How could the Bill Clinton administration have passed healthcare reform in the 1990s? Bonus points if the PoD is after the 1992 US election and Clinton serves his OTL term as President. It doesn't have to be the OTL Hillarycare proposal or Hillarycare, but it does have to be major healthcare reform. One possible way could be for it to be passed under budget reconciliation as the GOP is trying now IOTL, however given the OTL budget barely passed that may not work. What do you think could be a suitable PoD? What would be the effects if healthcare reform passed? Would the 1994 Republican Revolution be avoided? What if?
 
Hmmm...Honestly, I think that kind of thing would probably occur after the 1994 midterms. Of course, to have it succeed, you'd need to avert the Republican Revolution. As for how to do that...Scandals are always fun. Maybe Newt Gingrich's affairs come out ahead of schedule? The Democrats would still lose seats, and probably lose the majority, but it'd hopefully be a narrow loss.
 
Avoid having Hillary be involved with it, to begin with. That played poorly, no matter how it was intended or if that was fair or not.

Try and avoid the big government narrative and present a plan better equipped to deflect that.

Be willing to accept an incremental bill you get through as a compromise, once you've played it well enough that it's more politically palatable.

Get really lucky.

I honestly don't think the ground was quite ripe for healthcare reform in '93, plus things happening around the same time conspired against it.
 
I lived in PA back then. Ironically, Wofford bashed Thornburg for wanting to tax insurance that was"too good". Now the Cadillac tax is part of the ACA.
 
. . . Be willing to accept an incremental bill . . .
I think medium step is absolutely the way to go.

Go with what's already pretty good. So, extend Medicare from age 65 down to age 55. People this age have heard from friends and co-workers enough stories of people having a heck of a hard time getting another good job in this age bracket.

And be quite open and above board and tell people, we demonstrate that this works, and of course we're going to improve Medicare at the same time, we'll going to next extend it to children 0-18. And once this works, to all adults.
 
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I think it had to be completely changed from its original format. It's got to be a lot more business friendly. Maybe a mixture of tax write-offs, the government supplementing costs for employers, and malpractice reform.
 
If Bill Clinton had pointed to every other developed nation having it, de-emphasized various "communitarian" rhetoric when proposing it and keeping Hillary from having any public/visible role it would have passed easily.

You still lose congress in 1994, but the new healthcare system survives with the occasional expansion or tinkering in later years.
 
Clinton was popular when first elected Nov. '92, and people had high hopes when he was inaugurated Jan. 20, 1993, particularly that he would effectively push for legislation to re-build middle class jobs, and see that the economy would work better for those playing by the rules, and not just reward investment bankers and those doing leveraged buy-outs (not sure whether Clinton specifically criticized those aspects of the casino economy by name)

1) These are just very hard problems. Manufacturing jobs have been lost because a number of other countries have gotten good enough at manufacturing, and there hasn't been a large enough number of other good-paying jobs to take their place.

2) Clinton drained away too much momentum because his healthcare reform proposals were just too damn complicated, and I don't think the average full-time office holder fully appreciates how much this aspect sticks in the craw of the average citizen.
 
In OTL, Clinton started his presidency with a Democratic House and 57 seat majority in the Senate. If is Jesse Helms goes down in 1990, and the GOP loses a couple more seats in 1992, that will give Denocrats technically just enough votes to push past fillibusters.

I say "technically", because Blue Dogs were still a sizable part of the party back then; but at the same time, so were Moderate Republicans, including Senate leaders like Bob Dole and Alan Simpson. Taken together, I'd say this means the GOP is most likely going go push their own version of HCR (see the Dole-Chafee Bill) rather than obstruct everything.
 
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I don't really know much about the topic, but maybe Clinton focuses on providing healthcare to under eighteens by expanding Medicare, allowing them to get free vaccinations, health checks etc, so it looks more minor and less comprehensive, and maybe tackling pre-existing conditions by forcing insurers to cover those people.
 
I think it had to be completely changed from its original format. It's got to be a lot more business friendly. Maybe a mixture of tax write-offs, the government supplementing costs for employers, and malpractice reform.
Are you familiar with Clinton's OTL proposal in detail, or just making assumptions about what it must have been?

Can any health care reform that results in more care for more of the public without bankrupting working wage individuals and families ever appear to be "business friendly?" It is of course necessary for someone to pay for a more comprehensive system. It is possible that with a more comprehensive system, people take better preventative care of themselves thus lowering overall costs, but it seems frankly silly to bet that way--in reality, people are not going to take good care of themselves if they aren't already, and so either Healthcare Reform is a scam, or it costs a lot. If the burden is not put on the rich, then it will fall much too heavily on the working classes who are already marginal.

