Hillary Clinton's Health Care Diva

(Laurie Rubiner, Legislative Director in the Office of Senator Hillary Clinton)

Hillary's foreign policy team has some of the mega-stars in the national security business. She has Madeleine Albright, Richard Holbrooke, Sandy Berger, Wesley Clark, William Perry, and a good number of their acolytes -- but her counselors are about as top-heavy as George W. Bush's team was with Dick Cheney, Colin Powell, Condoleezza Rice, Donald Rumsfeld, Richard Armitage, Paul Wolfowitz and others on board.

Having a lot of big guns as advisers doesn't mean that they will all shoot the same direction. In fact, rumors continue to slip out of the Clinton camp that there are substantial tensions between Holbrooke, Albright, and Berger who all are trying to define the key features of Hillary Clinton's foreign policy persona. To give Hillary some credit that John Kerry's campaign doesn't deserve, I think she has more a sense of her own views than Kerry might have -- and is willing to knock back the counsel of her advisers and is willing to tell them to cease the bickering, elbowing, and theatrics between these competitive camps.

But in health care -- there is one voice who dominates the policy work in "Hillary Land" and that is Laurie Rubiner. (and yes I know, Hillary knows a lot about health care policy but I'm not counting her.)

Imagine a diva who was not haughty and spoiled -- but just emanated total confidence and knowledge of some skill or issue -- like quantum mechanics, or magazine editing, or health care. That is Laurie Rubiner.

Yesterday, the New York Times profiled Rubiner and her significant contributions to Hillary's much talked about health care proposal. The Washington Note profiled Laurie Rubiner's work this past January -- and today John Fund at the Wall Street Journal takes on Rubiner (and of course, Hillary).

Rubiner doesn't only do health care policy; she runs Hillary Clinton's entire policy shop in her Senate office. In fact, in my view some of the major power brokers in Hillary Clinton's political machine sometime forget that the actual Senate staff Hillary has hired are mostly better in their ability to project tomorrow's policy needs than the White House-hungry policy advisers she has brought in to the campaign.

I should probably disclose that Rubiner and I had one serious argument that had to do with communication, honor, and who said what to whom -- but her husband told me later that what I saw was a mild breeze compared to what was possible. But I have learned from several sources that Hillary Clinton and Rubiner have the kind of gritty give-and-take relationship that few have with the Senator and would-be President of the United States. They can argue about some serious policy difference, tell each other to go to hell, and then laugh it off.

Rubiner headed the health care policy program of the New America Foundation where I have worked for the last nine years. Before joining New America, Rubiner worked in a number of key policy and advocacy roles -- but it was her work for the late Senator John Chafee (R-RI) where she conceived under the Senator's name and at his direction a health care plan that would maintain private sector deployment of health care services as the backbone of America's health system, avoid the single payer debate that divides that policy community, and be universal.

Rubiner brought her work to New America -- and the DNA of her efforts exists in all of the significant "test efforts" of comprehensive health care coverage -- including in Republican Arnold Schwarzenegger's proposal for California, Democrat Gavin Newsom's in San Francisco, and Republican Mitt Romney's in Massachusetts.

Now, Hillary Clinton has brought the sensibility of the Chafee/Rubiner health care proposals into her own plan for the country and demonstrated considerable political bravery and sensitivity in doing so. I think it takes a lot for someone like Hillary Clinton to abandon her former approach on health care coverage in which she drilled down into the fine and messy details -- and change course, rather than doing what many people who acquire power do -- and that is just yell more loudly or force more strongly a posiition they previously held.

Rubiner does a killer impersonation of Senator John Chafee, and it's so compelling that on one occasion when I was quite upset with the vote of his son, the no-longer-Republican former Senator Lincoln Chafee, on John Bolton's UN confirmation, I advised the younger Chafee to go spend time with his dad via Laurie Rubiner. I can just imagine Rubiner channeling John Chafee for Hillary Clinton and giving the Senator the secrets to making this universal health care coverage work.

