The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Posts Tagged ‘Hillary Clinton’

Seeds of 1993 Health Care Plan Defeat Planted by Clinton

Posted by Alan on February 25, 2008

At the Democratic debate in Austin last week, Senator Hillary Clinton declared her experience in the 1990s in developing and promoting health care reform would serve her well if elected president. She claimed it would help her stand up to the special interests. Senator Barack Obama responded it was her approach to health care reform that doomed the effort. He is right. She is wrong.

Senator Clinton blames special interests, especially the insurance companies, for defeating the health care reform package she developed for her husband’s administration in 1993-94. There’s some merit to the claim. Tens of millions of dollars went to lobbying, advertising and organizing against the proposal. But while that level of spending would have made passage more difficult, if the plan had been well conceived and well promoted it would not have been enough. With Democrats in the White House and controlling Congress, the right plan, developed and sold in the right way should have been successful. And that was the problem. Under now-Senator Clinton’s leadership, the plan was developed in secrecy and presented to the public and decision makers with unforgivable ineptitude.

Senator Clinton talks a lot about reaching out to all points of view to fashion consensus policies and programs. Now. Then, however, it was her way or the highway. In late-1992 she began assembling a large group of very smart people to develop her health care reform package. They sequestered themselves in Washington and talked among themselves. Occasionally they’d seek input from outsiders. But like Ken Kesey’s Merry Pranksters, you were either on the bus or off the bus. And if you were off the bus, your opinions didn’t matter.

This created two problems. First, developing policy in an echo chamber rarely works. The results may look good when considered in a vacumn, but when exposed to the real world, one flaw cascades through the interwoven assumptions, reducing the whole to dust. The Clinton health care plan of 1993 and 1994 was beautiful to behold, an exquisite example of theoretical policy. It was also fragile. Because the Clinton administration was unwilling to accept advice or input or, heaven forbid, changes, from the outside, it lacked a foundation to withstand deep scrutiny. Much to the surprise of the Clinton health care working group, their plan was flawed. And those flaws led to the unravelling of the whole.

Second, excluding members of Congress from the process was just stupid. By ignoring even Democrats in Congress, there was no one at the other end of Pennsylvania Avenue who had any stake in the outcome. In fact, it merely engendered hostility. I participated in three Congressional hearings, representing the National Association of Health Underwriters (NAHU is an association for health insurance agents and other professionals). None of the questioning dived deeply into the Clinton health care plan. There was plenty of questions concerning other reform proposals, but our criticism of the Administration’s plan was pretty well accepted by the Congressional panels.

The lack of an open process is one of the reasons Assembly Bill X1-1 failed in the California legislature. To their credit, the staff of Governor Arnold Schwarzenegger consulted with far more “outsiders” than the Clinton health care task force. But these were seriel discussions held in private. No one really knew what the entire package looked like until months into the Year of Health Care Reform. As a result, when the legislation reached the State Senate, there were few there who had a stake in its passage. When faced with the state’s budget crisis, it was easier for them to let health care reform slide away.

The lesson is clear: developing health care reform requires an open, inclusive process. Every opinion and perspective needs to be represented. Senator Obama gets this. Unlike Senator John Edwards, who claimed he wouldn’t let the insurance industry participate in developing his health care reform legislation, Senator Obama said they’d have a seat at the table, they just wouldn’t be able to buy them all.

It’s this approach to openness and collaboration that holds the greatest promise of success. Senator Clinton tried the old way. It didn’t work. Her continuing the blame the special interests instead of her own mistakes for the defeat of the Clinton Administration’s health care plan shows she may not have learned the right lesson. And that’s another reason she’s no longer the frontrunner for the Democratic nomination.

Posted in Health Care Reform, Politics, Presidential Election | Tagged: , , , , | 1 Comment »

Candidates Need to Address the Real Health Care Reform Issue: Cost

Posted by Alan on February 13, 2008

Senators Hillary Clinton and Barack Obama have agreed to two debates before the critical Ohio and Texas presidential primaries. They’ll face off on February 21st in Austin, Texas and then meet again, just five days later on the 26th, in Cleveland. At both sessions Senator Clinton will go after her rival’s health care plan for failing to seek universal coverage. After all, she’ll remind viewers yet again, universal coverage is a moral obligation of society and a litmus test for real Democrats. Been there. Done that. Now it’s time for a new discussion on health care reform.

