The Past Is Prologue

Reviewing the opposition to the last major push for health care reform

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    “We’ve killed health care reform…Now we’ve got to make sure our fingerprints are not on it.”
    –Attributed to Senator Bob Packwood (R-OR), New York Times, September 1994 [NY Times, 9/18/1994]

    As progressives prepare to push for sweeping health reform, it is worth examining the nature of the opposition to the last major push for health care reform in 1994. The evidence already indicates that, while much has changed since 1994, we can expect those individuals and organizations opposed to reform to employ many of the same tactics.

    The opposition to reform in 1994 generally used three tactics:

    Fear-mongering: Conservatives of all stripes argued that health care reform was “creeping socialism” or “big government.”

    Denial: Members of Congress and activists opposed to reform denied that there was a health care crisis or argued that it was the wrong time to address health care.

    Pushing false reforms: Industry and special-interest groups opposed to reform co-opted the term “reform” to push their own agendas and dilute support for a comprehensive solution to the nation’s health care crisis.

    These tactics are likely to re-emerge among opponents and special interests in the months ahead as health care reform makes its way through Congress and various actors use their influence to determine the shape of the final policy.

    The following profiles shed light on the primary opponents to the 1994 effort; they are organized by the tactics used, and provide warning signs for how they are ready to be deployed today.

    Fear-mongering

    Newt Gingrich (R-GA): Then minority whip Newt Gingrich (R-GA) led a politically opportunistic and stubborn conservative charge against health care reform. He argued internally that any successful bill would set back Republican electoral prospects in November 1994. At a March 1994 strategy retreat, Gingrich warned GOP senators that “any Republican concessions will be met with more Democratic demands,” and that the GOP should concede nothing. [PBS, 5/96]

    Richard Viguerie, Phyllis Schlafly, and L. Brent Bozell:
    These three prominent and wealthy conservative activists ginned up the conservative base against any health care reform and sent a fierce letter to Gingrich and Dole warning that “willingness to compromise on behalf of Big Government” would make support for them in 1996 among grassroots conservatives “impossible.” [PBS, 5/96]

    Health Insurance Association of America: Seeking to “plant seeds of doubt” about Clinton’s reforms, the HIAA developed the influential Harry and Louise ads, organized grassroots campaigns, hired field operatives in six states whose lawmakers were expected to be swing votes, and recruited ground troops from their members’ companies’ networks of employees, managers, and agents. HIAA generated more than 450,000 phone calls, visits, and letters to Congress by the end of its campaign. “The government may force us to pick from a few health care plans designed by government bureaucrats. Having choices we don’t like is no choice at all. They choose. We lose,” the Harry and Louise ad warned. [Harry & Louise ad, 1994][The System, p. 206]

    National Federation of Independent Businesses: NFIB misrepresented President Clinton’s employer mandate as a crushing financial burden that would cost thousands of jobs. The organization dispatched a constant stream of “Fax Alerts” and “Action Alerts” to its tens of thousands of small-business owners. More than 2 million pieces of mail were sent to small-business owners. “Simply put, this health care plan is a job killer for Virginia and the nation,” said NFIB State Director John Broadway. [US News Wire, 4/18/1994]

    Heritage Foundation: In several primers, the foundation characterized Clinton’s reforms as a “top down, command-and-control system.” One primer portrayed the bill as a “system that would meticulously govern virtually every aspect of the delivery and the financing of health care services for the American people.” [A Guide To The Clinton Health Plan, 11/19/1993]

    Manhattan Institute: The institute placed two influential editorials in the Wall Street Journal that argued that Clinton’s reforms would provide less choice to consumers, drive doctors out of business, and lower the quality of care. “The Clinton plan is coercive. It takes personal health choices away from patients and families, and it also imposes a system of financing health care based on regional alliances that will make racial tensions fester and produce mean-spirited political struggles and lawsuits to shirk the cost of medical care for the urban poor.” [WSJ, 9/30/1993]

    Alert for today: “Limiting freedom”

    Karl Rove: Influential Republican operative and pundit Karl Rove fear-mongered in a recent Wall Street Journa l op-ed that, by endorsing the common sense measures proposed by Melody Barnes and Senator Tom Daschle, Obama had already broken his campaign promise not to run to the “‘extremes’ with government-run health care.” [WSJ, 11/28/08]

    Rep. Michael Burgess (R-TX): In a November 2008 op-ed in the Washington Times, Representative Burgess echoed the 1994 opposition’s talking points, charging that comprehensive health care reform would “nationalize health care,” “limit freedom,” and put “bureaucrats in charge of health care decision making.” More attacks along these lines are sure to come. [Washington Times, 11/19/08]

