It may be ancient news, but discussing why the Clinton White House bungled health care reform is certainly not wholly irrelevant considering that Hillary Clinton is the strong favorite to be the next president of the United States. After all, it seems probable that she would have the responsibility for fleshing out the Affordable Care Act and making it a permanent fixture in our politics. But, even without currency, the history is interesting and informative.

At the outset of the Clinton reform effort, the administration did not anticipate that the Republicans would feel compelled to oppose reform as a bloc. The most important document in this history is William Kristol’s December 2, 1993 memorandum. It began this way:

What follows is the first in what will be a series of political strategy memos prepared by The Project for the Republican Future. The topic of this memo is President Clinton’s health care reform proposal, the single most ambitious item on the Administration’s domestic policy agenda.

These four pages are an attempt to describe a common political strategy for Republicans in response to the Clinton health care plan. By examining the president’s own strategy and tactics, this memo suggests how Republicans might reframe the current health care debate, offer a serious alternative, and, in the process, defeat the president’s plan outright.

The most important part of the memo is its political rationale. Defeating the health care bill was considered to be important for winning a larger ideological battle about the role of government and how the two parties were perceived by the public.

Any Republican urge to negotiate a “least bad” compromise with the Democrats, and thereby gain momentary public credit for helping the president “do something” about health care, should also be resisted. Passage of the Clinton health care plan, in any form, would guarantee and likely make permanent an unprecedented federal intrusion into and disruption of the American economy–and the establishment of the largest federal entitlement program since Social Security. Its success would signal a rebirth of centralized welfare-state policy at the very moment we have begun rolling back that idea in other areas. And, not least, it would destroy the present breadth and quality of the American health care system, still the world’s finest. On grounds of national policy alone, the plan should not be amended; it should be erased.

But the Clinton proposal is also a serious political threat to the Republican Party. Republicans must therefore clearly understand the political strategy implicit in the Clinton plan–and then adopt an aggressive and uncompromising counterstrategy designed to delegitimize the proposal and defeat its partisan purpose.

The reforms would have signaled a “rebirth of [the] centralized welfare-state.”

…the long-term political effects of a successful Clinton health care bill will be even worse–much worse. It will relegitimize middle-class dependence 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.

It goes mostly unstated today, but these are the same reasons that the Republicans have opposed ObamaCare so vociferously. Last August, Senator Ted Cruz argued explicitly that the rollout of the exchanges needed to be prevented or the middle-class would become addicted to the subsidies:

Cruz, who has thrilled his conservative base with his promise to shake up business as usual in Washington, says that once the insurance subsidies kick in at the beginning of 2014, it will be too late to undo the Affordable Care Act.

He said that is precisely President Obama’s goal.

“His strategy is to get as many Americans as possible hooked on the subsidies, addicted to the sugar,” Cruz told a Kingwood Tea Party gathering. “If we get to Jan. 1, this thing is here forever.”

This analysis, whether right or wrong, formed the reasoning behind last fall’s government shutdown. If the Republicans retain control of the House in the upcoming midterm elections and take over the Senate, it’s possible that they might succeed in gutting ObamaCare, but even Ted Cruz is on the record as predicting that it is already too late to roll back the law completely.

In this sense, the ideological war that the Republicans won back in 1993-94 was lost in 2010, and particularly after Obama’s reelection in 2012. Yet, the GOP is still thrashing about, trying to figure out a way to put the genie back in the bottle.

Do the Democrats have any reason to fear nominating someone to defend this victory who so prominently failed on the same battlefield in the early 90’s?

I think the answer is mostly ‘no.’ Twenty years have elapsed, Congress has changed, the Democratic Party has changed, and Hillary Clinton has gained a tremendous amount of experience, as a senator, a presidential candidate, and a high profile cabinet member. In particular, she now understands her opponents much better than she did back in 1993.

But for much of 1993, the White House didn’t see the political realities that would bring the plan crashing down — including the pressures within the Republican Party that eventually created a solid wall of opposition.

She doesn’t have to pass the law; she just has to keep it going. She knows enough now not to think that she can get the Republicans to cooperate in making the law more efficient. If it is to be reformed, it must be on the strength of overwhelming Democratic majorities.

If Hillary can deliver those majorities, and other Democratic candidates cannot, then she will be in the best position to protect and improve Obama’s health care victories.

As Democrats size up the 2016 field of candidates, they will want to assess how well each candidate understands the history of the health care wars, and how big their coattails might be. Hillary has weaknesses that will concern progressive Democrats (including me), but this area should be one of her strengths.

Martin Longman

Martin Longman is the web editor for the Washington Monthly. See all his writing at