Health care reform is complicated, complex and challenging, but at its core it boils down to two issues: access and affordability. Access is actually the easier of the two for politicians to address. Just promise voteres they’ll be covered and, if at all possible, avoid talking about what that coverage will look like. If you must address the benefit package, say it will be similar to”fill in the blank” — Medicare, Medicaid, Congress’ health plan, Canada’s. Everyone will assume it covers what they want it to cover. (How many people know prescription coverage is not covered in most Canadian provinces?)

Controlling skyrocketing health care costs is a lot tougher. But as Congressional Budget Director Peter Orszag has made clear, it’s absolutely critical to the country’s financial wellbeing. Yet the topic makes politicians uncomfortable. They have to talk about voters getting the coverage they need, not everything they want. It means tough choices about what’s the responsibility of the coverage provider (whether it’s a private insurance company or a government agency) and what’s the responsibility of individual Americans. It requires explaining what is driving the costs — not only an aging population and new technologies, but consumer expectations, as well. There was a time when a drug addiction was dealt with by the criminal justice system; now it’s a medical issue. It means addressing America’s life style and pointing out that America’s obesity rate is 30 percent higher than Canada’s. That’s a harsh statement to make when you’re going after the couch potato vote. 

During previous debates, the candidates have gotten a free pass on addressing the issue. They’ve made vague references to how they’d reduce medical costs, but I don’t think there’s been a single follow-up question on the topic.

That should change — and it might. The Austin debate is hosted by CNN. On the channel’s Anderson Cooper 360 Degrees on Tuesday night, the pundits actually acknowledged the importance of addressing health care costs, lamenting the candidates’ failure to address the issue.

Was anyone at CNN watching CNN at the time? It’s a 24-hour news channel. CNN and its competitors have to put something between all those commercial breaks. If getting the candidates to talk about controlling medical costs, make them talk about it. Devote a 30 minute segment to the cost control provisions in the both the Democratic and Republican candidates’ health care reform packages. Ask them what ideas they are they pushing and which ones they won’t even consider. Ask them to discuss rationing. Make them describe the sacrifices they’d ask of Americans.

And those debates? CNN is hosting the one on February 21st. Maybe CNN could bring up this issue then?

There’s no need for CNN’s talking heads to lament the candidates’ failure to address an issue: they have the power to force them to discuss it. And they should.

Posted in Health Care Reform, Healthcare Reform, Presidential Election | Tagged: , | 3 Comments »

Obama’s Health Care Reform Plan Out of Balance

Posted by Alan on February 10, 2008

Senator Barack Obama has been on the defensive concerning his health care reform proposal for much of the past several months. Senator Hillary Clinton and, while he was in the race, former Senator John Edwards pounded Senator Obama for failing to seek universal coverage by mandating Americans to obtain health insurance. If you don’t start off with a plan for universal coverage, Senator Clinton claims in nearly every speech she gives, you won’t get it. She goes further, claiming universal coverage is a moral obligation of the nation and a litmus test Democrats.

Senator Obama counters that Senator Clinton would have to garnish wages to force people to buy coverage. He notes that Senator Ted Kennedy, the dean of Congressional health care reformers, is comfortable enough with the Obama approach to endorse the Senator. Finally, Senator Obama claims his reform package, by lowering  the cost of coverage, will result in Americans getting covered because they will finally be able to afford it.

Unfortunately for Senator Obama, his logic doesn’t hold up to any meaningful scrutiny. Virtually every study done shows Senator Obama’s approach resulting in fewer insured Americans than does Senator Clinton’s. Arguing that they’re equal in terms of “universal coverage” defies logic and experience.

But there’s a worse gap in in Senator Obama’s health care reform plan: his refusal to consider a mandate to buy coverage, coupled with his plan’s inclusion of requirement that carriers sell policies to all applicants, undermines his claim to making coverage more affordable. The carrier mandate (often called “guarantee issue”) raises the cost of insurance unless all residents are required to buy. That’s how New York and New Jersey approached health care reform — carriers there have to sell to all comers, but the purchase of coverage is voluntary. The result: premiums are twice as high in those states than in California.

