This is a nice point from Paul Waldman:
There is no doubt that the insurance companies and their Republican allies in Congress will fight the inclusion of a public option with every bit of power they can muster. They'll call it "socialized medicine" -- but by now we should all have realized that Republicans will call any health care reform Democrats propose "socialized medicine" (that's what they said about Clinton's 1993 health plan, whose chief cost containment measure was enhancing the role of HMOs). They'll scream about "government bureaucrats getting between you and your doctor." But anyone who has tried to get reimbursement for a medical service from an insurance company that didn't want to provide it knows that government bureaucrats are pussycats compared to insurance company bureaucrats.
One underappreciated difference between 1993 and 2008 is how insurers have neutralized, or at least changed, the question of choice. In 1993, the promised restrictions of the Clinton proposal promised a real, and unpleasant, change. But those restrictions were not, in fact, the result of government taking over health care, but of government giving health care over to HMOs. The threatened consequences of CLintonCare were in fact the promised innovations of managed care. Clinton's plan failed, of course. But the managed care revolution did not. HMOs ripped across the land, creating networks and denying treatments and imposing "gatekeepers" and generally doing exactly what they promised: Managing care. Which meant restricting choice. HMOs proved as unpopular in private practice as they were in the Clinton plan. They did much to cut spending growth, but consumer backlash had partially neutered them by the turn of the century. Now they annoy rather than deny. They make health care unpleasant, and they restrict choice, but they don't hold down costs. These are not, in other words, the innocent days of the early 90s. Your insurer is not your friend and your doctor is rarely your choice. In 1993, government really was selling a more restrictive, technocratic system. In 2008, government is a plausible counterweight against those who implemented that system anyway. This has changed the politics of health care reform in ways that I don't think many appreciate quite yet.