    Denial

    Sen. Daniel Patrick Moynihan (D-NY): “There is no health care crisis,” Senate Finance Chairman Daniel Patrick Moynihan blurted out on “Meet the Press” on January 9, 1994. The remark sprang from his ambivalence over the cost and scope of the Clinton proposal and his frustration for delaying his welfare proposal. He later acknowledged that there was a health financing crisis, but as head of one of the committees in charge of moving the proposal through the Senate, his lukewarm attitude gave reform opponents a powerful weapon. Then AFL-CIO President Lane Kirkland shot back that while Moynihan “may not have a health care crisis . . . we do.” [NY Times, 1/27/94] [Time, 2/14/94]

    William Kristol: In late 1993 and early 1994, Republican operative and conservative pundit Bill Kristol circulated a series of influential memos from his perch at GOP strategy group Project for the Republican Future. He argued that Republicans should refuse to compromise on a health care reform proposal and “kill it outright.” He advocated repeating the assertion that there was no “health care crisis.” He convinced rank-and-file Republicans that any health care victory would present “a real danger to the Republican future,” and persuaded many to close ranks against the plan. [Wall Street Journal, 1/11/08] [PBS, 5/96]

    Pushing false reforms

    Sen. Bob Dole (R-KS): In his rebuttal to President Clinton’s 1994 State of the Union address, Senate Minority Leader Bob Dole, adopting the messaging suggested by William Kristol, insisted that America did not have a “health care crisis.” As the debate wore on, Dole made motions toward proposing a viable compromise bill with Senator Moynihan (D-NY), but backed off under pressure from the right. Instead, he offered his own far-right plan without measures to assure access or affordability. [NY Times, 1/26/94]

    Senator Phil Gramm (R-TX): On CNN in April 1994, Sen. Gramm said he wanted to “improve the system.” He also introduced his own alternative bill in the Senate. In closed-door GOP strategy meetings, however, he joined Gingrich in agitating “against any Republican compromise on health reform.” After the plan failed, Gramm said he was “certainly proud of [his] part of killing the Clinton plan in all of its incarnations.” [CNN, 4/18/94] [PBS, 5/96] [NY Times, 9/18/94]

    Health Insurance Association of America: The insurers’ trade association, known today as America’s Health Insurance Plans, “endorsed the idea of universal coverage mandated by federal law, along with new measures to control costs, including a larger role for the government in supervising fees charged by doctors and hospitals.” Yet insurers, afraid that the regional alliances in the president’s bill would bar some smaller insurers from the marketplace, released their own competing and inferior plan that rejected premium growth constraints and community rating. [NY Times, 12/3/1992]

    Business Roundtable: The organization endorsed a rival plan that promised only access, not coverage. The rival plan, sponsored by Rep. Jim Cooper (D-TN), would have created insurance cooperatives, but for small businesses only. The Cooper plan did not require businesses to pay 80 percent of employee insurance costs as the Clinton plan did. John Ong, chairman of the Roundtable, criticized the Clinton plan for creating “unfunded off-budget entitlement programs” and “price controls.” [CNN, 2/03/1994]

    Chamber of Commerce: After initially using the rhetoric of reform and supporting an employer mandate, the Chamber reneged and decided that “our membership is not in support of the employer mandate approach. “The board is rejecting any form of employer mandate,” Chamber president Richard Lesher said. [USA Today, 3/1/1994]

    Alert for today: Accessibility vs. affordability

    America’s Health Insurance Plans: This new incarnation of the HIAA has already put forth their own plan, which supports a universal individual mandate and co-opts the progressive rhetoric of reform. Yet while they seem to support reform, they have only endorsed “affordable” coverage as long as it is paid for on the government’s dime. Rather than agreeing to end premium discrimination based on age, sex, or health status, they want the government to subsidize premiums and cap total health expenditures for lower-income individuals to protect Americans from bankruptcy. The plan calls on the government to ensure affordability, while protecting industry profits. [Wonk Room, 12/3/08]

    Conclusion

    Opponents of the Clinton health plan used a combination of these tactics to kill progressives’ last national effort to reform the health care system. Today’s opponents are likely to echo these strategies, with opposition groups conflating affordability and accessibility, arguing that now is not the time for reform, and using the same old scare tactics. The lesson for progressives is clear: Anticipate the opposition, call it out for what it is, and fight for our positive vision of universal, accessible, and quality health care in America.

    **A previous version of this memo unintentionally mischaracterize d the concerns of health care commentators Joseph Paduda and Bob Laszewski. Those lines have been removed.

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