Clinton: Be Bold On Health Care

I was fortunate enough to be part of a group of journalists and bloggers invited to meet with President Clinton at his offices in Harlem this afternoon. The main subject was the Clinton Foundation, but as one would expect the conversation ended up being quite wide-ranging. There was lots of interesting stuff, but perhaps best was Clinton’s argument for being very bold on health care. Clinton identified four major ways in which the current context differs from the one he faced in 1993:

• A different psychological and political landscape. Because, as Clinton noted, Democrats in Congress had stopped Reagan’s strongest anti-government from being enacted, stated Republican retained a popularity that, after 8 years of Bush (much of it under unified government) they no longer do. Knee-jerk anti-government opposition won’t be nearly as effective. And, of course, Obama has larger and more liberal majorities to work with.
• Obama doesn’t have the same budget restraints. Clinton, having barely gotten a minor tax increase through Congress, wasn’t in the position to raise taxes. Obama will have more options, along with a political context much more receptive to spending increases (although of course this window will close shortly, making quick action on health care essential.)
• Obama doesn’t have to deal with a Republican Senate leader running for President. The famous letter from Bill Kristol to Dole played a significant role in killing Clinton’s proposed reforms, although Dole might have been willing to cut a deal in different circumstances.
• Health Care has gotten even worse. Since the GOP killed reform, American health care has continued to get more expensive while failing to even come close to universal coverage and failing to produce outcomes any better than countries that provide care to more people for less money.

I might quibble with #3 — while of course this precise factor shouldn’t be an issue, it looks like most Republicans in Congress plan on being just as obstructionist. The other 3 points are certainly valid, and for this reason Obama needs to be aggressive rather than living in fear of the failure of reform that happened under Clinton.

From a strategic perspective, Clinton said that it was smart for Obama to try to get 60 votes rather than using reconciliation, to preserve his relationship with Congress for other issues. However, that doesn’t mean “giving away the store”; if the only way to get a good bill — i.e. universal coverage combined with policies that will contain spending — is a 50%+1 vote, then that’s what Obama should do. I think that this is right (and if Obama attempts to get a more bipartisan bill, this would also contain the political damage if he needs to do it with a simple majority.)