeming caution as just part of her grand plan.
"My order here is deliberate. In order to forge a consensus on universal health care, we need to assure people that they will get the quality they expect at a cost they can afford."
Clinton's time-release formula for health care may be deliberate, but it may also be a convenient guise for testing the political winds. While her opponents in both parties get buffeted, Hillary Clinton apparently is biding her time for calmer conditions.
On Friday, Senator Clinton in essence laid bare her inoculation strategy, declaring "I hope we're getting to a point where the quality of our health care is not a partisan issue."
With their rehash of tax breaks and free-market insurance schemes, her Republican opponents like Mitt Romney and Rudolph Giuliani couldn't disagree more. Meanwhile, the choice for Clinton and her Democratic opponents seems to be this: concede to the conventional wisdom politics of the possible or risk all on a universal care program that could propel a candidate to the White House and perhaps the Democrats to an enduring majority. While she has yet to divulge her promised universal coverage plan, Hillary Clinton thus far seems unwilling to place that bet.
It's certainly understandable that Hillary Clinton feels once bitten, twice shy when it comes to the health care issue. But to get to the White House, she has no alternative but to offer her own prescription and, like all the candidates, take her medicine.