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Presidential Candidate Clinton Unveils Health Care Plan

September 17, 2007 at 6:15 PM EDT

GWEN IFILL: Now, the rise of health care as an issue in the 2008 election. Today, it was Hillary Clinton’s turn.

Senator Hillary Clinton returned to the scene of her biggest political defeat today, unveiling a long-awaited universal health care plan.

SEN. HILLARY CLINTON (D), New York: I believe everyone — every man, woman, and child — should have quality, affordable health care in America. Americans are impatient. We’ve seen that doing nothing makes the problem worse. We’ve gone from 39 million uninsured in 1994 to 47 million today.

GWEN IFILL: The price tag attached to Clinton’s ambitious plan: at least $100 billion a year. Every American would be insured through a mix of public and private coverage. Employers would assume much of the burden, either by offering employees private insurance or contributing toward their coverage. Insurers would also not be allowed to deny coverage because of preexisting conditions.

Hillary Clinton has been here before. In her husband’s first presidential term, she authored a massive 1,300 page health care reform plan that failed.

SEN. HILLARY CLINTON: This is a crucial moment in the fight for health care reform in our nation.

GWEN IFILL: The proposal, dubbed Hillarycare by opponents, became a symbol of bureaucratic overreach that has dogged the New York senator ever since. Today, she said she still bears the scars from that losing fight.

SEN. HILLARY CLINTON: And perhaps more than anyone else, I know just how hard this fight will be, but that is why I’m running for president. Today’s plan is simpler, yet still bold. Now, I know my Republican opponents will try to equate health care for all Americans with government-run health care. Well, don’t let them fool us again. This is not government-run. There will be no new bureaucracies.

GWEN IFILL: Other candidates today were quick to criticize. Republican Mitt Romney, who signed a bill approving universal coverage in Massachusetts, posted a video on YouTube.

FORMER GOV. MITT ROMNEY (R), Massachusetts: In her plan, it’s crafted by Washington, it should be crafted by the states. In her plan, we have government-Washington-managed health care. Instead, we should rely on the private markets to guide health care.

GWEN IFILL: Former New York Mayor Rudy Giuliani said the plan “includes more government mandates, expensive federal subsidies, and more big bureaucracy.”

Democrats weighed in, too. Illinois Senator Barack Obama reminded voters of the earlier Clinton plan, saying in a statement, “The real key to passing any health care reform is the ability to bring people together in an open, transparent process.”

And Democrat John Edwards said Senator Clinton’s plan didn’t go far enough. “The lesson Senator Clinton seems to have learned from her experience with health care is, if you can’t beat them, join them.”

Early polls show that many voters consider health care the most important issue of the 2008 campaign.

Another try at health care

GWEN IFILL: Now to decipher the Clinton plan, as well as the politics of health care this year, we turn to NewsHour health care correspondent Susan Dentzer and Karen Tumulty, national political correspondent for Time magazine.

OK, Susan, you're here to translate for us. Let's try. How different -- she was the last one out of the box of all of the major candidates with a health care plan. How different is what she's proposing from what others have said?

SUSAN DENTZER, NewsHour Health Correspondent: Actually, Gwen, the parallels to the other plans are striking, not just to the other Democratic plans, but also to some of the really high-profile state proposals that have come out recently from Massachusetts, which now, of course, is in law, and California.

In fact, I talked with John Edwards' people today. They were almost in shock at how parallel her plan was to what he had announced.

If you look at shared responsibility, the theme of having an employer mandate, businesses over a certain size -- undetermined as yet what size -- having to contribute to coverage, also an individual mandate requiring individuals to have coverage, those are part and parcel of some other plans.

If you look at the notion that she's set forth of having a big health insurance purchasing pool that is modeled after the Federal Employees Health Benefits plan -- that's the way 8 million federal workers and dependents get their coverage, including members of Congress -- opening up that pool so that others can buy into it or creating a pool very much like it has been a feature of many plans. Bill Richardson has talked about it.

Some viewers may even remember that Republicans in the late '90s were talking about remaking Medicare along those very lines. So those are very -- those are very important parallels to both previous ideas, as well as current ideas.

GWEN IFILL: Let's go back to the '90s. How different is this plan today from what she was peddling or pushing or selling in 1993-'94?

SUSAN DENTZER: Some features in common, again, an employer mandate, the notion of a purchasing pool, although, in those days, in '93 and '94, the Clintons were talking about purchasing alliances being created around the country, some commonalities in terms of substance, but very, very different in the themes, for example.

Just the name, America's Health Choices. This is aimed right at the fact that there may be 47 million Americans without health coverage, but there are 250 million Americans with coverage who are very worried about losing it and were very worried in '93 and '94, when the specter was created of a government takeover of health care, that would take options away from people. Now the notion is to give people as many choices as possible, and that's one of the important themes that the Clinton campaign was stressing today.

GWEN IFILL: Those Thelma and Louise -- not Thelma and Louise -- Harry and Louise ads from 15 years ago.

SUSAN DENTZER: Harry and Louise.

Few differences among plans

GWEN IFILL: OK, Karen, so what was the political impact today? We saw some of the comments, some of the predictable criticism. What else?

KAREN TUMULTY, Time Magazine: Well, Susan is right. You could really almost see Hillary Clinton maneuvering around all the landmines that did her in, in '93 and '94, chiefly telling people, "You got health care you like? You can keep it."

