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The Obama healthcare challenge: Right lessons vs. wrong lessons

Full disclosure: I support President Obama’s effort to pass a national health insurance plan that would ultimately provide insurance for every American and make access to quality healthcare a right of citizenship, not of wealth.

That being said, I still have concerns that the administration and the current Democratic Congress learned the wrong lessons from the failure to enact national healthcare during the Clinton administration effort of 1993-94.

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So here are a few suggestions that seem to be instances of the administration and Congress learning the wrong lessons, and possibly paying the price:

• Let Congress do the work first, and the administration come in next.

Administration strategists picked this course of action because, it seems, they thought the Clinton White House had made the mistake of not adequately consulting Congress before writing a 1,000-page bill without consulting with Congress.

What has happened, though, may have been to take this lesson too far in the other direction. Congress was encouraged to do most of the drafting, although surely the White House was and is involved. But that still means a perception that the president, at least until this week, was not fully engaged. And the bill — at least the House version — was still more than 1,000 pages!

• Pass an insurance program that ultimately will cover everyone — and do it this year.

This still is, to me, the right policy — morally as well as economically.

But practically, I wonder — and I don’t know if I am right about this — why didn’t the administration do incremental steps this time rather than going for the 100 percent solution from the get-go? I thought that was one valuable lesson learned from the difficulties experienced in the 1993-94 effort.

For example, while that effort did not succeed, the Clinton administration did succeed in proposing and passing guaranteed health insurance for children — the State Children’s Health Insurance Program, or SCHIP. So why not in this instance, in 2009, just start with a national insurance program that would guarantee access to the health insurance covering all members of Congress and federal employees for the 44 or more million Americans who have no insurance?

Then next year, a national program as presently proposed — but with no public option.

Then the year after, try to sell the public option. But do a better job of explaining to businesses that already are generous and pay for their employees’ health insurance why the public insurance option won’t cost them more money. This is what many think today — that they will be penalized with higher insurance costs for being more generous. Their fear is that with a public option, many of their employees will opt out to get better coverage, and then their insurance costs will go up. Or they will have to pay more to match the public option, which is subsidized by taxpayers.

I am not sure whether these concerns will ultimately turn out to be baseless, but clearly they need to be better addressed before passing the public option.

• Promise to pay for the program only by raising taxes on higher-income taxpayers.

 If this is true, then I am in favor of it — which means I will pay more taxes for sure. But I have two suggestions: First, don’t make an absolute commitment that this is true, since cost estimates continue to vary — just recently, the nonpartisan and professionally respected Congressional Budget Office disputed the administration’s estimates of total savings.

Second, leave on the table a possible special graduated surtax to pay for the program — but guarantee by law the money can only be used to pay for healthcare, and not for “bridges to nowhere.” This notion of a “targeted healthcare tax” probably does much better in the polls than the general notion of raising taxes — as long as there is a legal guarantee the money cannot be raided (as is the case in the so-called Social Security Trust Fund). Perhaps the only exception would be a national economic emergency, and even then, a vote of two-thirds or three-quarters of both chambers of Congress would be required in order to gain access to the “healthcare trust fund.”

In the final analysis, whatever the strategy, some national insurance healthcare plan needs to be passed — so that America is not the only Western democracy without a guarantee of healthcare for all citizens.

And there’s one other reason: to remind Americans of the bedrock principle of American democracy, that elections do matter.



Davis, a Washington lawyer and former special counsel to President Clinton from 1996-98, served as a member of President George W. Bush’s Privacy and Civil Liberties Oversight Board in 2005-06. He is the author of Scandal: How ‘Gotcha’ Politics Is Destroying America.