This shouldn’t come as a surprise. Imagine a system in which homeowners could wait to buy fire insurance until after their house burned down. Or one in which drivers could wait until after their accidents to buy car insurance. The cost of these policies would be astronomical. After all, if consumers can avoid paying a premium until they need the coverage, they’ll wait. That’s not being irresponsible, that’s human nature.

There’s no reason to think introducing this imbalance nationally will produce any other result when it comes to health insurance. Without including both, a mandate for carriers to sell and for consumers to buy coverage, Senator Obama’s plan will increase health insurance costs in spite of other provisions in his reform package.

Senator Obama no doubt is aware of this reality. He may be in denial about it, but he’s bright and so are the people around him. In an ideal world he’d address the imbalance in his health care reform plan now, during the primaries. But doing so would open him to charges of flip-flopping. It would demonstrate that Senator Clinton’s experience dealing with health care reform led her to a more responsible conclusion (at least on this aspect of their plans). Senator Obama might be interested in bringing a new approach to politics, but even he’s not ready to hand his opponent a cudgel on an issue as important to voters as health care reform.

My guess is he’ll wait until after he’s secured the nomination — if he does, indeed, secure it. Then, sometime in the summer he’ll introduce a willingness to consider guarantee issue in combination with an “affordability exemption” to assure it doesn’t bankrupt consumers. And if it doesn’t happen during the campaign, guarantee issue is certain to find its way into his Administration’s reform package.

If Senator Obama is lucky, Senator Clinton will continue to level only the “lack of universal coverage charge” against him. That line of attack is getting old, but she seems unwilling to abandon it, even though she’d be far better served by forcing Senator Obama to defend an indefensible imbalance in his plan.  

Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , | 6 Comments »

Clinton and Obama on Health Care Reform: 95% the Same

Posted by Alan on January 31, 2008

Health care reform was one of the few issues on which Senators Hillary Clinton and Barack Obama tried to differentiate themselves during their debate tonight. They acknowledged substantial similarities in their plans. Senator Obama went so far as to describe them as being “95 percent” the same. Both candidates call for the government to offer consumers an alternative to the private market, for example.

When compared to the health care reform packages offered by the Republican candidates  (which rely more on market reforms and avoids extensive government intervention) the Democratic Senators’ proposals are virtually indistinguishable. But campaigns are about choices, so they emphasized the five percent.

Senator Clinton’s proposal seeks to provide universal coverage by requiring health plans to accept all applicants and all residents to buy coverage. Senator Obama focuses on reducing the cost of health care coverage. As I’ve written before, this tension between access and affordability mirrors California’s recent health care reform debate.

The candidates described their differences in stark terms, as a seemingly irreconcilable chasm between them. In reality, while differing in emphasis, these two approaches are not really either-or propositions. They’re complimentary. Don’t take my word for it — ask my son.

He turned 13 a few weeks ago. Health care reform is not high on his list of interests. However, he’s recently gotten interested in the primary so he joined me tonight to watch the debate. As Senators Clinton and Obama went back and forth on their reform packages, he asked me what the argument was about. Thanks to the miracle of DVRs I was able to pause the debate and explain. We resumed watching and, after another couple minutes of the candidate’s throwing health care statistics around he grabs the remote, presses pause and exclaims, “This is so stupid. First you make it affordable and then you make sure everyone buys it.”

So, now that we’ve got that resolved, I’m going to have him start work on creating the Democratic party’s position on immigration. 

Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , | 5 Comments »

Not That Obama Needs My Advice

Posted by Alan on January 25, 2008

Senator Barack Obama got hammered by Senator Hillary Clinton and former Senator John Edwards on his health care reform proposal at their debate earlier this week in South Carolina. Senator Obama’s focus is on making coverage affordable; Senators Clinton and Edwards emphasize universal coverage. If he continues to let his opponents define the debate this way they win and he loses.

For those who might find it interesting, I discuss how what happened in California provides a way for Senator Obama to reframe the Democratic debate on health care reform over at the political blog.