And the fact that there are so few differences between her health care plan and the other Democratic candidates, hers is almost identical to John Edwards'. The only thing that's really different between hers and Barack Obama's is that hers require that individuals who don't have health care, go out and get it.

So what you've heard today was that the candidates were arguing less about the substance of the plan than the person who would be implementing it, who the messenger is, who has the credibility to actually make this happen. Hillary Clinton said change is just a word unless you have the strength and experience to get it done. Barack Obama is saying, no, for this to actually happen, you need somebody who will do it transparently and bring people together. They're now arguing...

GWEN IFILL: Hint, hint, harking back to...

KAREN TUMULTY: Exactly, precisely.

GWEN IFILL: But what is it that they can do -- they've seen this coming for a long time. They've all had their plans on the table. I think Edwards was in February and Obama was in May. Now that it's out there, is this something that they are already ready to use as a hammer?

KAREN TUMULTY: I think so. I think so. But at this point, the real -- if you're looking at the substance, the real differences are between the Democrats and the Republicans, because health care has become such a big issue with voters that the Republicans, too, are advancing plans. And theirs rely primarily on tax breaks and market incentives.

It's very ironic that Mitt Romney is distancing himself not only from Hillary Clinton's plans, which has almost all the same moving parts that he signed into law in Massachusetts, but even from his own Massachusetts plan.

GWEN IFILL: I have to ask you, why is it that Republicans are attacking Democrats at this stage before the first primary votes have been cast?

KAREN TUMULTY: Because at this point, these are the moments, these are the times when you frame the race, and this is going to be a very long and difficult race, and also Hillary Clinton on health care is a very easy target for any Republican. That's why we kept hearing them say over and over today, not just Mitt Romney but Rudy Giuliani, this is just Hillarycare all over again.

Requiring individual insurance

GWEN IFILL: We have heard this plan described as based on individual mandates. Now, what does that mean? Individual makes it sound like you have a choice, but mandate makes it sound like someone is making that choice for you.

SUSAN DENTZER: No. In this case, it really is just a requirement that individuals buy insurance, much the way people are required, if you own a car, to have auto insurance. And that was a feature, for example, of the Massachusetts plan that, as Karen says, Mitt Romney has now been somewhat distancing himself from.

It's really a notion that, unless you require individuals to buy coverage, you really can't get to universal coverage. Many people will make the choice to go without coverage, it's so expensive, but usually they'll end up in an emergency room and getting treatment, at which point the cost of that is shifted back to all the people who did buy coverage.

So unless you're going to somehow require people to have coverage, you'll get these so-called free riders in the system. It will drive up costs for other people, and you won't get all the way to universal coverage. And that's what the individual mandate is about and every plan that has put it in place.

GWEN IFILL: Is it just me or does it seem that the argument last time was about the notion, the very notion of universal health care coverage and whether that was a good idea, and that this time everyone seems to agree it's a good idea, it's how you implement it?

SUSAN DENTZER: On the Democratic side, everybody agrees it's a good idea. On the Republican side, I think there's still lots of debate. If there weren't debate, they would not be talking about primarily market-based approaches and not using -- as they are not using -- any of the m-words.

No employer mandates have yet surfaced from the Republican plans, no individual mandates. So I think the Republicans are a long way from saying, "Everybody in the United States has to be covered." Currently, the Democrats do agree about that.

KAREN TUMULTY: I think that, too, goes to what has changed since '94. The problems have gotten worse. The number of uninsured has grown. The costs are going up so fast that now it's the business community that has joined in demanding some kind of health care reform. That is why it's incumbent on Republicans to have some sort of solution out there, as well.

Waiting to get out a health plan

GWEN IFILL: Senator Clinton mentioned today that, for a first time, the Service Employees International Union and Wal-Mart are on the same side of this debate. But the question is whether, by having to get inevitably into this fight, Senator Clinton is now -- it enhances her strength -- she's been leading in all the polls -- or it showcases a vulnerable spot that people can slide in and go after her?

KAREN TUMULTY: You know, I think by waiting and coming in after the other two leading Democratic candidates have put their own plans on the table, she has tried to insulate herself from precisely that kind of criticism, and I think that it was a cautious move and probably, ultimately, a smart move.

Don't forget, when Bill Bradley in the 2000 campaign put out a very detailed health care plan, Al Gore came after him, and that became one of his primary selling points at the end of that primary campaign, was pulling Bill Bradley's plan apart. Hillary Clinton has waited until everyone else is already out there with one.

GWEN IFILL: So ideas sometimes get you beat. Is that what happens here? Are we finally going to see the great big health care debate we've all said, we always say is going to happen?

SUSAN DENTZER: I think certainly we'll hear more and more about it, and particularly on things that have nothing to do with financing health care. There's a lot of agreement, also, on the fact that the delivery system of health care in America is in big trouble and that there's a lot we can do that's really not potentially politically motivated to improve the quality of care.

You're going to hear much more about that, both from, I think, from all sides, as people recognize that, to make health care more affordable and efficient in this country, a lot has to be done.

GWEN IFILL: Susan Dentzer, Karen Tumulty, thank you both.

SUSAN DENTZER: Thanks, Gwen.