As the chaos continues surrounding implementation of the new healthcare law, the 2014 election campaign begins and jockeying for the 2016 presidential campaign is underway, the two most intriguing political questions surrounding the healthcare law are these:
First, how will Democrats running for the House and Senate in 2014 discuss healthcare during the campaign?
Second, if Hillary Clinton runs for president in 2016, how will she discuss healthcare going into the presidential campaign?
Let me begin with my conclusion. Democrats should not be trapped into defending the healthcare status quo. They should champion and defend the most effective and popular aspects of the law, and champion more aggressively than ever the more progressive (and popular) reforms that should have been included in the reform law but were not.
When the healthcare law was being debated, I believed then, and believe now, that a single-payer system or a robust public option needed to be included to make any reform fully effective. And I believed then, and believe now, that an expansion of the use of generic drugs, or high-quality and low-cost imports of drugs from other nations such as Canada, were also needed to protect consumers and lower costs to government.
As usual in Washington these days, these bold progressive provisions were dropped even by a Democratic president and Democratic Congress with large Democratic majorities. This was a major political mistake, because the public option and similar reforms had strong majority public support, and it was a policy mistake, because it removed low-cost pro-consumer options that would have created alternatives that would have lowered the costs of both insurance and pharmaceuticals.
This is not brain surgery. If mandates forced companies with a certain numbers of employees to pay fines if they do not provide insurance, many companies would limit jobs to avoid the employee threshold that trigger the fines, and would cut hours to avoid the working-hour threshold that trigger the fines. The Obama administration retreat on these provisions was predictable, inevitable and wise.
With the absence of a single-payer system with a public option and lower-cost drug provision, it was also predictable, and inevitable, that insurance premiums and pharmaceutical costs, as well as pain for consumers and the profits of insurance and pharmaceutical companies, would all rise in unison.
I warned Democrats ahead of the 2010 campaign not to be trapped into defending the status quo and treating the healthcare law as a panacea. I offer the same warnings today. The GOP will try to blame Democrats for higher healthcare costs and rising insurance premiums. Democrats should renew the battle for lower costs and lower premiums by championing progressive alternatives.
Enter Clinton. Hillary Clinton has a been a leader in the battle for healthcare reform for a lifetime. As first lady when Bill Clinton was governor of Arkansas and president, she was a true champion of powerful healthcare reform that would serve workers, women, children, the poor and the middle class.
Hillary Clinton as secretary of State could not participate in domestic political debates, but carried her interest and her commitment to better healthcare to the global arena. She has a golden and historic opportunity if she runs for president in 2016, and becomes the most sought-after campaigner for Democrats in 2014, to lead the charge for the healthcare reforms that are most needed by America and most favored by voters.
On healthcare the left was right and the right was wrong. Liberal Democrats were right and corporatist and conservative Democrats were wrong. The people want lower insurance premiums, lower drug costs, better care for women and children, better healthcare for American workers and — yes — lower healthcare costs for business that a public option and lower-cost pharmaceutical choices would create.
Should Democrats support the best aspects of the healthcare law? Absolutely, definitely and strongly.
Should Democrats support the status quo of the current law? Absolutely not. Democrats should run against the status quo. Democrats should run against rising premiums and high drug costs. Democrats should run against Republican war against women’s healthcare programs. Democrats should use the current law as a platform to launch the next great era of healthcare reform.
Most Americans agree with the Democratic wing of the Democratic party on healthcare. Democrats should not retreat; they should advance. Democrats should not be afraid; they should be bold. Who better than Hillary Rodham Clinton to win an FDR-magnitude landslide in 2016 while championing the healthcare reforms initiated by Franklin and Eleanor Roosevelt?
Democrats have nothing to fear by letting the next great healthcare debate begin.
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