Why Do Democrats Keep Fighting Over Healthcare?

February 2, 2016

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“In short [my opponent] offers a flawed trillion-dollar plan that will cost the American people even more in the long run.”

“[My opponent] abandoned that fundamental Democratic principle of basic health care for all Americans.”

You may think these quotes were quite likely uttered just last week as the Democrats running for President made their final pitch to Iowa voters. But in fact, the more things change, the more they stay the same. The quotes belong to Al Gore and Bill Bradley during the election cycle of 2000.

So if the current squabble over healthcare policy between Hillary Clinton and Bernie Sanders in the lead up to yesterday’s Iowa Caucuses rang a bell it’s no wonder. Democrats have been arguing over the best path to take to healthcare reform for 37 years. It usually boils down to a fight between the “visionaries” and the “pragmatists.” Looking back, the pragmatists have usually prevailed in the primaries but haven’t always done so well in the general election.

Sanders is calling for a “Medicare for all” approach that would have the federal government take over the job of insuring all Americans’ health, doing away with private insurance. His plan would cover all citizens and be financed with new taxes on workers and employers. Clinton claims Sanders’s proposal would reignite the nasty debate over the Affordable Care Act and could “never, ever” pass.

NBC News’ exit polls conducted during the Iowa caucuses showed Democratic voters place a high value on healthcare, ranking it second in terms of priorities (30% of Democratic caucus goers ranked it their most important concern, just behind the 33% who cited “the economy and jobs”). The argument is likely to continue in New Hampshire in advance of the February 9 primary there.

boxing gloves

The Sanders-Clinton debate has roots at least as far back as the 1980 Democratic primary faceoff between then-President Jimmy Carter and Sen. Ted Kennedy. Kennedy called for a “national health insurance” program that would cover everyone, saying: “If health insurance is good enough for the President, the Vice President and the Congress of the United States, then it is good enough for you and every family in America.” Carter argued that the country couldn’t afford Kennedy’s prescription and should take a step-by-step approach. Carter won the nomination but lost the White House to Ronald Reagan and reform began an extended hibernation.

In 1992, Bill Clinton’s campaign was best known for the sign in his headquarters that read, “It’s the economy, stupid.” But the second sentence on the sign, which was more or less forgotten, read: “Don’t forget healthcare.” Clinton made a series of vague promises of pursuing health reform and once he was in office spent a big chunk of his first two years on a failed attempt to broadly reform healthcare. The person put in charge of that effort: First Lady Hillary Clinton. And we know how that turned out.

The fight picked up again in 2000 when Al Gore was challenged for the Democratic nomination for President by Bill Bradley. Bradley proposed a sweeping national insurance reform plan while Gore said he would continue the incremental reform approach adopted after Clinton’s reform plan crashed and burned. Gore attacked it as too expensive and won the New Hampshire primary with room to spare. Eventually Bradley dropped out and Gore lost to George W. Bush.

In 2008, it was Barack Obama and Hillary Clinton’s turn. Both promised broad reforms but Obama attacked Clinton for her proposal to mandate all Americans have health insurance. “What she’s not telling you about her healthcare plan? It forces everyone to buy insurance, even if you can’t afford it, and you pay a penalty if you don’t.” We know how that one worked out. Obama won and then embraced the insurance mandate as part of the Affordable Care Act. Clinton’s response is ironic (considering the current debate): “Since when do Democrats attack one another on universal health care?” Apparently the answer is early and often.