Last week, Hillary Clinton unveiled a single-payer health insurance plan that would allow people to buy into Medicare starting at age 50 or 55. To some political reporters, this embrace of a public option represents an ideological shift. “Mrs. Clinton is moving to the left on health care,” asserted The New York Times, attributing it to her unexpectedly strong challenge from Bernie Sanders. Clinton was “floating a new idea,” declared The Wall Street Journal.
But this is not precisely correct. There’s nothing remotely new about Clinton’s support for a Medicare buy-in or a public option for health insurance. From the beginnings of her husband’s administration, health care has been a major priority for her, and she deserves major credit for the Affordable Care Act, which closely resembles the plan that was a centerpiece of her 2008 campaign. Sanders is having an effect on Clinton, but he is not causing her to change her stance, so much as he is compelling Clinton to emphasize her existing, more-liberal positions.
Indeed, Clinton’s support for a Medicare buy-in is nothing new, and dates back at least 15 years. In a 2000 debate in her New York Senate campaign against then-House Republican Rick Lazio, Clinton said that she would ideally “allow people between 55 and 65 to buy into Medicare.” This shouldn’t have been surprising, since her husband had floated the idea in his 1998 State of the Union address. It’s hardly a novel concept.
The fact that both Clintons have long supported Hillary’s supposedly “new idea” has slipped past many analysts, illustrating the narrow lens through which we tend to evaluate the Clinton administration. For obvious reasons, presidents are largely judged based on the legislation passed during their tenures.
In Clinton’s case, this makes him look well to the right of Barack Obama. While Obama’s first two years constituted one of the four most far-reaching periods of progressive governance since the Civil War, much of the major legislation signed by the Clinton administration reflected conservative priorities—deregulation, welfare “reform,” free trade, and crime bills. These laws, to be sure, represent a major part of Clinton’s legacy. But we also must remember that he was facing Republican Congresses during the final six years of his term, and before that was working with far more conservative Democratic congressional majorities than those that presided over Capitol Hill when Obama first took office. Because Clinton’s liberal priorities were much less likely to become enacted into legislation than his conservative ones, they tend to be much less remembered.
This context is crucial in evaluating whether Hillary Clinton would govern more like her husband than like Obama. Bill Clinton, were he in office today, would almost certainly govern more like Obama, because the Democratic Party has changed. A Democratic Congress would be much more likely to enact Clinton’s more liberal ideas than the one he presided over during his first years in office. And today’s polarized politics make it virtually impossible for any president to compromise and pass major legislation with a Congress held by the opposition, even if he or she wanted to.
Citing the Medicare buy-in as something new is also odd because it’s a mainstream Democratic position. (If then-Democrat Joe Lieberman had lost to Ned Lamont in the 2006 Senate election, some version of it may have been included in the Affordable Care Act.) This is not to say that Clinton has failed to make any bold progressive moves, particularly in the arena of health care. But a better example is her expressed support for repealing the Hyde Amendment ban on Medicaid coverage of abortion.
The Amendment is one of the most important legislative barriers to abortion access, and also exacerbates the unequal access to reproductive care faced by poor women. Even if a Clinton replacement for the late Supreme Court Justice Anonin Sclaia ensures that Roe v. Wade survives, the Hyde Amendment substantially limits practical access to abortion. So it was very welcome for progressives to see Clinton come out against it (as has Bernie Sanders.)
Even so, this is not actually new for Clinton. In a 2008, her campaign told a reproductive rights website that she “does not support the Hyde amendment. She believes low-income women should have access to the full range of reproductive health care services.” Her opposition to the Hyde Amendment is a change in emphasis, not a change in ideology.
Does this mean that the Sanders campaign is having less of an effect that some people have claimed? I don’t think so. For national political leaders, emphasis and priorities matter. There’s a difference between opposing the Hyde Amendment while answering a question in an online interview, and pledging to repeal it during a presidential campaign speech. That’s not because Clinton’s saying something in public will cause people to change their views, but because party leaders help set the legislative agenda. Democrats have to try to figure out what they will do during the next period of unified Democratic government, even if it doesn’t come about in 2017. For the presumptive nominee to support policies like a Medicare buy-in and a repeal of the Hyde Amendment makes the next Democratic Congress more likely to put them on the front burner.
Like most politicians with ambitions for national office, Clinton has both more-liberal and more-conservative aspects of her record and policy views. Sanders, and the support he’s receiving, are encouraging her to emphasize the former—and to progressives, who want the party’s left flank to keep the pressure on, this is an immensely valuable thing.
In that sense, whether these ideas are “new” positions for Hillary Clinton may not matter very much in the end. Progressives saw more of their agenda realized under Obama than under Bill Clinton, but that had more to do with political circumstance than with the president’s personal ideological preferences. Opposition to the Hyde Amendment is a longstanding part of Hillary Clinton’s record; so is feinting to the center by saying that abortion should be “safe, legal, and rare.” That she feels more inclined to emphasize the former rather than the latter matters, and it’s evidence of a party moving in a more progressive direction.
This story has been updated.