Posted in Health Care Reform, Healthcare Reform, Presidential Election | Tagged: , , | 1 Comment »

Democrats Debate Access versus Affordability in South Carolina

Posted by Alan on January 22, 2008

Health care reform was a hot topic during the presidential candidate’s debate in South Carolina on Tuesday. Senator Hillary Clinton and former Senator John Edwards claimed universal coverage was the most important priority while Senator Barack Obama put affordability at the top of his list. This dichotomy mirrors the debate California experienced with Governor Arnold Schwarzenegger insisting on coverage for all and the legislature’s Democratic leadership questioning the fairness of requiring individuals to buy coverage they couldn’t afford.

I’ve written more about this somewhat strange, but probably not surprising, echo of California’s health care reform debate on the political blog.

Posted in Arnold Schwarzenegger, California Health Care Reform, Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , , , , | Comments Off on Democrats Debate Access versus Affordability in South Carolina

New Hampshire Votes: Thoughts on the Democratic Primary

Posted by Alan on January 8, 2008

Well, let’s see. I already handed the Comeback Crown to Senator John McCain in the previous post on the Republican New Hampshire primary vote. It seems unfair to deny Senator Hillary Clinton the same honor considering the polls and pundits showed her losing big to Senator Barack Obama there. Yet she defied the surveys and eked a victory, surprising, it seems, even herself.

A week ago, winning New Hampshire by just two percentage points — less than 7,500 votes — would have been proclaimed a disaster by most analysts. Now it’s a major victory and a tremendous shock. Of course, the shock is to those who wrote her off just five days ago.

Which shows how significantly, and inappropriately, Senator Obama’s victory in Iowa last Saturday changed the expectations of the Democratic nomination fight. Prior to those caucuses, Senator Clinton’s campaign focused on the depth of her experience and on the inevitability of her nomination. Then she finished third, losing out to Senator Obama and, barely, to former Senator John Edwards. Both Senators Obama and Edwards had campaigned as change agents. Senator Clinton’s message had failed to resonate and the inevitability of her success was seriously in doubt.

So in New Hampshire, she modified her message slightly, promoting herself as the candidate whose experience made her most capable of achieving change. The message seemed to reinforce the opinion of those who had supported her before the Iowa and may have been strengthened by New Hampshire voters’ penchant for thumbing their noses at expectations. According to the CNN exit poll, thirty four percent of the voters said they had made up their minds at least a month ago and Senator Clinton garnered 48 percent of their votes while Senator Obama received 31 percent.

What this says to me is that the Iowa bump for Senator Obama was in the eyes of the pundits, not among voters.

The New Hampshire results does seem to have accomplished three things. First, it put to rest talk of inevitability concerning any candidate.  Second, it confirmed the old cliche that the only poll that matters is the one on election day. Voter surveys as recent as yesterday projected a decisive win for Senator Obama. But it’s who shows up at the polls that matter, and the Clinton campaign got their voters out. I also think the polls may have worked against Senator Obama as New Hampshire voters seem to dislike being told what to do.

Third, the New Hampshire results have all but reduced the primary trail to a two person race, sending Senator Edwards on a downward spiral from which he is unlikely to recover while limiting Governor Bill Richardson to showcasing his Vice Presidential credentials and seeking favorite-son status from New Mexico.

Senator Edwards’ post-Iowa strategy was to convince voters — and the media — that the campaign was about change and Senator Clinton was incapable of delivering it. He then believed his more aggressive and partisan approach to transforming America would win out over the more conciliatory style of the Senator from Illinois.

It didn’t turn out that way. Senator Edwards received only 17 percent in the New Hampshire primary, less than half of what Senator Obama earned. Perhaps even more disastrous, polls show Senator Edwards to be even further behind Senators Clinton and Obama in the upcoming South Carolina primary, the only state he won in his unsuccessful presidential bid in 2004. As a southerner, if Senator Edwards can’t win there, it will be tough for him convince anyone he can win anywhere.

Senator Edward’s downfall stems, at least in my opinion, from his extremely partisan stance. He positioned himself as a fighter, but too much so. For example, after castigating insurance executives as greedy and accusing them of valuing profits over human life, Senator Edwards proclaimed, “And people say to me that as president of the United States, they want me to sit at a table and negotiate with these people? Never. It will never happen.’”