So first of all, HC costs money, the burden of the cost needs to be put on the rich to be acceptable to the majority, and anything that costs the rich money is automatically called "bad for business."

On the other hand, depending on the details of the proposal, it would be quite possible for such a reform to be very very business friendly in an objective sense while also serving the public well. Consider a straightforward form of Single Payer--Uncle Sam expropriates the entire health insurance industry (AAAH! Business-unfriendly! Think of the investors!) but with compensation (Aaah...how much? and on what time table? with what funds) and using the data from all the various private insurance policies, conferring with the medical profession to determine fair and sustainable rates for procedures, calculates what full coverage available to everyone would cost, and legislates to add that to the annual income tax, so that poor workers pay little or nothing of it, and the rich pay the larger share (BUSINESS UNFRIENDLY!!11!!). Now every citizen is entitled to drop into any medical facility and announce they'd like to be examined and treated. But who wants to be sick? People will only do this when they feel a need, or because they are told come back in four months, or something like that; hospitals and clinics can refuse all but emergency services. A health care professional who does something they are licensed to do documents it (as they would for responsible medical record keeping anyway, or for applying to private insurance) and sends the bill to the Federal payer, which verifying the procedure was legitimate and was done, promptly pays the standard amount for that work.

The upshot is, people have universal and automatic coverage; they may or may not be given the procedures they think they want, but if not it will be because responsible medicine does not deem it necessary. If they do, they get it for free except in the sense they pay their fair share through income taxes. But coverage is decoupled completely from everyone's employment; it does not matter if you are an executive pulling in millions in salary a year or unemployed, your doctors and nurses and therapists get paid the same for the same services. Therefore it is not any long any company's business, big or small, to handle their employees's health policies. Health benefits have nothing to do with one's job any more.

That removes a burden from corporate management even for the biggest businesses. It is no longer a tradeoff between paying more in health benefit costs versus having a sicker workforce.

For the small businessman--and politically speaking, the politicians who scream about a policy or law or program being "Business Unfriendly" are just about always pretending that it is the small businessman who is their concern; whose heart bleeds over General Motors or IBM?--it is a complete boon. On their scale of operations the tax bite is unlikely to hurt them, certainly not more than the cost of private insurance would, but their employees and prospective hires--and customers for that matter--all have their health costs covered without bothering himself. He can focus on business practice, not have to choose between being forced to hire people in desperation due to zero coverage or paying costs big companies with good connections as well as economies of scale can afford he cannot.

The bottom line--while I can agree it is smarter to shape realistic policies for the USA in terms of due attention to the actual needs of business, we can hardly trust that whatever party is screeching that their opponent's policies are "unfriendly to business" is telling the simple truth either. Fact is, it might be a matter of good policy demanding that business pay to play in the USA, or it might be very beneficial to some business sectors while on the whole burdensome to others. But if the latter who are so "unfairly" burdened now have in the past benefited from policies that unfairly burdened say the small business sector while benefiting them, perhaps this is merely rebalancing the scales.

Anyway I admit to having a tin ear for what might be actually business unfriendly, for them having deafened us with a thousand cries of "Wolf!" while they themselves are the wolves.

So--how exactly was the '94 "HillaryCare" proposal unfriendly to business? Was it in fact the simple matter that any means whatsoever of benefiting people who were getting nothing under the existing evolved system would be costly to everyone and business did not want to bear any of the burden? Was the burden unduly high and unduly shifted onto the rich--and if so, did this come close to offsetting the way these same classes had been benefiting from lowered burdens and rising benefits at the expense of the larger public since the Reagan administration began? Was it organized in a silly way that was unnecessarily destructive of industry?

Funny thing though, at the time I recall progressive critics stating that the whole plan was to enshrine HMOs and force everyone to join one, much as modern HCA requires everyone to sign up with some private insurer or other. Both HillaryCare and ObamaCare mainly suffer from seeming to care more about guaranteeing corporate profits that actual healthcare. In which case I might suggest, the only thing "unfriendly" to business about Hillary's scheme might have been that the benefits to private sector owners were not even larger than she was offering. It might have been better for the public not to pass it than to do so.

I don't know, I am not knowledgeable of the details as you implicitly claim to be by describing it as you do, "not business friendly." Perhaps you can share this expertise by spelling out how it so failed, and illustrate what would have been feasible that would be business friendly instead. Would not a properly business friendly program result in higher costs and less benefit for the general public? Or can you show a win-win?