Interestingly, John Fund today hardly scrapes the policy framework or nuts-and-bolts of the Hillary/Chafee/Rubiner health care plan -- but rather the optics and the politics of it. He slams Clinton's plan for being like Schwarzenegger's -- and then asserts that this plan will lead to new bureaucracies, open up tensions on coverage for illegal aliens, and fail to generate needed bipartisan support.

The fundamental, underlying problem that exists in America's health care sector is getting people with financial means who elect not to get health care to do so. If a mandate were generated that everyone needed to be in health care, not only would the nation as a whole become healthier but the costs of subsidizing those in real need or without financial means declines on a relative basis. I hope John Fund and other critics of Hillary Clinton's new proposal don't believe that the less well off should just stay that way and should get nothing at all from America's health care system.

Clinton's (and Rubiner's) proposal maintains a vibrant private sector backbone for the provision of health services; there is no "socialization" of providers and no single payer requirement.

John Fund may revisit this issue of how to get to a healthier health care system in the United States, so let me share with him and others what conservative libertarian Ronald Bailey wrote in 2003 in Reason Magazine about the New America Foundation's health care proposal (as hatched and incubated by Laurie Rubiner). This from Bailey's "Mandatory Universal Health Insurance? Perhaps It's a Better Idea Than You Think It Is":

Since it's unlikely that Americans will allow their improvident neighbors to expire without medical care in the streets, is there a politically palatable alternative that can preserve and expand private medicine in the United States? Yes: mandatory private health insurance.

Should the federal government require all Americans to buy private health insurance? This intriguing proposal is being pushed by the New America Foundation, a liberal policy shop in Washington, D.C. "Universal coverage in exchange for universal responsibility," is how the NAF characterizes it.

Before rejecting the proposal out of hand, stop and consider that it may be a second-best alternative for relieving the growing political pressure to create some sort of nationalized single-payer health care system modeled on the nearly bankrupt and increasingly shabby health care schemes in Canada and Western Europe. Make no mistake about it--private health care is imperiled in the United States, given that all of the Democratic presidential hopefuls want to expand existing government health care programs and/or create some sort of universal government-run system. The NAF proposal could derail this pernicious political dynamic.

The devil is in the details, of course. Still, the NAF plan offers some interesting possibilities. For example, mandatory health insurance coverage might be combined with desirable features such as medical savings accounts, which would encourage people to save and invest for future medical emergencies.

The NAF proposal preserves private insurance and allows consumers to choose among competing insurance plans and coverage options. Most intriguingly, NAF offers a way out of the dysfunctional employer-financed third-party-payer system that is so grievously distorting our current health insurance system. Employers would eventually devolve responsibility for health insurance to their employees by giving them the money the companies currently pay out to insurance agents. Employees would then have a strong incentive to shop around for the best health care deals, putting pressure on insurance companies to keep costs low.

While I think the New America Foundation is more "radical centrist" than "liberal", I completely agree with Bailey's general take on how to get Americans covered by health insurance without tipping towards inefficient socialized bureaucracies or the alternative, manic market provision of health care which assures humanitarian nightmares for the tens of millions and growing in the United States who have little prospect of securing health insurance.

If the libertarians in addition to Democrats like Gavin Newsom and Hillary Clinton and Republicans like Mitt Romney and Arnold Schwarzenegger can sign up for what John Chafee launched some years ago -- then this deserves serious national scrutiny at all levels of government. Next to America's deteriorated national security and foreign policy standing in the world, the absence of strategy to credibly broaden health care in this country is our largest problem.

Kudos to Hillary Clinton for having the confidence of self to allow a "Senate staffer" in her employ to get some of the media credit for her proposal. This alone says something about Clinton that I haven't noted before. Staffers aren't supposed to get credit, and they certainly can't angle for it.

Rubiner is getting credit not because she wanted any of this -- but because to connect the dots in the political history of what is the most likely universal health care plan to come into being -- one must tell the story of Laurie Rubiner.