Now, contrast this with Senator Obama’s approach. In his concession speech tonight he promised supporters he would tell insurance and drug companies that “while they get a seat at the table, they don’t get to buy every chair. Not this time. Not now.” (This can be viwed about five minutes into the clip).  Senator Obama’s rejection of Senator Edward’s contention-as-usual politics was explicit, describing his supporters as a new majority “who are tired of the division and distraction that has clouded Whasington, who know we can disagree without being disagreeable.” (About four minutes into his speech).

Senator Edward promises a new agenda, but the same ugly, tired politics of division. Senator Obama promises changes in policy and in politics. Senator Obama finished a close second. Senator Edwards finished a distant third and, while he retains enough support and money to to continue to slog ahead, at least until February 5th when the bulk of delegates will be selected, he’s likely to be increasingly marginalized over the next four weeks.

Meanwhile, attention on the Democratic side turns to the Nevada Caucuses and the South Carolina primary (Michigan will hold a primary on January 15th, but neither Senators Obama’s or Edwards’ name is on the ballot). Senator Clinton and Obama will be seeking momentum prior to Super Duper Tuesday when California and 21 other states caucus or vote. Which means by February 6th one of the two may have emerged as unbeatable.

Which one? The odds are, marginally, favoring Senator Clinton. According to the CNN exit poll, she out-polled Senator Obama among Democratic voters 45 percent to 33 percent. It was independent voters participating in the Democratic primary that kept the Illinois Senator close with 41 percent of them supporting Senator Obama and 30 percent voting for Senator Clinton (in New Hampshire, independents can choose to cast either a Democratic or Republican ballot) .

However, not all states allow non-Democrats to vote in their primaries. Of those that do, independents comprise less of the electorate than in New Hampshire where they represent about 45 percent of all voters.

Before proclaiming Senator Clinton as the inevitable winner, however, keep in mind that in California voters registered as Decline to State  — about 19 percent of the electorate — can cast a Democratic ballot (but not a Republican one). Senator Obama’s broader appeal should serve him well here. And on February 5th, California is the biggest prize of all.

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Close Votes in Reader Presidential Survey Results

Posted by Alan on January 8, 2008

The polls are open in New Hampshire, but they’ve closed on the first Alan Katz Health Care Reform Blog Unscientific Presidential Survey (the AKHCRBUPS, for short). And while we won’t know who won in the Granite state for awhile, we can now report on the winners, and losers, among this blog’s readers.

Republicans: Respondents gave a plurality of their first place votes to former-Mayor Rudy Giuliani takes the top spot followed closely by Senator John McCain who, in turn, was just ahead of former Governor Mike Huckabee. Former front-runner and former Governor Mitt Romney finished a distant fourth.

The survey asked participants to list their second and third choice. Weighting the results (first place = 3, second place =2 and third place =1), however, doesn’t change the order of the finish, although Governor Romney does move closer to the pack as does former Senator Fred Thomas. 

The comments provided by respondents showed some Republicans displeased with their choices this election cycle. As one Republican put it, “It just might be the first time I won’t go to the polls during the primary season.”

Republicans were asked whether they “would be willing to support a Democratic candidate in the general election” and, if so, which one. A majority said no. But of those who said yes, Senator Barack Obama was their top choice, followed by former Senator John Edwards.

Democrats: Senator Hillary Clinton would be the Comeback Kid of 2008 if New Hampshire follows the AKHCRBUPS results. She tied Senator Obama for the top spot as the first choice among Democrats. Yep, tied. (They were right, every vote does count!) Senator Edwards was a distant third.

When second and third choice votes are taken into account, Senator Obama squeaks out a win over Senator Clinton. Senator Edwards and Governor Bill Richardson makes strong moves, however, with Senator Edwards coming in just ahead of the Governor. Governor Richardson seems to impress more people than are voting for him. One supporter of Senator Clinton said, “I think Richardson is being overlooked. His … national experience would be a BIG help should he be elected.” Is this the start of a Clinton/Richardson boomlet? (Probably not, but I though it was interesting.)

Good news for the GOP: When asked if, and who, Democrats would support among the Republicans, the majority said yes. Of these, Senator McCain edges out Mayor Giuliani followed, at a distance, by Representative Ron Paul.

