The System

Haynes Johnson and David Broder

Clinton and Health Care

Intersecting Political Careers: Reagan, Clinton, GingrichAll came from poverty, troubled families. Clinton experience tuned him into

the challenges of poor and working class people, particularly with regards to the issue of health care.

Politics of Health Care: 1990s

What was the Political Context of Clinton Health Care ReformsClinton’s health care reforms came as little surprise to a Congress that been

debated the issue for years.

Health Care a Major Issue: 1991 PA Senate RaceOne indicators of exactly how important health care had become as an issue was the 1991 race to fill the PA Senate seat left open by the death of John Heinz.

Democratic Harris Wofford defeated the favored a Republican Dick Thornburgh after making health care an issue.

Politics of Health Care: 1990s

Harris Wofford Message: Health Care Should be a Right

National Democrats Seize on Wofford MessageSensing an opportunity, the Democratic leadership in Congress talk about pushing national health care reform.

Results: History of Failed Health Care LegislationThe Democratic proposals failed to materialize, as had previous efforts in the 1980s.

Politics of Health Care: 1990s

Defining Issues in American PoliticsThe authors identify four:

1) War and National Security2) Race Discrimination and Inequality3) Economic Inequality4) Social Safety Net

Politics of Health Care: 1990s

Social Safety Net: The Challenge of Health CareThe need to provide some type of health care system in the US has been a

vexing, and costly issue.

Two Issues:

1) Cost2) Coverage

Politics of Health Care: 1990s

Social Safety Net: The Challenge of Health Care

1990s:

Cost: 1 out of every 7 dollars spent on Health CareCoverage: 37 Million (15% 0f pop) uninsured

(in 1996 alone, 1.2 lost health care coverage)

2000s:

Cost: (2007) 2.2 Trillion, (2016) 4.1 Trillion Coverage: 47 Million (16% of pop) uninsured

Politics of Health Care

History of Health Care Reform in the US

1930s: FDR removed Health Care from 1935 Social Sec. bill due to doctor opposition

1940s: Democrats Push National Health Insurance, AMA led opposition1950s: Rise of employer-based System.1960s: Great Society programs: Medicare1970s: Nixon introduced HMO legislation

Politics of Health Care

Clinton Reforms: 1992 Election

Competing Democratic Plans

1) Bob Kerrey: Type of Single-Payer Plan2) Paul Tsongas: Managed Care, Jackson Hole Plan3) Bill Clinton: Pay or Play

Clinton Reforms: 1992 Election

Details of Democratic Plans

Managed Care1) Employers pay a Portion of Health Care costs2) Government Sets Standards of Care3) State administered “Health Insurance Purchasing Cooperatives” (HIPCs)4) Community-Rate pricing

Unmanaged Care: 1) Individuals buy insurance in the private market.

Clinton Reforms: 1992 Election

Details of Democratic Plans

Pay or Play: 1) Employers pry for health insurance2) If they don’t, they must pay into a federal pool

Clinton Plan

Modified Clinton PlanAfter considerable internal debate, and both Kerrey and Tsongas dropped out

of the race, the Clinton adopted a modified managed care plan.

Details of Clinton Plan1) Employers pay a Portion of Health Care costs2) Government Sets Standards and Flat Rate for Care3) State administered “Health Insurance Purchasing Cooperatives” (HIPCs)4) Federal Health Budget to cap costs

Health Care: 2008

Obama and McCain on Health Care: Managed v. Unmanaged

Obama Ad

McCain and Obama Ads

McCain Ad: • http://www.johnmccain.com/Informing/Multimedia/Player.aspx?guid=68f

a68ac-e57e-41ef-861e-879aa5442b7e

Obama Ad:• http://www.youtube.com/watch?v=jnk8minM3Qg