Lately, every day seems to bring word about some new employer struggling with the costs of their employees' health insurance; if it's not the automakers, it's the airlines or the telecommunications industry. It's hurting American competitiveness; in one celebrated case a few years ago, Toyota cited high, unpredictable health care costs here as a reason to locate a new plant in Canada instead. And it's poisoning labor-management relations. In 2004, California grocery workers walked out for four months because their employers--fearful that Wal-Mart, with its famously meager benefits, was coming into the area--were threatening to offer lower health benefits. Now both the union and the grocers say they support a universal health care system that, even if it requires some employer contribution, would at least create a level playing field and began to restrain rising costs, which have started climbing again almost as quickly as they were before. In other words, they support doing exactly what the Clinton health care plan would have done.
And, of course, today some 45 million Americans have no health insurance--or nearly 16 percent of the population, which is about one point higher than the figure was when Hillary and her task force got to work. You can say a lot of things about the plan that process produced: that it was complicated to explain, that it was botched politically, and that, above all, it was hardly perfect. (Some of us still think a true single-payer system would work better.) But, if Hillarycare accomplished absolutely nothing else, it would have made certain every American had access to affordable health care--sparing millions of people physical harm, financial calamity, and countless indignities. For a plan that was supposedly such a debacle, that would have been an awfully mighty accomplishment.
You won't hear anybody in U.S. politics admit as much right now. In Washington, at least, praising Hillarycare will get you laughed off the talk shows. But the rising anxiety about affordable medical care, combined with the worries about health care's effect on the economy, have launched yet another serious debate about health care reform-- the first since the early '90s. And, if you look closely at the proposals experts and officials are tossing around, you may start to recognize some familiar elements. With the exception of true single-payer plans, virtually every idea for universal coverage now on the political agenda envisions creating a system in which, like Hillarycare, people will shop around for private health plans. They also envision, as did Hillarycare, a government role in making sure affordable, high-quality plans are made available--typically, by creating (again, like Hillarycare) some sort of purchasing cooperative through which some, if not all, of the population would buy their coverage. That's true of the plan former Senator John Edwards proposed as part of his presidential campaign a few months ago. It's true of the plan Senator Ron Wyden introduced to Congress back in December. It's even true of the plan former Massachusetts Governor Mitt Romney signed into law before leaving office last year--even though Romney has made mocking Hillarycare a staple of his campaign rhetoric as he seeks the Republican presidential nomination.
Still, while just about every reformer has borrowed elements of the old Clinton health plan, none of the leading presidential contenders has yet proposed something as comprehensive and far-reaching--aware, no doubt, that trying to do so much so quickly may be more than the political system will tolerate. For the most part, the serious reformers concentrate on getting coverage to everybody--leaving more wholesale reorganizations of the health care system, the kind that might yield serious cost savings, until later.
What remains to be seen, though, is whether Hillary herself can take even that more modest step. No candidate in the presidential race knows more about health care than she does. No candidate has a stronger, more proven record of fighting to expand coverage. And, yet, no candidate has to act with the caution that she does. Achieving universal health care will probably require the leadership of somebody who can push public opinion--and it's not clear that she can do so, at least, not as long as Hillarycare's reputation remains what it is. It's a shame, really, because if there were any justice, she'd have the best one-liner on health care of any candidate out there: "I was right the first time."
Jonathan Cohn is a senior editor at The New Republic, a senior fellow at Demos, and the author of Sick: The untold story of America's health care crisis--and the people who pay the price (HarperCollins). http://www.tnr.com/doc.mhtml?i=20070604&s=cohn060407
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