The Duopoloy Watch by Steven Jonas, MD, MPH

 

“The Clinton Health Plan (1994), the Affordable Care Act,
GOP Politics, and Chief Justice Roberts”

Dateline: July 8, 2015

At about the time that the Clinton Health Plan was introduced to the Congress in the fall of 1993, through the American Public Health Association I was recruited to be a “Designated Speaker for the Clinton Health Plan.”  Of course, as a left-winger I had been a “Single-Payer” supporter for many years.  Some of my friends and colleagues on the health care field were outraged that I would do such a thing.  But my position was a simple one.  While the CHP was highly complex and hardly perfect, the intent of the Act was to get most U.S. covered by some kind of health insurance in a fairly highly regulated system.  A simple, government-run, single-payer system, it wasn’t, but: for millions of U.S. citizens it was far better than what they had (too often, nothing). 

Further, and equally importantly, I felt that it was the only alternative to what was the then-looming total takeover of health care financing by the private, for-profit health insurance companies.  (I must say that I was also pleased that the CHP looked something like a something-short-of-single-payer proposal that I had published back in 1981 [1, 2]. At the same time, I doubted very much that any of the CHP framers had ever seen my fairly obscurely-published proposal.  Certainly, I had received no calls about it.)

It is well-known that the Clintons ran a totally terrible campaign in support of their proposal.  (And P.S., after its defeat the for-profit health insurance industry did take over the U.S. health care financing system.)  Not only did the CHP lose in the Congress, but the Republicans used it politically to take over the House of Representatives in 1994, in what was widely known as the “Gingrich Landslide.”  Little known is that it was hardly a landslide.  Altogether, the GOP candidates for the House took 18% of the eligible vote while the Democratic candidates took 17%.  But how the media handles such events is another story.  Also little known is that the CHP looked remarkably like a plan for National Health Insurance that in 1973 was introduced into the Congress by the then-Senate Minority leader Bob Dole, on behalf of the Nixon Administration. 

On that occasion, Dole gave a speech, the introduction of which, on what was wrong with U.S. health care and what needed to be fixed, could almost have been used to introduce the CHP.  This time around, of course it was Bob Dole who led the successful charge in the Senate against the (very similar) CHP.  I (and perhaps others) attempted through channels, to inform the CHP leadership of this anomaly, but the political point was never taken up by the Clintons.  In fact all through the spring of 1994, as the plan was being hammered by the Repubs. and their allies, by the famous “Harry and Louise” ads and a bunch of other stuff, the CHPers essentially sat on their hands, much to the frustration of those of us who were out in the field trying to promote it.  Why the Clintons did virtually nothing I have never understood.  But why the Repubs. were so totally against it, even though it looked much like the Nixon Health Plan, was very obvious: politics.  Ironically…The ACA (“Obamacare”) is MUCH less ambitious than the Clintons’ 1993 plan.  

In December, 1983, just as the Clintons’ campaign for the CHP was getting underway, Bill Kristol (yes, that Bill Kristol), circulated a FAX (no widely-used email back then) to about 1200 top and (not-so-top) Repubs. around the country. But what route of delivery I have never known, but a copy happened to come across my desk. Kristol made it absolutely clear, briefly and precisely, that the Repubs. had to defeat the CHP, not on the basis of whether it was good or bad for health care in the United States, but for political reasons. If the Clintons were allowed to get the CHP or some reasonable facsimile of it (like the Nixon Health Plan, with which Kristol may or may not have been familiar) into law, he said, the Democrats would be in control of politics in the U.S. for quite some time.  Which brings us to Repub. politics and the Affordable Care Act (the ACA or “Obamacare”). 

The ACA is MUCH less ambitious than the CHP.  Although it has provided health care financing for some several millions of U.S. who did not have it previously (or had totally inadequate insurance), essentially it provides a massive-subsidy/expansion-of-market for the now-dominant, highly profitable, private health insurance industry.  At the same time, it provides another very profitable health care sector, Big Pharma, market protections.  Furthermore, just as the CHP was modeled in part on the Nixon Health Plan, so, as is well-known, the ACA was heavily modeled on “Romney-care” in Massachusetts.  In fact the Obama folks thought that by doing that they might be able to protect themselves from Repub. attacks.  HA!  It happens that among the strongest supporters of the ACA have been the private health insurance industry, Big Pharma, and the big hospital chains, for the most part Repub. supporters.  BUT, don’t you see, the misshapen ACA was being put forth by a Democrat.  Then, the Repubs., in their eagerness to make it totally abominable to their white, racist, “birther” base, hooked President Obama’s name on to it.  And what was it all about?  Politics of course. In America, the eternal game of short-term advantage in a corrupt power system. 

Obamacare (ACA), a new iteration of “Romneycare”, provides a massive-subsidy/expansion-of-market for the now-dominant, highly profitable, private health insurance industry…while also giving Big Pharma substantive market protection.  This is a plan flawed by design. 

Virtually echoing what Bill Kristol had to say in that December, 1983 FAX, (but in more colorful language) at a meeting of right-wing power-brokers at the American Enterprise Institute shortly after the ACA passed in 2010, one Michael Greve, a board member of the Competitive Enterprise Institute (sic), had this to say about it (3): “This bastard has to be killed as a matter of political hygiene.”  Nothing about the nature of the Act, about what it did or didn’t do, about how many, or few, U.S. citizens would get health insurance coverage without making any major changes in the U.S. health care system.  It had to be “dismembered,” “tarred and feathered,” “strangle[d],” (Greve’s words), for political reasons.  Greve’s people then went on to find the famous (mis-drafted) “four words” that almost led to the Act’s undoing before the Supreme Court.  But then the Right-Wing was (seemingly) undone by Chief Justice Roberts. 