I figure HillaryCare would have been a mixed bag, probably tilted too far in the direction of mollifying and gratifying the investors in the existing badly functioning health system, less beneficial than the same overall tax burden could deliver via simple Single Payer, but better for many people than the regime before, that we were forced to live with until 2010.

My belief with radical programs like providing National Health is that more is more, that when the public gives a populist a mandate like this they should jump on the back of the establishment with all their weight and grab as much as possible, and the more sweeping, drastic and prompt the change the more that politician can count on popular support at the polls next election. But of course pissing off the money people is always dangerous.
 
Maybe Clinton tackles Welfare Reform in 93 instead, making it better than the reforms of OTL and taking a major issue away from the GOP in 1994. The Dems would lose seats, but would probably maintain the majority in both houses. Then maybe in 95, 96 or 97 he tackles Healthcare reform and does it with the input of Congress.
 
So first of all, HC costs money, the burden of the cost needs to be put on the rich to be acceptable to the majority, and anything that costs the rich money is automatically called "bad for business."
Point very well taken. Health care is expensive.

If we're going to expand care to under 18, well, in real life CHiPs kind of worked. Now, it was a new program which was taking a chance. Maybe it could have instead been part of Medicare.
 
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Point very well taken. Health care is expensive.

If we're going to expand care to under 18, well, in real life CHiPs kind of worked. Now, it was a new program which was taking a chance. Maybe it could have instead been part of Medicare.

But still the problem has to be addressed somehow, someday. (BTW, you somehow got a quote of me under the label of dw93, I can't guess how). Cutting off support at age 18 strikes me as something reactionaries can parley into limiting their liability--"we take care of kids, make sure they have a fair start in the world with public education and public health--then the little brats are on their own to sink or swim based on how much money they can make, and whether they can learn to spend it wisely!" It certainly would be better to have standard levels of care for all children, and it helps their parents if that relieves their budgets a bit. But it is also easy to draw the hard line there and shrug off what happens to the majority of adults. Perhaps that is politically sustainable indefinitely, in which case we can expect very large numbers of adults who have essentially nothing. Some of these will be judged disabled enough to be exempt from the workforce (more than would be the case if everyone were taken care of to be sure!) and they fall in the same category as the children do perhaps. But this probably means that the working classes, not the rich, will be hit up for the considerable cost of caring for their own children and disabled, collectively instead of individually, via Social Security type payroll taxes and regressive state taxes. The watchword among the politicians openly serving the "business-friendly" mentality is after all to prevent wealth redistribution (overlooking that wage work amounts to massive wealth redistribution,any upward, a process the 'pro-business' crowd will accelerate where they can) and therefore the working classes, including the middle classes, will be forced to pay for any benefits any of them get--meaning it amounts to collective payment for the children and disabled, with the profit-taking sector being exempted for the most part.

And it may be politically sustainable because the experience of the working classes would be that redistributive health care seems quite expensive to them, a burden they must shoulder to be sure for the sake of the children and disabled-but not one they can contemplate being expanded. That the source of funds for covering them as well as their children should be drawn from another class is not something that will be easy to say or hear in the USA.
 
. . . And it may be politically sustainable because the experience of the working classes would be that redistributive health care seems quite expensive to them, a burden they must shoulder to be sure for the sake of the children and disabled-but not one they can contemplate being expanded. . . .
And this might be something Democrats and Republicans contend over, with most Democrats saying up to age 18 is merely a sensible medium step towards expanding Medicare, and most Republicans saying, no, it shows that we can just barely afford it as it is. And this political struggle could play out in different ways.

And on taxes, something Warren Buffet said may come into play earlier than in OTL. Warren said, Why am I paying a lower tax percentage than is my administrative assistant? It's because his income is taxed at the lower capital gains rate while his administrative assistant has their income taxed at regular rates for ordinary income. Now, some conservatives will defend this by saying, the income is already taxed the first time when you make it, it shouldn't be taxed a second time as you make money by investing. Even though you're only taxed on the dividends and the growth and not the principal, I guess the conservatives do have some point, although I'm not sure it's enough to carry the day.

Lower rates for capital gains was not part of Reagan's 1986 Tax Reform Act. And this was also advocated by Democratic Senator Bill Bradley as part of an overall strategy of, fewer loopholes and lower rates. I think favorable treatment for capital gains was re-introduced in a bill signed by Bush, Sr., sometime around 1991.

