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Health care reform has long been a hard sell in America

Caroline Anthony and other opponents to reforming the

Caroline Anthony and other opponents to reforming the U.S. health care system protest in Philadelphia. Photo Credit: AP

WASHINGTON - When President Bill Clinton stood before Congress on Sept. 22, 1993, to make a speech laying out his version of "health care reform," six in 10 Americans surveyed supported his proposal.

His plan, he said, would finally expand health insurance coverage to the more than 40 million uninsured people and would rein in the fast-growing expense of providing care.

But after the intense political struggle in the months that followed - with a complex 1,300- page bill, alarming TV ads run by the health industry and Republicans, and an ineffective response by divided Democrats - only four in 10 in July 1994 still backed his plan.

Health care "reform," history shows and experts agree, is a hard sell in the United States.

As with the two other previous major attempts to legislate universal health coverage since 1945, what appeared at first as an almost inevitable victory became a political quagmire and then a defeat for Clinton.

Now that President Barack Obama has put his political capital and political future on the line with his address to Congress about his health-care overhaul, he must try to avoid repeating history.

In 1949, President Harry Truman introduced national health insurance only to see it die the next year amid GOP opposition and what has been called the first modern issue campaign, underwritten by doctors.

In 1971, Sen. Edward Kennedy (D-Mass.) proposed national health insurance and later a compromise plan. But beset by a confusing proliferation of proposals, conservative opposition and liberal insistence on a more sweeping bill, the moment for action ended by 1975.

In 1993, Clinton unveiled a complex plan hammered together by first lady Hillary Rodham Clinton and 600 experts. But a year later, the Senate declared the measure dead.

Jonathan Oberlander, a University of North Carolina health policy scholar, cited four roadblocks to past health care reforms:

"The U.S. system of political institutions that makes it very difficult to pass controversial legislation and forces compromise, including the requirement of a Senate supermajority to beat back the filibuster.

"The prevalence of high-powered interest groups in the health care system whose incomes are at stake in health reform and who historically have organized to protect the status quo and defeat change.

"Fear of government is in Americans' political DNA and there is a long history of deep ambivalence over government's role in social policy, to say nothing of an issue as personal and emotional as health care.

"The political reality that most uninsured are low-income and politically not influential, while most insured Americans are satisfied with their insurance coverage and doctors, though not the cost."

Americans like the idea of "reform" until they are confronted with a plan and its alternatives, said Harvard health care policy expert Robert Blendon.

Then they balk.

For a 2001 Health Affairs paper, Blendon and other researchers reviewed more than 100 public opinion surveys since can public has conflicting views about the nation's health care policy."

Americans are dissatisfied with the health care system, insurance companies and managed care, and like the idea of a national health plan to fix those problems, the review found.

At the same time, Americans trust their doctors and are satisfied with medical arrangements, Blendon wrote, but they "do not trust the federal government to do what is right."

In a recent update, Blendon said he found little had changed. Yet he predicts Congress will pass some kind of health-care bill with Obama's name on it - to avoid a repeat of Clinton's experience.After Clinton's plan failed, the GOP won control of Congress and thwarted his agenda.

"Democratic political leaders learned a sobering lesson from 1994," Blendon said. "You cannot raise public expectations to a near fever pitch about reform and then enact no legislation."


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