President Obama hopes to learn from protests to the 1994 plan.
March 5, 2009
Obama Taps Clinton Ideas but Not Clinton Herself
By SHERYL GAY STOLBERG
WASHINGTON — Hillary Rodham Clinton has not participated in any of the White House’s planning sessions on health care, the issue that defined her public persona during the 1990s. Intent on establishing herself as a powerful secretary of state, she has steered clear of public statements on the topic and has not discussed it in any detail with President Obama.
Mrs. Clinton’s distance from the health care initiative, figuratively and literally — she will be in Brussels on Thursday when Mr. Obama begins his effort to overhaul the system with a high-profile gathering of experts — underscores how the Obama White House is grappling with the cloud that still lingers over the Clinton plan 15 years after it imploded.
Mr. Obama is at once trying to distance himself from the baggage Mrs. Clinton carries as the architect of that plan, while demonstrating that he has learned from it. He is drawing on the experiences of a host of aides who are Clinton veterans, notably Rahm Emanuel, the White House chief of staff. But he is not relying on Mrs. Clinton herself.
“I think we’ve got her pretty well occupied,” said David Axelrod, Mr. Obama’s senior adviser, adding that the president and Mrs. Clinton had spoken about her experience with health care “only in the most general terms.”
In an interview, Mr. Emanuel described the White House effort, beginning with Thursday’s policy forum, as “the manifestation of a series of learned examples, learned lessons,” a litany of health policy do’s and don’ts. To begin with, the Clinton plan was drafted in secret and delivered to lawmakers as a fait accompli; Mr. Obama is articulating broad principles and leaving the details to Congress.
President Bill Clinton waited 11 months after taking office in 1993 to roll out his plan, a delay many Democrats say was deadly. Mr. Obama is forging ahead after six weeks. Mr. Clinton focused heavily on access to care; Mr. Obama is framing the debate in terms of cost. The Clinton plan left Americans worried that they would be forced to switch doctors. Mr. Obama’s message, Mr. Axelrod said, is, “If you are happy with what you have, you can keep it.”
For Mrs. Clinton, who spoke of many of these lessons during her run for president, being on the sidelines of the debate is bittersweet, friends and associates say. She agonized over leaving the Senate to join the cabinet, said John D. Podesta, another Clinton White House veteran who ran Mr. Obama’s transition, because “she wanted to be an active player on health care and get it done.”
Now, if anyone scores a victory on health care reform, it may be Mr. Obama. Experts say the political climate for passing major health care changes is more favorable than ever, with business leaders, pharmaceutical and hospital executives, insurance officials and advocates for patients all agreeing the need is urgent.
“There’s no question that from a very limited start, she mastered an incredible amount of material, became quite expert and quite sophisticated,” said Bruce Vladeck, who was Mr. Clinton’s Medicare chief. “Maybe this is the story of her life. Now that health care is achievable, that the political moon and stars are lined up to do it, she’s no longer there.”
Some who know Mrs. Clinton predict she will not be able to stay entirely out of the debate. Among them is Senator Max Baucus, the Montana Democrat and chairman of the Finance Committee, who said he last spoke with Mrs. Clinton about health care before she took her cabinet post.
“Oh, Hillary’s very smart, she’ll figure out a way to sidebar with the president,” Mr. Baucus said. “I have a hunch that she’ll give a word or two of advice to the president and to me, and I intend to talk to her.”
Others, like Donna E. Shalala, who was health secretary to Mr. Clinton, say Mrs. Clinton does not need to advise Mr. Obama on the lessons of the past; she already did so when she ran for president by laying out a plan far different than the complicated proposal, heavy on government intervention, that flopped so badly when she was first lady.
“The way she laid out the issue during the campaign is a clear indication that they learned something over the last decade, and her proposal was very close to Senator Obama’s,” Ms. Shalala said. “That reflects what we learned — that people don’t want to lose the health insurance they currently have, that they are desperately concerned about cost, that they want evidence based medicine and prevention. I think in many ways she’s done her work.”
For Mr. Emanuel and other Clinton veterans who now work for Mr. Obama — among them Lawrence H. Summers, the chief economics adviser; Peter R. Orszag, the budget director; and Neera Tanden, a longtime policy aide to Mrs. Clinton who is now a senior official at the Department of Health and Human Services — Mr. Obama’s effort to remake the nation’s health system is something of a do-over.
It began with the economic recovery bill Mr. Obama recently signed, a measure that included $20 billion to modernize medical records and $1.1 billion for research on the cost effectiveness of drugs and medical treatments, initiatives that the White House says are critical to helping to bring down the cost of care.
Once the stimulus bill was enacted, Mr. Obama moved quickly to include money for health care changes in his budget, something Mr. Clinton did not do because his economic advisers wanted to focus on deficit reduction first, said Chris Jennings, who was Mr. Clinton’s senior health policy adviser. “That’s really key,” Mr. Jennings said. The delay, he said, “probably was the reason why we were unable to sustain interest and support.”
Mr. Obama, by contrast, made a conscious decision to tackle deficit reduction and health care, for which he set aside $634 billion in his budget, at once. “We’re 16 years later,” Mr. Axelrod said, “and I think the imperative is even greater because of the budget. Health care reform is a fiscal imperative now, not just a moral imperative.”
In a sign that the White House is determined to learn from the Clintons’ mistakes, Mr. Obama appointed Nancy-Ann DeParle, another former Clinton official, to run the new White House Office of Health Reform. Associates say Ms. DeParle had some misgivings about the Clinton plan. “She was worried about the cost,” Mr. Jennings said, “and wanted to make sure we weren’t overpromising and underfinancing.”
Another sign is Thursday’s bipartisan health care summit meeting, which was Mr. Emanuel’s idea. He modeled it after a forum he helped Mr. Clinton convene during his second term. The topic then was welfare legislation, an initiative that, unlike the doomed health plan, passed Congress and was signed into law.