Independents: Those who identified with neither major party got to select their preferences among all the GOP and Democratic candidates. Senator Obama was the clear winner here.

The Issues: When asked what “the two most important issues you will consider in determining which candidate to support for president,” survey participants cited the Economy as their most important issue, followed by Health Care Reform and Terrorism/National Security and then Tax Policy. Iraq was on the list, but not as high as in national polls, not suurprising given the subject matter of this blog. When second choices taken into account, the standings don’t change, but the Economy moves even further ahead while Iraq gets closer to the pack. Yet, the comments would indicate that all of these issues matter. As one respondent put it, “So which one do you pick? Holy cow!! Most all of them are crucial.”

My thanks to all of you who participated n this survey. We’ll do at least one more as the vote in California approaches.  These polls may not be scientific, but they’re fun!

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Iowa Speaks!

Posted by Alan on January 4, 2008

The voters of Iowa have spoken. What they have to say may not mean much to you, but they certainly mattered to the candidates who spent months and millions trying to persuade voters not only to support them, but to brave the cold and stand around for hours in dozens of town hall like caucus meetings.

For Senator Barack Obama and former Governor Mike Huckabee it was a good day. Coming in first, by definition, is a good thing.

The key message for Democrats is that their constituency wants change. For Senator John Edwards it had to be frustrating to position yourself as the fighter for change and then to watch Senator Obama claim the change crown. But that’s what happened according to the CNN entrance survey of participants in the Democratic caucuses, 51 percent of those who stated the quality they were most looking for in a candidate was the ability to bring about change voted for Senator Obama. My guess is that Senator Edward’s extreme rhetoric worked against him and for Senator Obama.

Many voters are tired of the attack politics that is business as usual in Washington. It’s one of the reasons Congress is held in even lower esteem than President George W. Bush. House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid promised to change the tenor of the debate in Washington. They failed.

I believe most Americans want leaders who will build solutions, not tear down opponents. Seeking the mantle of Change Agent in Chief while promising to make Washington even more partisan and vicious, as Senator Edwards did, is counterproductive — at best. All he did was emphasize how much of a change the more open and inclusive style of Senator Obama would be. No wonder Senator Edwards earned only 20 percent of the vote from those whose top concern was bringing about change.

Senator Hillary Clinton had a rough night, too. Now she has to pivot from a campaign based on the inevitability of her nomination to demonstrating that she has the experience to implement the change that Senator Obama promises. Not an easy sell, but her campaign is very capable. It’s far too early to count her out.

By the way, expect both Senators Clinton and Edwards to claim second place. According to CNN, when the dust settles, Senator Edwards will have gotten a few more votes, but Senator Clinton will get 15 delegates to his 14 — compared to Senator Obama’s 16.

When asked by CNN for their top issue, health care was cited by 27 percent of those attending the Democratic caucuses, behind the war in Iraq and the economy (each mentioned by 35 percent of the voters).  Of those citing health care as their top issue, 34 percent said they were voting for Senator Obama, 30 percent for Senator Clinton and 27 percent for Senator Edwards. These numbers are so close it’s unlikely to have made much difference in the outcome. These results also reflect the narrow differences in the health care reform plans offered by the three front runners.

The CNN survey of Republican caucus goers indicate a different dynamic was at work there. First, the candidate leading in national polls, former New York mayor Rudy Giuliani didn’t campaign in Iowa. This left the field to former Governors Mitt Romney and Mike Huckabee with former Senator Fred Thompson and Senator John McCain fighting it out for a relatively distant third place finish (and it looks like Senator Thompson won the consolation prize by a hair).

The candidates views on God seemed to be the big issue for those showing up at the GOP caucuses. According to the CNN’s entrance poll,  77 percent of those attending the Republican caucus stated that the religious belief of the candidates mattered a great deal (36 percent) or somewhat (31 percent) in their decision. Only 15 percent of Republican caucus participants said the candidate’s religion didn’t matter at all. Of those who said it mattered a great deal, 56 percent said they’d be supporting Governor Huckabee. Only 11 percent said they’d be supporting Governor Romney — the same percentage that professed support for Senators McCain and Thompson.