-- Steve Clemons is Senior Fellow and Director of the American Strategy Program at the New America Foundation and publishes the popular political blog, The Washington Note

Comments

[ProgressiveChange]

ATTENTION RATIONALIZERS:

SINGLE-PAYER UNIVERSAL HEALTHCARE is the only fix possible.

Real world political constraints are the stuff of those, who admit that the insurance-model is rife with unnecessary costs (as Clinton, Richardson, Biden, Edwards and Dodd did yesterday in their PBS debate) ... but won't risk alienating special interests by supporting single-payer universal healthcare. Judy Woodruff didn't bother to query, "Why not?"

So, give them credit for creating an illusion that somehow, some way ... insurance-creep, tax incentives, and electronic medical records will enable all Americans to access and retain affordable, high quality, and safe healthcare. By the time GOP and Democratic shills for the industry get done minimizing and diluting any legislation, what is left won't be worth the paper it will be written on.

Some Americans are so tired of this crap ... of the hollow promises ... of the failure to cite all of the adversities and corrupt elements which are characteristic of the non-system ... that they will look elsewhere for a reason to vote for a Democrat. The GOP is a public interest wasteland altogether.

We are back to choosing between B.S. and Super-B.S. or the lesser of inadequacies and political cowardice.

[ConradGaarder]

Clemons says "getting people with financial means who elect not to get health care to do so" is the fundamental problem.

He could state it another way: "From each according to his abilities, to each according to his needs," although I wouldn't expect him to do so.

If the inexorable slide towards socialism must include "universal healthcare", then it would have been much more acceptable to the American people if the powers that be hadn't been so determined for the last four decades to deconstruct the American identity.

Charity begins at home, but when to that obnoxious socialist anthem "This land is your land, this land is my land" is added "and this land is their land, and this land is everyone's land", people's natural feelings of charity towards kin (in the larger sense) disappear.

[visadeclined]

ATTENTION LIBERALS:

SINGLE PAYER HEALTHCARE IS NOT ON THE TABLE!!!!

Every thinking person agrees that it is the best healthcare solution but it aint gonna happen, at least not in my lifetime. Let's give Hillary (and Edwards, Obama, Schwartzenegger and even the 2004 version of Romney) credit for offering a workable solution within the real world political contstraints.

[joekonn]

Any health care program that does not address costs is bull.... While the first goal has to be to cover those not covered (which mandatory health insurance may address), the second is the skyrocketing cost driving working folks out. Without some basic way to negotiate or set drug and other prices, everyone will be covered and no money will be left for driving the rest of the economy. Folks will be spending all discretionary funds on healthcare. Preventive strategies may help, but, bottom line, you cannot have affordable healthcare and clip coupons from pharma stocks. too.

I don't know how efficiency is measured, but I do know that big business is not as efficient as government from the consumer perspective. Decent private schools (church $upported schools aside) are more expensive that public, private everything is more expensive, any 'efficiency' savings are passed on to the stockholder not to employees or to the consumer.

[bbln]

Why is this a picture of Laurie Rubiner at a bar? And all the glasses and cups couldn't have been cropped out? This might be picky, but when talking about the Health Care Diva behind Clinton's plan, why doesn't this pic reveal the same seriousness as the article's theme.

[ProgressiveChange]

Hillary has done it again. Last time around, she chose Ira Magaziner as her healthcare policy guru. Now its Laurie Rubiner.

These choices have given 'healthcare expert' new meaning. In this definition, one need not have seasoned experience working as a doctor, nursing director, administrator, or consultant in several different healthcare settings. One need not have practical, hands-on exposure to the infinite number of issues and charades operative in the healthcare non-system. One need not have been involved in the crazy healthcare finance apparatus.

