Via the estimable Maggie Mahar comes this graph from pollster Stan Greenberg:
Costs, of course, are the major problem, and the first thing Americans want fixed. But the loathing of insurance companies is notable, too. One thing folks forget about the 1994 reforms, and that I didn't have space to put in my article, is that they happened in the context of traditional fee-for-service insurance, rather than in the contemporary world of managed care. Indeed, part of what was so scary about the proposal, what all those "your government will choose your doctor" ads referred to, was that ClintonCare was managed care before anyone knew what the hell that meant. The basic idea of managed care, particularly as it was used when it went national (as opposed to its usage in a few small practices) was that patients often made bad care decisions and, due to the cost insulation of insurance coverage, didn't feel their repercussions. But no one wanted to go the route of contemporary conservatives and square that circle by forcing folks to pay out-of-pocket. So the idea was that medical professionals would watch over the decision making, greenlighting visits to specialists and reviewing certain care recommendations, ushering in a new era of wiser, more evidence-based, more cost-conscious health care. As I say in the piece, "Managed care, the then-new theory of health insurance that Clinton based his plan on, had basically two constituencies: The New York Times editorial page, and the Jackson Hole Group, a business-based coalition of industry stakeholders, centrist academics, and corporate leaders." That wasn't enough.Even so, the Clinton administration thought this a brilliant idea and made it the core of their health care plan. Americans found it unnerving, and rejected the health care plan. Then it happened anyway. Now we're all in HMOs and PPOs and related options. Traditional insurance hardly exists. And so modern insurers seem a lot less benign -- in fact, they're quite similar to what folks feared the Clinton plan would be. That's why fear of their involvement is so widespread, and anger over the government's involvement, as you can see on the graph, is marginal. It's also one reason that the coming fight over health reform will be very different than the last. In 1994, it was accurate to say that the Clinton reforms wanted to change the way health care worked. None of the current Democratic plans do much but change the way insurance is purchased, and regulated. And communicating that fact will be one of the key planks of any sound strategy for health reform.
Costs, of course, are the major problem, and the first thing Americans want fixed. But the loathing of insurance companies is notable, too. One thing folks forget about the 1994 reforms, and that I didn't have space to put in my article, is that they happened in the context of traditional fee-for-service insurance, rather than in the contemporary world of managed care. Indeed, part of what was so scary about the proposal, what all those "your government will choose your doctor" ads referred to, was that ClintonCare was managed care before anyone knew what the hell that meant. The basic idea of managed care, particularly as it was used when it went national (as opposed to its usage in a few small practices) was that patients often made bad care decisions and, due to the cost insulation of insurance coverage, didn't feel their repercussions. But no one wanted to go the route of contemporary conservatives and square that circle by forcing folks to pay out-of-pocket. So the idea was that medical professionals would watch over the decision making, greenlighting visits to specialists and reviewing certain care recommendations, ushering in a new era of wiser, more evidence-based, more cost-conscious health care. As I say in the piece, "Managed care, the then-new theory of health insurance that Clinton based his plan on, had basically two constituencies: The New York Times editorial page, and the Jackson Hole Group, a business-based coalition of industry stakeholders, centrist academics, and corporate leaders." That wasn't enough.Even so, the Clinton administration thought this a brilliant idea and made it the core of their health care plan. Americans found it unnerving, and rejected the health care plan. Then it happened anyway. Now we're all in HMOs and PPOs and related options. Traditional insurance hardly exists. And so modern insurers seem a lot less benign -- in fact, they're quite similar to what folks feared the Clinton plan would be. That's why fear of their involvement is so widespread, and anger over the government's involvement, as you can see on the graph, is marginal. It's also one reason that the coming fight over health reform will be very different than the last. In 1994, it was accurate to say that the Clinton reforms wanted to change the way health care worked. None of the current Democratic plans do much but change the way insurance is purchased, and regulated. And communicating that fact will be one of the key planks of any sound strategy for health reform. 