When it came to specific issues, the top issue for 33 percent of the Republicans was illegal immigration, followed by the economy (26 percent), terrorism (21 percent) and the war in Iraq (17 percent). Health care reform didn’t make the list. A plurality of the voters citing each of these four issues as the most important to them said they’d be supporting Governor Huckabee.

What to make of the Iowa results?

  1. The expectation for Governor Huckabee and Senator Obama going into New Hampshire’s January 8th primary have gone up considerably. And it’s always a bad thing when a candidate fails to meet expectations.
  2. Coming in first in Iowa will give their war chests a nearly immediate infusion of cash (actually, credit card and Paypal donations). The Internet enables candidates to harvest contributions at speeds unfathomable in prior elections. More money will make it a bit easier for them to meet expectations. But as Governor Huckabee demonstrated to Govenor Romney, money doesn’t always translate into votes.
  3. Iowa will become yesterday’s news as soon as the New Hampshire polls close. Whatever happens there will serve as the context for the next news cycle.
  4. Perhaps most meaningful to regular readers of this blog, and as predicted here earlier, health care reform is unlikely to be a decisive factor in the primaries.

Roughly 340,000 residents of Iowa have now shaped the 2008 presidential election (that’s roughly the size of the city of Santa Ana). Now you can, too, by participating in the Alan Katz Health Care Reform Blog Unscientific Presidential Survey #1. I hope you’ll take a couple of minutes and participate. 

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Health Care Reform and Iowa

Posted by Alan on January 3, 2008

With Iowans going to caucus today it’s tempting to write about how this marks the beginning of journey toward national health care reform. Unfortunately, that’s not the case. The impact of Iowa on the health care reform debate will be minimal. To be sure, there will be exit polls parsing the issues that matter to voters (health care will be high on the list). In reality, however, the positions of the candidates within each party are too similar to be sway many voters one way or the other.

On the Democratic side, the health care reform plans outlined by Senators Barack Obama and Hillary Clinton, former-Senator John Edwards, and Governor Bill Richardson are fairly similar. They all seek to reduce the uninsured through expansion of public programs. They all have cost containment provisions. The only differences are that Senator Clinton and Senator Edwards would require all consumers to obtain coverage. Senator Obama focuses more on affordability issues and Governor Richardson’s proposal avoids the creation of new bureaucracies.

On the Republican side Senator John McCain, former-Governors Mitt Romney and Mike Huckabee, and former-Mayor Rudolph Giuliani all seek to increase the number of Americans with medical coverage through tax incentives and fewer restraints on the private sector. Even Governor Romney has backed away from the heavy government role he championed in Massachusetts.

Once the general election is engaged the differences between Democrats and Republicans on health care will move front and center. That’s then. For now, even though voters are concerned about the issue, it won’t greatly impact the results coming out of Iowa.

There will be one interesting dynamic to watch, however. In Iowa, independents can choose to attend the caucus of either party. If exit polls show unaffiliated voters made their choice of caucus because of a candidate’s stand on health care reform it would provide important insight on which party’s approach is resonating with swing voters. 

That today’s caucuses in Iowa are unlikely to provide much insight into voters thinking about health care reform doesn’t make them any less interesting. They kick off the most unusual presidential election in generations. For the first time since 1928 no sitting president or vice president is on the ballot. Then there’s the sheer number of possible “firsts” we may witness. Senator Clinton could be the first woman president? Senator Obama could be the first African American to hold the office? Governor Romney is seeking to be the first Morman elected president and Mayor Giuliani wants to be the first Italian chief executive. The list goes on, but you get the idea.

And think of the possible match-ups in November. The nominees could both be New Yorkers (Senator Clinton and Mayor Giuliani). Far more interesting would be having the Republican most willing to work with Democrats (Senator McCain) facing off against the Democratic most willing to work with Republicans (Senator Obama). Then there would be the most ironic match-up: Governor Romney versus Senator Edwards — two wealthy, out-of-office white guys with perfect haircuts.

Iowa matters — just not so much concerning health care reform. Regardless of the match-up the next 11 months will be exciting. OK, not if we get stuck with Romney versus Edwards, but let’s hope it doesn’t come to that.

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