Apparently, one needs only to have intellect and ethereal or academic research acumen to be a healthcrare expert. Magaziner was a business consultant. Rubiner is a policy wonk. Her family has had some personal experience with being uninsured. That's not enough to 'get it'. It is enough to make an effort to patchwork a broken system by throwing more money at it and invest in playing nice with highly profitable sources of opposition to fundamental change.

[ConcernedAboutRFuture]

If you HAD to vote for a Repub or Hillary.... which would you choose?

[ConcernedAboutRFuture]

There is NO WAY we can work with Insurance Companies in creating a universal health care system. They are in fact a business, have investors and care ONLY about the bottom line... as corporations should.....because that's what investors want to see. Involving them in such desperate and delicate situations as health issues... will only CONTINUE to breed greed, corruption and dissatisfaction.... as it continues now.... and has done with Medicare.

[dmacgregor]

This is the first article I've read that explains the positive economics of the Clinton/Rubiner plan. Why can't we rely on our mainstream media to give us this kind of information? I suspect many voters would like to know that this plan forces rich folks to contribute to financing the health care in this way. Kudos to Arianna for getting the word out to the blogosphere. Shame on mainstream media for focusing on fluff like cleavage and haircuts instead of informing us about the actual voter issues.

[johnOneOne]

First, no, that's not the fundamental problem. But if you understood the implication of your first sentence, Mr. Clemons, you'd see why the second is not a solution at all, and how your solution works against the very problem you state.

I'm sure you mean health care insurance, not health care. Someone not getting health care at all doesn't cost anyone anything. But that's picking nits, and I point it out only to note how incoherent and illogical the statement is as a whole.

But more to the issue, your first sentence does have a grain of truth: the expectation to have an insurance system that's individually funded by insurance premiums paid by those who actually receive care is not viable, whether those not those who don't pay such premiums are just healthy and don't need care at all, or wealthy and don't need insurance at all, or too poor to afford to pay either for their own care directly or for insurance that pays for it. Funding has to be universal, whether also individual or not. But if it's universal, there's no reason for it also to be individual; the only reason for it to also be individual is to satisfy capitalist ideology. The solution to this problem is not mandates to require individual funding, but funding that has nothing to do with individuals at all - i.e., truly collective funding.

And that's single payer.

So why won't a universal individual mandate work? Simple: it's not enforceable, for starters.

By the way, I'm a socialist. Have been for decades. Socialism isn't about using government for authority - that's what this mandate idea is - socialism is about using government for provision - things like infrastructure that isn't profitable on an individual level. That's how the totalitarians got it wrong, and that's how this idea gets it wrong. This isn't socialism; it's authoritarianism, and the two are opposite things, not just different things.
They certainly aren't the same thing.

[johnOneOne]

I was referring to this quote:

"The fundamental, underlying problem that exists in America's health care sector is getting people with financial means who elect not to get health care to do so. If a mandate were generated that everyone needed to be in health care, not only would the nation as a whole become healthier but the costs of subsidizing those in real need or without financial means declines on a relative basis."

But I had to cut it out to get under HuffPo's word limit...

Respect your audience, HuffPo, or you'll end up not having one.

[sundog58]

I will not vote for Hillary until she stops being Repub lite.

I'm starting to think that something of a Progressive Party has to be started to force these so-called Demos to listen to the base. Something of a political union of sorts consisting of progressive think tanks, civil rights groups, environmental groups, fair trade groups, left leaning blogs, unions, etc.... The union of political groups would have power of money, ideas, and votes.

These Demo presidential candidates are so screwing us over. We support them because there isn't any alternative. Hillary is representative of the corporate overlords that is pushing the Demo party away from its roots. So sad.

I fear that I'm not going to vote for my Demo party in 2008. I'm not the only one that feels this way. Progressives are feeling used and abused. We still will fight for a strong, fair, just, civil, and democratic society . I just didn't think I would be fighting the party that I've been voting for the last 20 years.

[drricklippin]

Health Care in the US is a huge $2 trillion dollar plus mega-enterprise ship we are trying to navigate through very rocky rough waters. Not every "i" will be dotted or "t" crossed- just yet. Also no country on the planet has figured it all out.