And of course the best solution is for Bill Clinton to do what he was kind of elected to do, which is to grow the number of middle-class jobs.

PS And sorry about my mistake with the edit.
 
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Have the Republicans offer up what would essentially be the OTL Affordable Care Act as a bipartisan compromise.

The only way I see it working is an "only Nixon could go to China" type of compromise. Well that or the Dems in 1993/1994 figuring that they're humped in the 1994 midterms anyway, so decide to just go for broke on Medicare for All anyway.
 
Alternate 1994 midterms if Hillarycare is successful.
1994 Senate elections
Tom Daschle-Democratic: 50-6 47.5%
Bob Dole-Republican: 50+6 46.4%
100 seats
51 for majority

Minnesota: Ann Wynia(DFL) defeats Rod Grams(R)
Pennsylvania: Incumbent Harris Wofford(D) defeats Rick Santorum(R)

It is unclear if Campbell and Shelby will still defect TTL.

1994 House elections
Tom Foley-Democratic: 237-21 48.3%
Newt Gingrich-Republican: 197+21 48.4%
435 seats
218 for majority

Arkansas 4: Jay Bradford (D) defeats incumbent Jay Dickey (R)
California 1: Incumbent Dan Hamburg (D) defeats Frank Riggs (R)
California 22: Walter Capps (D) defeats Andrea Seastrand(R)
California 49: Incumbent Lynn Schenk (D) defeats Brian Bilbray (R)
Connecticut 5: James H Maloney (D) defeats incumbent Gary Franks (R)
Georgia 7: Incumbent George Darden (D) defeats Bob Barr (R)
Indiana 8: Incumbent Frank McCloskey (D) defeats John Hostettler (R)
Iowa 4: Incumbent Neal Edward Smith (D) defeats Greg Ganske (R)
Kansas 4: Incumbent Dan Glickman (D) defeats Todd Tiahrt(R)
Kentucky 1: Incumbent Thomas Barlow (D) defeats Ed Whitefield (R)
Maine 1: Dennis L Dutremble (D) defeats James B Longley Jr(R)
Massachusetts 6: John F Tierney (D) defeats Incumbent Peter G Torkildsen(R)
Nebraska 2: Incumbent Peter Hoagland(D) defeats John Lynn Christensen(R)
Nevada 1: Incumbent James Bilbray (D) defeats John Ensign (R)
New Hampshire 2: Incumbent Dick Swett(D) defeats Charlie Bass (R)
New Jersey 8: Incumbent Herbert Klein (D) defeats William J Martini (R)
New York 1: Incumbent George Hochbruckner (D) defeats Michael Forbes (R)
North Carolina 3: Incumbent Martin Lancaster (D) defeats Walter S Jones (R)
North Carolina 4: Incumbent David Price (D) defeats Fred Heineman(R)
Ohio 6: Incumbent Ted Strickland (D) defeats Frank Cremeans (R)
Ohio 19: Incumbent Eric Fingerhut (D) defeats Steve LaTourette (R)
Oklahoma 2: Virgil R Cooper(D) defeats Tom Coburn (R)
Oregon 5: Catherine Webber(D) defeats Jim Bunn (R)
Pennsylvania 13: Incumbent Marjorie Margolies-Mezvinsky(D) defeats Jon D Fox (R)
Pennsylvania 21: Bill Leavens (D) defeats Phil English (R)
Tennessee 3: Randy Button(D) defeats Zach Wamp (R)
Texas 9: Incumbent Jack Brooks (D) defeats Steve Stockman (R)
Washington 1: Incumbent Maria Cantwell (D) defeats Rick White (R)
Washington 4: Incumbent Jay Inslee (D) defeats Doc Hastings (R)
Washington 5: Incumbent Tom Foley (D) defeats George Nethercutt (R)
Wisconsin 1: Incumbent Peter W Barca (D) defeats Mark Neumann (R)

1994 gubernatorial elections
Democratic: 26-3
Republican: 24+4

Albama: Incumbent Jim Folsom(D) defeats Fob James (R)
Connecticut: Bill Carry (D) defeats John Rowland (R)
Maine: Joseph Brennan (D) defeats Angus King (I)
New York: Incumbent Mario Cuomo (D) defeats George Pataki (R)
Pennsylvania: Mark Singel (D) defeats Tom Ridge (R)
Rhode Island: Myrth York (D) defeats Lincoln Almond (R)
South Carolina: Nick Theodore(D) defeats David Beasley (R)
 
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