Throwback to 1993? What's New About Democrats' Health Care Plans

Extent of Government Involvement

The complex structure of the Clinton plan involved close government involvement in the health industry. In brief, the plan packed public organizations under the umbrella of health care alliances. A federal national health board would have overseen the health system, and would be tasked with regulating premiums and overseeing benefits. Health care alliances at the state level would conduct a similar task, and states would have had the authority to regulate plans and have the option to create a single-payer system. The plan was widely panned as a government takeover.

Today, Democrats have been firm in saying that those who have private insurance will be able to keep it. The HELP Committee and House Democrats' plan includes the idea of a "public option," a government-run insurance plan that would compete with private companies. Obama has favored this approach, although he has left the door open to alternatives. Republicans have vehemently opposed the idea of a government insurance plan, saying it would stifle competition and the private market.

Some moderate lawmakers, such as Sen. Olympia Snowe, R-Maine, have suggested a "trigger" mechanism by which government-run insurance would come into play in areas where the private industry does not provide affordable, accessible coverage to Americans within a certain time frame. Democratic critics of that idea say that proposal in effect kills the option altogether and simply pushes back the debate.

Baucus' plan -- keeping in mind that a public option may not get ample votes in the Senate -- suggests the creation of health care cooperatives -- member-owned, nonprofit firms.

Medicaid and Medicare

The Clinton administration's plan was to incorporate Medicaid recipients into the mainstream health care system, and enroll patients on that plan into the mainstream. It also planned to cut Medicare and Medicaid costs by cutting payments to doctors and hospitals.

Sixteen years later, Democrats are looking to cut costs in those two programs by scaling back on inefficiencies, but at the same time, expanding coverage, a contentious point for some Republicans.


The idea that health care costs are too high and reform is needed hasn't changed in the last decade and a half. Most people acknowledge that health care -- the largest single expense for the U.S. government -- needs changes and cost cuts in the long term.

But confusion remains as to how the federal government would pay for a massive overhaul.

The Clinton administration argued, and Obama has used today, is that reform would reduce inefficiencies in the current system, thereby cutting costs in the long term. It identified savings by cuts in Medicare, Medicaid, integrating federal employees into the new system, reducing tax-free health benefits, and "sin taxes," namely a 75 percent per pack cigarette tax and a 1 percent tax on those businesses that chose to form alliances for health coverage. Obama's mention of a similar "sin tax" on soda has invited backlash.

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