I'm betting the ONLY way out of this mess is ultimately single payer with MUCH more emphasis on prevention- both individual( personal health behaviors) and institutional(public health). Hillary's plan is a good first step.

Dollars saved through single payer with much less administrative overhead and prevention will then be freed up to be applied to those who have non-preventable diseases and to all US citizens. More in my blog below

Be Well,

Dr. Rick Lippi
http://medicalcrises.blogspot.com

[ConcernedAboutRFuture]

Dr. Rick.... I perused your site and am anxious to read all the referenced material. Thank you for your insightful input.

[drricklippin]

thxs "ConcernedAboutRFuture"

One of the few handles I like :)

Rick Lippin

[chett]

The fact that, even if you make a good living, you need insurance to even dream of paying a hospital bill IS the problem. I'm tired of hearing the term "health care" used to refer to "health insurance plans." Getting everyone covered doesn't address the issue that medical care is prohibitively expensive, it just continues to enable it. And to actually mandate that everyone should be required to have a plan - in other words, to legislate that a premium must be paid to a corporation for every single American - seems evil to me.

All of these health care proposals seem to focus on getting health coverage for people who don't already buy it. This is not addressing affordable health care. It's selling insurance. I'd like to see a health care proposal that focused on health care rather than insurance plans.

[Overd0g]

There is no way to get what you want without evil. You must take a gun (held for you conveniently by your government) and hold it to your neighbors head, and force them to contribute involuntarily to something they may have no interest in. Pure, unadulterated evil.

[tiggersthotfulspot]

HillaryCare 2.0 is just RomneyCare in drag. AKA the "enhanced profitability for insurance corporations act".

It's disgusting that Hillary is following the same triangulating footsteps that Bill laid down.

After the miserable failure of the so-called market based solutions, we will be addressing this question again in another 10 or 12 years. That's assume the rabid dog wingers let even this thing pass.

Hilarious quote from 1993's NAFTA debate: Janet Reno wrote an op-ed saying that NAFTA would be the only cure for illegal immigration. More free trade was just what everyone needed! We saw how well that worked. Mexicans make 15% less in real terms, and illegal immigration has almost doubled since NAFTA passed. It would be nice if we lived in a country where politicians who've been WRONG ABOUT EVERYTHING would not get voted back into office (or be promoted to President).

You're doing a Heckuva Job Brownie could be the motto of just about everyone in the US government. Consistently steering the train down the wrong tracks, for decades now.

[DocTwain]

Rubiner Schrubiner. Blue Cross or Aetna is who really authored this plan.

What's wrong with HR 676, the single-payer National Health Insurance Program which has been proposed by Kucinich?

What was wrong with it in Truman's day?

We should have gotten single-payer back then. The only reason we didn't was because the insurance cartel conspired with plutocratic-republicans to create a zero-value-added, utterly vampiric health insurance industry, whose every dollar in overhead, advertising, and (above all) PROFIT is a dollar taken away from actual health care Americans needs--adding up to hundreds of billions of dollars sucked out of the system each year.

How does Hillary's plan change that?

Just read it (following the link in the blog above): it's enough to make you want to vomit.

Why should workers have to pay a "percentage of their income" for a basic human right, health care?

What percentage do CANADIANS pay? Answer: ZERO.

What the hell is wrong with this country?

Evidently three-quarters of a trillion dollars blown annually on a monstrous war cartel, billions in subsidies for fossil fuel and agrobusiness, and more than 70 tax cuts for billionaires since 2001 makes it impossible for us to achieve parity with Canada in health care, or even in the value of our respective dollars.

Don't let the plutocrats in either party take your money and give it to the health insurance cartel: support only single-payer health insurance.

Support Dennis Kucinich, the only truly progressive running for the presidency--the man who'd get the endorsement of Truman and FDR.

Hillary is just one more DLC agent for the cartels.