WASHINGTON - For Sen. Hillary Rodham Clinton, the problems of the American health care system have been a political danger zone since she unsuccessfully tackled the issue as first lady in the early 1990s.
Health insurers and conservatives vilified Clinton for her efforts then, and Congress reacted coolly to her presentation of a universal health care plan as a fait accompli after months of secret meetings. The “Harry and Louise” commercials, aired by the insurance industry, mocked her effort, and the plan’s perceived complexity made it a laughingstock in some quarters.
On Thursday, as a candidate for president, Clinton, D-N.Y., returned to the complicated and contentious topic, acknowledging mistakes and promising that she had learned from the experience.
“Now, I’ve tangled with this issue before, and I’ve got the scars to show for it,” Clinton told an auditorium packed with medical students and doctors at George Washington University. “But I learned some valuable lessons from that experience. One is that we can’t achieve reform without the participation and commitment of health care providers, employers, employees and other citizens who pay for, depend upon and actually deliver health care services.”
Clinton delivered a proposal Thursday focused on reining in health care costs, a problem affecting virtually everyone in the United States. Two other proposals are in the offing - one to improve the quality of health care and the other to insure all Americans. She has already introduced legislation in Congress to expand health care coverage to all children.
Together, these ideas represent the senator’s best effort to confront the fact that to many of her doubters, Clinton’s 1993-94 health reform push represents much of what they dislike about her - an imperiousness, a belief in big government and a seeming certainty that she knows best.
A recent Kaiser Family Foundation survey showed that health care ranks second in the minds of voters as the most important problem for government to address, following only the war in Iraq. Republicans, Democrats and independents all gave health care the same weight. Previous polls had shown the issue tied with the economy, or the economy ranking slightly ahead of health care.
Drew Altman, president of the Kaiser Family Foundation, a national, independent health philanthropy, said voters are having trouble identifying which presidential candidate would best address their concerns on health care. But in a twist, Clinton has a head start on the issue, he said.
“Even though there was a great failure in the `90s, voters associate her with the issue and know she cares deeply about the issue,” Altman said.
Next Tuesday in Iowa City, Sen. Barack Obama, D-Ill., will lay out his own vision for bringing down health care costs and expanding health coverage. Former Sen. John Edwards, D-N.C., has already proposed insuring all Americans, including the 45 million who are uninsured, by 2012.
At George Washington, Clinton delivered a flurry of facts and figures to back up her contention that health care costs are out of control: premiums have almost doubled since 2000; the nation spends 16 percent of its gross domestic product on health care; 30 percent of the cost increase is related to the doubling of obesity among adults during the last two decades; and the nation’s administrative costs are the highest in the world.
“If we spend so much, why does the World Health Organization rank the United States 31st in life expectancy and 40th in child mortality, worse than Cuba and Croatia?” she asked.
As president, Clinton said, she would focus on prevention, keeping people well rather than treating them later when they are sick and the cost of treatment is more expensive.
“Under my reforms, all Americans will have access to comprehensive preventive care, which will save money in the long run,” she said, noting that only 38 percent of adults are screened for colorectal cancer and about 20 percent of children don’t get immunized against preventable diseases.
The senator said she would require all insurers who participate in a federal health program such as Medicare or Medicaid to cover prevention, paying for such procedures as cancer screening and immunizations. Switching from paper medical records to electronic records would also save money, she said.
Clinton said she wants individuals and small businesses to have access to larger insurance pools to lower costs and stop insurance companies from discriminating against those with pre-existing conditions. “The whole point of insurance, lest we forget, is to spread risk across a group of enrollees,” she said. “It’s one of the reasons that the administrative costs of Medicare are so much lower - because they are actually insuring everyone.”
Medicare should be able to negotiate for lower drug prices, she said, a proposal that has failed to gain traction in Congress over the last several years. And she cited medical malpractice reform as another avenue for reducing costs.
“The money we save from the waste we eliminate and the way we change how we care for people should be used to help finance coverage for the 45 million Americans who have no insurance,” Clinton said.
Political candidates often cite “eliminating waste” as a way to produce a windfall, but it is unclear how much money could actually be saved. And some of the items Clinton proposed - such as malpractice reform and drug negotiations - have proven difficult to enact.