December 2, 1993: Republican Strategist: Clinton Health Care Plan Must Be Stopped Because Its Success Would Endanger Republican Image Neoconservative publisher and pundit William Kristol writes a five-page memo explaining why and how Republicans can ensure the Clinton administration’s health care proposal fails. The memo warns that if the Clinton health care plan is implemented, and actually improves the lives of Americans, the success of the program would badly damage the Republican Party by improving Americans’ relationship with government. Therefore, the plan must be stopped before it can begin. The memo’s strategy will be used in the powerful “Harry and Louise” media campaign, based on TV commercials featuring an older couple who worry that the program would destroy their relationships with their family doctor. Kristol writes in part: “Passage of the Clinton health care plan, in any form, would guarantee and likely make permanent an unprecedecented federal intrusion into and disruption of the American economy—and the establishment of the largest federal entitlement program since Social Security. It’s [sic] success would signal a rebirth of centralized welfare-state policy at the very moment we have begun rolling back that idea in other areas.… The long term political effects of a successful Clinton health care bill will be even worse—much worse. It will relegitimize middle-class dependency for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.… Its rejection by Congress and the public would be a monumental setback for the president, and an incontestable piece of evidence that Democratic welfare-state liberalism remains firmly in retreat.” In 2009, Washington Post columnist Greg Sargent will note: “Here’s what’s striking about this. Kristol repeatedly says defeating Clinton on health care would deal a death knell to something that at the time already appeared on its way towards extinction—the ‘welfare-state,’ or the idea that government can improve the lives of the middle class. Kristol describes this idea as ‘firmly in retreat,’ in the process of being ‘rolled back,’ in need of ‘re-legitimizing.’ At the time the defeat of health care was viewed as a potential final victory over liberalism.” [Plum Line, 3/2/2009; Politico, 3/2/2009; Plum Line, 3/2/2009] Entity Tags: William Kristol, Clinton administration, Greg Sargent Timeline Tags: US Health Care

Mid-January - February 4, 1994: Lawyer Lambasts Clinton Health Care Reform Proposal Elizabeth “Betsy” McCaughey (R-NY), a lawyer and future lieutenant governor of New York, writes a scathing analysis of the Clinton administration’s health care reform plan. The article, “No Exit,” is published in the New Republic, and sparks not only a detailed rebuttal from the Clinton administration, but numerous editorials and responses praising the article and joining in the attack. Echoing McCaughey’s arguments, Newsweek writes, “The plan would reduce the quantity and quality of health care and medical technologies by vastly expanding government’s coercive role.” McCaughey and Newsweek question the proposed creation of a seven-member “National Health Board” which will, she claims, “guess the nation’s health care needs and decree how much the nation may spend meeting them.” According to Newsweek: “Everyone would be locked into one system of low-budget health plans picked by the government. Fifteen presidential appointees, the National Quality Management Council, not you and your doctor, would define the ‘medically necessary’ and ‘appropriate’ care a doctor could give you. Escaping government control to choose your doctor or buy other care would be virtually impossible. Doctors could be paid only by the government-approved plans, at rates set by the government. It would be illegal for doctors to accept money directly from patients, and there would be 15-year jail terms for people driven to bribery for care they feel they need but the government does not deem ‘necessary.’ Government would define a minimum level of care and herd people in particular regions into dependence on the lowest-cost organization able to deliver that level. Doctors would be driven into organizations in which they would be punished financially for giving more treatment than the organizations’ budget targets permit. The primary care physician assigned to you would be, McCaughey notes, a gatekeeper with an incentive to limit your access to specialists and high-tech medicine. The premise of the Clintons’ plan is not just that government knows best, but that government knows everything relevant, including how many specialists there should be no more than 45 percent of all doctors [sic]. McCaughey says many medical students will be told that the specialties they prefer are closed, or closed to them because they are not the right race or ethnicity. Yes, the plan subordinates medical values to ‘diversity.’” Prescription drug prices would be controlled through the Department of Health and Human Services, and, McCaughey and Newsweek claim, would “certainly suppress research” that might benefit patients of incurable diseases and disorders. [Newsweek, 2/7/1994]

Refuting McCaughey - The Clinton administration details the “numerous factual inaccuracies and misleading statements” contained in McCaughey’s article. The administration’s response says that doctors and patients, not “government bureaucrats” or a board of governors, will decide what treatments are “necessary and appropriate.” The government will not decide what treatments are, and are not, provided: “If anything, the ‘necessary and appropriate’ care provision in the bill delegates authority to the medical profession—rather than imposing further government bureaucracy between the patient and the doctor.” The plan will not block Americans from opting into private health care plans just as they do now, nor will it block doctors and hospitals from accepting payments from “non-approved” health care plans. Nor does the plan require doctors and hospitals “to report your visit to a national data bank containing the medical histories of all Americans,” as McCaughey writes. And the so-called “National Health Board” will not “decide how much the nation can spend on health care beginning in 1996,” as McCaughey claims. The plan will not seek to reduce quality of care in the interest of saving money, and it does not contain price controls. [White House, 1/31/1994] A year later, author and columnist James Fallows will call the article “a triumph of misinformation,” and refutes McCaughey’s (and others’) claims point by point. [Atlantic Monthly, 1/1995]

Instrumental in Derailing Reform - The article will later be cited by House Speaker Newt Gingrich (R-GA) as “the first decisive breaking point” in the plan’s initial support; the plan will never be implemented. The article itself will spark tremendous controversy, winning the National Magazine Award while being attacked for being fundamentally inaccurate. (In 2006, the new editor of the New Republic, Franklin Foer, will apologize for his magazine having run the article.) In 2009 McCaughey will be a fellow at the conservative Manhattan Institute and will soon join the equally conservative Hudson Institute. Both are heavily funded by health care corporations. [Daily Beast, 5/15/2009] Entity Tags: Newt Gingrich, Franklin Foer, Elizabeth (“Betsy”) McCaughey, Clinton administration, James Fallows, US Department of Health and Human Services, Hudson Institute, Manhattan Institute Timeline Tags: US Health Care, Domestic Propaganda

February 9, 2009: Conservative: Obama Will Deny Elderly Health Care Betsy McCaughey (R-NY), the former lieutenant governor of New York and a fellow at the conservative Hudson Institute, writes that health care provisions in the Obama administration’s economic stimulus plan will affect “every individual in the United States.” McCaughey writes: “Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors. But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and ‘guide’ your doctor’s decisions.” McCaughey says the provisions are similar to suggestions in the book Critical: What We Can Do About the Health Care Crisis, by former Senate Majority Leader Tom Daschle (D-SD), until recently Obama’s pick to head the Department of Health and Human Services. McCaughey writes that hospitals and doctors who do not use the system will be punished, by a federal oversight board to be called the Federal Coordinating Council for Comparative Effectiveness Research. Perhaps most worrisome is McCaughey’s claim that elderly Americans will be given reduced health care based on their age and expected productivity. “Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost-effectiveness standard set by the Federal Council,” she writes. “The Federal Council is modeled after a UK board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis. In 2006, a UK health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.… If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the US will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later. The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined.” [Bloomberg News, 2/9/2009] McCaughey’s claims are very similar to the ones she made against the Clinton administration’s attempt to reform health care in 1994 (see Mid-January - February 4, 1994). They will be proven false (see July 23, 2009). Entity Tags: Hudson Institute, Elizabeth (“Betsy”) McCaughey, US Department of Health and Human Services, Tom Daschle, Obama administration Timeline Tags: US Health Care, Domestic Propaganda, 2010 Elections