Forget the public option. The real news is that Democrats may pass a bill. Adam Clymer on how the failures of 1994—which spurred a GOP takeover of Congress—could make reform happen this year.
On Tuesday, a key liberal value (the so-called public option) was beaten in the Senate Finance Committee. Public support is declining, especially among the elderly. Republican attacks on imaginary issues like “death panels” make it clear their party sees a political opportunity as at least as important as the responsibility to debate a serious issue. It sometimes seems like 1993-94 all over again. Indeed now as then, only one Senate Republican seems supportive (Olympia Snowe today, James Jeffords yesterday) and no House Republican will sign on. And the Finance Committee, once again, is the last panel to finish its work, wrangling through attacks on “rapacious” insurance companies and a “Trojan horse for a single-payer system.”
As one senior House aide put it, “Almost everyone keeps repeating that they know health-care failure cost seats in 1994.” That’s the view in the Senate, too: “Coming up empty-handed is the worst outcome,” said Senator Richard Durbin.
But the differences are more important. Start with the Finance Committee itself. In a few days, it is certain to approve a bill that the Congressional Budget Office says will insure 94 percent of the public and provide that individuals get insurance. Fifteen years ago, in July 1994, the panel rejected the idea of near-universal coverage. A key difference is the committee’s chairman. Max Baucus may be one of the left’s favorite punching bags, and he may have deluded himself about whether Chuck Grassley would ever come around. But he finally pushed a bill on the table and has persuaded his Democratic colleagues he is determined to get one passed. (On Tuesday, Baucus said the public option was a good idea, but voted against it because he said including it would keep the bill from getting a filibuster-proof 60 votes.) Fifteen years ago, Daniel Patrick Moynihan didn’t think health care was all that important and he waited for Bob Dole to come around and support it. Dole finally has signed on, but in 2009, not 1994; it’s only now that he’s said “We probably should have passed the Clinton bill.”
There are other important differences. The most remarked on are President Obama’s decisions not to send up a bill of his own but to let Congress do the work and to make deals with the drug industries and the hospitals to support the legislation, instead of opposing it as the drug industry did in 1994. Without Bill and Hillary Clinton’s pride of authorship, he may be more comfortable with compromise than they were. But to be fair, by the spring of 1994 there were no Republicans for Clinton to compromise with, even if he’d wanted to. There don’t seem to be any these days, either, but compromising with moderate Democrats is in the cards, whether it’s done by congressional leaders or the president. In any case, Obama comes from a stronger position, 56 percent approval according to the latest New York Times/CBS News Poll compared to 42 percent for Clinton in July 1994, when the issue went to the Senate floor.
Congress is different, too. In the Senate, there are now 60 Democrats. That is not a filibuster-proof majority because of Ben Nelson’s unpredictability, but it certainly is filibuster-resistant. In 1994, there were 56 nominal Democrats, two of whom formally switched to the GOP in 1995. This time, furthermore, Harry Reid, the Democratic leader, has made it clear Democrats will go for the 51-vote reconciliation route if they can’t get 60 votes, even if that means dropping some parts of the bill. In 1994, Robert Byrd, at the height of his influence, blocked that approach.
In the House, the numbers are not very different: there are 256 Democrats now, and there were 258 in July 1994. But the leadership has changed significantly. Speaker Tom Foley was not excited about health care and he was patient with his committees and their chairmen. The best chance for a bill died when Dan Rostenkowski was indicted and had to step down from his perch as chairman of Ways and Means. Speaker Nancy Pelosi drives her chairmen hard, cares about the issue, and approaches its politics skillfully.
On the flash point of the day, the so-called public option shot down Tuesday, Pelosi has made it clear that she wants it—but also signaled that nothing in the legislation is “non-negotiable.” She has scoffed at the idea that the left wing of her caucus—her own roots in the party—would kill a final bill if it was left out. The eventual outcome is likely to be some version of Snowe’s plan for a “trigger” that would create the public-insurance option if coverage without it fell short. Reid told his Nevada constituents last week that was a “pretty doggone good idea.”
There is one ominous sign that does parallel 1994. Bob Blendon of Harvard, a leading student of public opinion on health care, says that now as then “more and more people are getting worried that it isn’t going to be good for them or the country”—despite the greater emphasis this time around on reassuring those who have insurance that covering the uninsured would not hurt them. The latest Times/CBS News Poll bears that out. In June, 64 percent of the public said the government should guarantee health insurance for all Americans; last week only 51 percent did. Then and now, the doubts are strongest among seniors; 45 percent agreed in June and just 31 percent did last week. It may all be personal; among Americans generally, last week 23 percent said the legislation would help them personally while 26 percent said it would hurt them. Among those 65 and older, only 1 percent said it would help them personally.
On some issues, those numbers might be a mortal wound, especially because seniors vote heavily. But Democrats seem to have shrugged off the hostility of August’s town meetings and have drawn an electoral lesson from 1994—that failure on health care led to the sweeping Republican victory that took control of the House and the Senate. As one senior House aide put it, “Almost everyone keeps repeating that they know health-care failure cost seats in 1994.” That’s the view in the Senate, too. “Coming up empty-handed is the worst outcome,” said Senator Richard Durbin, the Senate Democratic Whip.
The 1994 comparison may be simplistic. The crime bill with its anti-gun provisions almost surely cost the Democrats more seats than health care, on which there were no roll calls to hold against an incumbent. But the overall picture of Democrats being in control at both ends of Pennsylvania Ave. and incapable of action surely hurt, too.
But what matters now is what Democrats think happened. Large numbers, from right and left, think health care was critical in the 1994 election. Today, they think failing to pass major legislation will be hazardous to their political health.
Adam Clymer is a former chief Washington correspondent of The New York Times and author of Edward M. Kennedy: A Biography.