Hillary Rejoins the Health Care Debate

On April 4th, 1991, the hull of a Piper Aerostar carrying Senator John Heinz across Pennsylvania was punctured by the rotor of a Bell 412 helicopter that had been dispatched to help diagnose possible technical problems aboard the plane. Both craft crashed, killing all aboard.

Heinz's death left Democratic Governor Bob Casey scrambling to find a replacement able to fill the seat until a special election could be held. Casey first turned to a star: legendary Chrysler CEO Lee Iacocca, who promptly turned down the appointment. So Casey, desperate, chose an obscure academic named Harris Wofford, who was then serving as Pennsylvania's secretary of Labor and Industry, for the job.

Wofford's days were numbered -- or were supposed to be. The Republican candidate, Dick Thornburgh, was a popular former two-term governor of Pennsylvania who started the race with a 44 point lead in the polls. Wofford, on the other hand, was so anonymous that the papers had to publish guides explaining how to pronounce his name. A few months later, whats-his-name trounced Thornburgh, 55 percent to 44 percent. The secret of his remarkable victory? A 34-word catchphrase that pithily expressed the agonizing injustices of our health care system. "The Constitution says that if you are charged with a crime, you have a right to a lawyer," Wofford kept telling the voters. "But it's even more fundamental that if you're sick, you should have the right to a doctor."

The people of Pennsylvania agreed, and Wofford's stunning win launched health care onto the national agenda. "Harris Wofford's victory creates a tremendous momentum forward toward enactment of meaningful health care reform in Congress," said Senate Majority Leader George Mitchell. Wofford's unexpected victory running a single-issue campaign focused on health reform showed health care to be acutely resonant in a way few had realized. His victory ? and the political lessons it supposedly taught -- led directly to Bill Clinton's 1994 attempt to reform the health system. Had Clinton succeeded, Harris Wofford would have deserved some of the credit; he was the catalyst.

Sixteen years later, it's a new Clinton, with a new plan, and a new Wofford whose brave campaign has once again demonstrated health care's resonance and centrality: John Edwards.

Edwards was perhaps an unlikely candidate to push the health care conversation forward. In 2004, his primary campaign released a plan that didn't even pretend to cover every America -- it sought little more than coverage for kids. But freed from the (partly self-imposed) strictures of his 2004 role as the southern moderate, Edwards' 2008 campaign has been far bolder in its policy. Exhibit A is his health care plan, released long before that of any other major candidate, which achieves full coverage, offers a public insurance option, regulates the insurers, and much more. It is easily the most impressive health care reform proposal adopted by a national Democrat in 15 years.

The mixture of a progressive, transformative health care plan and a credible candidate instantly reshaped the politics of health care in the Democratic primary. Any politician who proposed an overly cautious or incremental plan would lose voters to Edwards. Barack Obama's plan, which was decidedly broad and ambitious by the standards of 2004, received criticism (some of it from this writer) for merely getting near to, rather than actually achieving, universality. In the absence of Edwards' plan, it would almost undoubtedly have been lauded for its vision. (Though without the leftward pressure exerted by Edwards' plan, Obama's proposal may have been yet more cautious than what he released.)

Hillary Clinton was the wild card. After failing to enact health care reform in 1994, many speculated that she'd be too cowed to try again. Further evidence appeared to come from her Senate career, where she didn't attach herself to many high profile initiatives on the subject, and said things like, "I [have] learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done." To most, that sounded like an admission that she'd push for the safe changes but avoid the transformative battles. Meanwhile, she became the second largest recipient of medical industry money in the Senate -- a record that seemed to fit with her apparent reticence on the issue. While Edwards released his plan in February and Obama offered his in May, it was only in September that firm word emerged from the Clinton camp that there would even be a plan.

Yesterday, the details came out, and lo, they are good. Her plan includes an individual mandate to ensure universal coverage, offers all Americans access to the same menu of regulated private insurance options that members of Congress use, creates a new public insurer based off of Medicare that anyone can buy into, bars the insurance companies from price discriminating based on preexisting conditions, and uses refundable tax credits to limit the percentage of a family's income that health costs can consume (a more detailed summary of the plan can be read here, the full plan can be downloaded here.). If those planks sound faintly familiar, they are: They're very close to what the Edwards campaign proposed back in February, which is to say they're very close to the best health care plan proposed by a national Democrat in 15 years.

Given Clinton's history, her record in the Senate, and the sense of caution that afflicts every frontrunner, it's hard to imagine she would have been so bold had Edwards not opened up the political space, and indeed created an electoral imperative, for boldness on health care reform. Edwards, in fact, met her new plan with a speech making an issue out of his commitment to passing his plan, even announcing legislation that would terminate health coverage for Congress if they failed to pass health reform by July 2009. The issue of health care, and thus Clinton's plan, will not be able to gather dust on a shelf while the candidates speak of safer things -- it will be brought up, and she will need to recommit to it, again and again.

Even if Edwards doesn't win, Clinton's plan shows that some of his priorities may: His insistence on centering his campaign around a bold vision for health care reform bettered the campaigns of his opponents. It made them more courageous, and showed that a serious commitment to health care reform was popular in the party and viable in the press. If he fails to capture the nomination, but sees one of his fellow candidate's plans pass, he will have helped enact Harris Wofford's dream from over a decade ago: That one day, we would be a country, in which if you are sick, you have a right to a doctor.