More than a year ago, Ezra Klein, on this site, put the health care lessons of the Clinton years as succinctly as it's ever been done. Quoting an administration official who directed the bill's legislation for the president:
"I was the biggest mistake of the Clinton health care bill," says Sara Rosenbaum, who sat in a hotel room with other policy experts and drafted the legislation. "It was a terrible error to have the President doing what Congress was supposed to do. It was a misuse of the relationship between the legislative branch and the executive branch. The executive branch is supposed to generate action and the committees are supposed to actually take the action. By sending a 1,300 page bill, you're writing a detailed blueprint for the policy rather than using the congressional process to create a consensus."
Ezra referenced the argument this morning, recommending that Obama “sit and wait,” and use political capital only later.
For anyone who worked on the Hill through the Clinton debacle, the Klein/Rosenbaum analysis rings exactly true. No mistake in the Clinton process was half as significant as the process itself, which sidelined Congress and then produced a legislative proposal that had no constituency and generated no enthusiasm. The Obama administration has plainly taken this advice to heart, and at this point is gently cheering on each turn in the congressional process, over-optimistically hoping that the Dance of Legislation will eventually lead not just to consensus, but to an actually good health care plan.
But is that the actual lesson of 1994? What do we suppose would have happened if Clinton had taken Rosenbaum's advice? It would not have been a smooth, elegant process leading step-by-step to the higher ground. Rather, it would have looked a lot like the process we're seeing right now, and the process after Clinton backed off and former Senate Majority Leader George Mitchell took up the reins: an ugly, seemingly aimless ramble, in which various committees and ad hoc caucuses put their bids on the table, all distorted by the ever-present lobbyists, by Democrats' endemic fear of right-wing slogans, and by the disruptive interventions of the Congressional Budget Office. The problem in 1993-94 is that by the time that ugly process started -- in early 1994 -- the administration had already lost momentum, Republicans were in the ascendant, and the issue was tainted by the Clinton failure. The lesson, then, is not back off and let the grandees of the Hill do their thing. It is, don’t waste a year and poison the issue before getting the process started.
The Obama White House has a huge advantage that the Clinton administration didn't: The plan is basically written, and it has a constituency. Everything Clinton spent a year on is done. All the work to build consensus around fundamental features – a regulated insurance market, an individual mandate, and a public plan to provide a competitive benchmark – made up the outlines of every Democratic presidential candidates' proposals. They have been further developed at the think tanks and various “strange bedfellow” coalitions that have been at work in Washington for at least four years. There are some questions about details and cost containment, but all the major alternatives have fallen by the wayside. It's an extraordinary accomplishment, and a real testament to the infrastructure that's been constructed for progressive policy as well as politics.
The White House should not squander all the work that went into that consensus. It doesn't need a 1,300 page bill. But it should also not just gently cheer on every twist and turn in the debate. It needs to set the outlines of an acceptable health plan as sharply as possible, and make clear that pushing a plan that doesn't meet a minimal standard of coverage, regulated competition, and cost-containment is a vote for no health plan at all. It's not 1994 anymore.
-- Mark Schmitt