Oh, the outrage, the calumny, the threats of impeachment, that came pouring forth from the Repubs. and the Right.  “How could he do such a thing — to us?”  Well, Mr. Greve, et al, the Chief Justice was just playing politics, to the benefit of the Repubs. (see just below).  The Supreme Court playing politics, you ask?  Nah.  Couldn’t be.  Really?  In my last semester at Columbia College in 1958, I took a course in U.S government that focused on the Constitution and the Supreme Court (subjects with which I have been fascinated and have studied ever since). 

The most important book that I read at the time was Nine Men: A Political History of the Supreme Court of the United States from 1790 to 1955, by Yale Law School Professor Fred Rodell (New York, Random House, 1955).  Prof. Rodell clearly established that throughout its history the Supreme Court has been first and foremost a political institution.  Further, as it happens, Prof. Rodell established that for most of its existence its principal function has been to protect the rights of property (p. 78).  The current case for the understanding of the Court as a political institution which for most of it history has defended right-wing interests, is excellently made by Senior Fellow at the Center for American Progress Ian Milhiser’s “Injustices: The Supreme Court’s History of Comforting the Comfortable and Afflicting the Afflicted,” (New York: Nation Books, 2015).

Historically, as a political institution, the chief role of the US Supreme Court has been as a protector of the rights of private property. This has made the Supreme Court a de facto rightwing instrument. 

And so, getting to the politics of his decision, here was Roberts, another in the long string of GOP-appointed right-wing Chief Justices, making a very political decision, on an Act that he was likely very viscerally opposed to (just as he, a very strict Catholic, was obviously viscerally  opposed to legalizing gay marriage across the country).  But on this one, as it happens, even if folks like Greve don’t understand it, the decision vastly benefits the Repubs.  If the obviously Repub. Supreme Court had overturned the law on an obviously Repub.-led challenge to  it, especially using an obvious drafting error to do so, causing millions of U.S. to lose their  [precarious] health insurance, that would hardly stand the Party in good stead in 2016.  At the same time, upholding the Act gives the Repubs. a very clear 2016 target to shoot at.  And, once having recovered their breath, they will.  They are already readying their guns and stock-piling their ammunition.  To which ammunition was added by the current news that because of a variety of features of the Act (which we won’t get into now), for 2016 health insurance premiums are going to sky-rocket. 

Some non-Rightists think that the Court is “moving leftward.”   Un-uh.  When examined closely, both “liberal decisions,” on the ACA and on gay marriage, benefit the Repubs. electorally by giving them, as I said, very clear targets to shoot at.  On the important stuff for the ruling class — the decision gutting the EPA’s role in combatting global warming through controls on burning coal — and to benefit the Repubs. by the gutting of the Voting Rights Act, — they are clearly acting on the reactionary side of the equation.  On these important decisions, once one looks past the surface, there is the Court again, in the words of Ian Milhiser “Comforting the Comfortable and Afflicting the Afflicted.”

 

And so, getting to the politics of his decision, here was Roberts, another in the long string of GOP-appointed right-wing Chief Justices, making a very political decision, on an Act that he was likely very viscerally opposed to (just as he, a very strict Catholic, was obviously viscerally  opposed to legalizing gay marriage across the country).  But on this one, as it happens, even if folks like Greve don’t understand it, the decision vastly benefits the Repubs.  If the obviously Repub. Supreme Court had overturned the law on an obviously Repub.-led challenge to  it, especially using an obvious drafting error to do so, causing millions of U.S. to lose their  [precarious] health insurance, that would hardly stand the Party in good stead in 2016.  At the same time, upholding the Act gives the Repubs. a very clear 2016 target to shoot at.  And, once having recovered their breath, they will.  They are already readying their guns and stock-piling their ammunition.  To which ammunition was added by the current news that because of a variety of features of the Act (which we won’t get into now), for 2016 health insurance premiums are going to sky-rocket. 

Some non-Rightists think that the Court is “moving leftward.”   Un-uh.  When examined closely, both “liberal decisions,” on the ACA and on gay marriage, benefit the Repubs. electorally by giving them, as I said, very clear targets to shoot at.  On the important stuff for the ruling class — the decision gutting the EPA’s role in combatting global warming through controls on burning coal — and to benefit the Repubs. by the gutting of the Voting Rights Act, — they are clearly acting on the reactionary side of the equation.  On these important decisions, once one looks past the surface, there is the Court again, in the words of Ian Milhiser “Comforting the Comfortable and Afflicting the Afflicted.” 

Senior Editor, Politics, Steven Jonas, MD, MPH is a Professor Emeritus of Preventive Medicine at Stony Brook University (NY) and author/co-author/editor/co-editor of over 30 books. In addition to his role with The Greanville Post, he is a Contributor for American Politics to The Planetary Movement, a columnist for BuzzFlash@Truthout, a “Trusted Author” for OpEdNews, and the Editorial Director of and a Contributing Author to The Political Junkies for Progressive Democracy.  Dr. Jonas’ latest book is The 15% Solution: How the Republican Religious Right Took Control of the U.S., 1981-2022: A futuristic Novel, Brewster, NY, Trepper & Katz Impact Books, Punto Press Publishing, 2013, http://www.puntopress.com/jonas-the-15-solution-hits-main-distribution/, and available on Amazon.

References:

1) Jonas, S., “Planning for National Health Insurance by Objective.” Policy Studies Journal, Vol. 9, No. 2, Special #1, 1980-81.

2) Jonas, S., “Planning for National Health Insurance by Objective: The Contract Mechanism,” chap. 8 in Straetz, R.A., et al., Eds. Critical Issues in Health Policy. Lexington, MA: D.C. Heath and Co., 1981.

3) Toobin, J., “Hard Cases,” The New Yorker, March 9, 2015, p. 27)