Health care debacle evokes bitter memories

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By Ricardo Alonso-Zaldivar ASSOCIATED PRESS

Shock and awe. That's what survivors of the Clinton-era health care collapse are feeling as President Obama's overhaul legislation teeters in Congress.

Aides who shaped Bill and Hillary Rodham Clinton's 1990s plan to cover all Americans, then labored in vain to pass it into law, are adamant that the Democrats can't afford another health care disaster. But they're divided on whether scaling down Mr. Obama's plan would be the best fallback plan.

The Clintonistas — now in think tanks, universities, serving in the Obama administration or lobbying are a potent voice in the furious debate within the Democratic Party over how to salvage health care. As veterans of Washington's last health care policy war, they carry the scars of intense striving reduced to utter futility.

"If Bill Clinton couldn't get it done, and Barack Obama can't do it, no Democrat will ever try again," said economist Len Nichols, health policy director at the New America Foundation. A Clinton White House health budget aide, Mr. Nichols has been operating as an unofficial adviser to lawmakers and administration officials wrestling with details of the current legislation.

"History is written by the victors, not the vanquished," said Chris Jennings, congressional liaison for then-first lady Mrs. Clinton during the 1990s debate. "Failure would serve as the ultimate judgment as to whether this effort was worth doing."

Mr. Jennings, now a lobbyist, replaced Ira Magaziner, principal architect of the Clinton plan, as White House health policy adviser.

The former first lady, now secretary of state, said it was "really hard" watching the travails of Mr. Obama's plan. Mrs. Clinton has been giving advice, as requested, to lawmakers in Congress and administration officials, and insisted she is still hopeful. "I'm not sure that this last chapter has been written," she told CNN's "State of the Union" on Sunday.

For most of last year, the health care debate was among Democrats. Republicans were left heckling from the sidelines. That changed when Republican Scott Brown pulled off a Senate upset in Massachusetts, winning the seat held by the late Sen. Edward M. Kennedy and depriving Democrats of the 60-vote majority they were counting on in the final push.

"Many of us thought we were really at the one-inch line, then literally it was like being hit by a freight train with about 10 seconds' warning," said Ken Thorpe, a senior Health and Human Services official during the Clinton-era debate. Now a professor at Emory University in Atlanta, Mr. Thorpe has proposed a scaled-back alternative in case Mr. Obama's plan can't get unstuck.

The mere mention of settling for less is causing consternation among other former Clinton aides. Mr. Obama's health care plan denounced as a government power grab by critics is already scaled back from the ambitions of the Clinton years.

"It takes too much work to figure out what 'scaled back' means," said Judy Feder, a former colleague of Mr. Thorpe and now a health policy professor at Georgetown University. "You can't do insurance reforms alone without expanding coverage, and the expansion costs money. I don't see the politics coming together for scaling back."

Mr. Obama has sent mixed signals. Shortly after the Brown race, he raised the possibility of scaling back, but then insisted he still wants a comprehensive approach. Last Thursday, Mr. Obama publicly raised the prospect that Congress might not act at all. Sunday, he invited GOP and Democratic leaders to discuss possible compromises in a televised summit later this month.

The Democrats' reversal "is like a big body blow," said Mr. Jennings. "You either stammer and fall down, or you stammer and regain your balance. What Americans respect are those people who can take a punch and come back."