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The Next Movement

Why Bush Blocking S-CHIP Helps Universal Health Care was ready to pounce. At noontime on Wednesday, some two hours after President Bush vetoed a proposed expansion of the State Children's Health Insurance Program (S-CHIP), MoveOn e-mailed its members and supporters, urging them to protest. "In the coming days, Congress will try to override Bush's veto with a two-thirds majority," the e-mail explained. "Our goal is to pressure a few more Republicans to stand up to Bush--enough to pass the children's health bill." The e-mail included information about local rallies that organizers had planned late the previous week, as well as some advice on how supporters could best make their point: "If you have kids, definitely bring them, too!"

The result, according to MoveOn, was more than 200 rallies nationwide. And those rallies, in turn, were part of a broader, ongoing campaign that includes not just grassroots organizing but also television advertising attacking Bush and his supporters for blocking the S-CHIP expansion. In one particularly potent ad, sponsored by the liberal group FamiliesUSA, a group of children appear on camera one after another, each praising President Bush to a background of soft piano music: "I think President Bush is a nice person . . . He's just a very sweet man . . . I want to play football with him. . . He protects us . . . He loves kids." But as the kids are talking, the screen flashes words that tell a different story: "President Bush just vetoed health care for 10 million children. . . including all of these children."

Whether this campaign succeeds in pushing the S-CHIP expansion into law remains to be seen. As of this writing, the House plans to take an override vote next week, with Democratic leaders said to be at least 15 votes short. But even if the campaign fails, its mere existence seems significant for what it says about the coming debate over universal health insurance--in particular, why this debate might play out differently than the last one did.

When supporters of universal health care look back on what went wrong in 1993 and 1994, when President Bill Clinton famously lost his bid to create universal coverage, they frequently focus on the role of hostile interest groups like the insurers and small business lobby. And, to some extent, that makes sense. Whether it was financing advertisements like the infamous "Harry and Louise" spots or working at the grassroots level through local affiliates, these interest groups were brutally effective at persuading the public to oppose universal coverage.

But an equally important factor in the Clinton's plan demise was the inaction of groups supporting universal health care. Even a modest push back against the lobbies of the right could have blunted the impact of hostile groups--if not enough to pass the Clinton plan itself, then perhaps enough to pass some lesser measure. Yet that push never came.

Why not? The answer begins with the plan itself. Clinton had embraced a model for universal coverage called "managed competition," which envisioned every individual (except the elderly) buying a private insurance policy--and private insurers competing for the business. Although it would have meant coverage for every American, it deeply disappointed the most passionate advocates of universal coverage, most of whom preferred some sort of "single-payer" system--that is, a system, like Medicare, in which the government provides benefits directly. And since many of these advocates were already suspicious of the new president, thanks to his embrace of welfare reform and other traditionally centrist causes, they sat on their hands once the attacks from the right came.

Granted, the single-payer advocates were never so great in number or influence; ultimately, their support might not have made such a difference anyway. The same cannot be said for the labor movement--which, even in its weakened state, remained at that time the largest and most potent political force on the left. While labor was willing to fight for the Clinton plan, it wasn't willing to fight for Clinton--at least, not in 1993. That's because it was busy battling Clinton over something else: the North American Free Trade Agreement. Although that struggle ended in late 1993, labor by then had expended tremendous resources on the anti-NAFTA effort--and, thanks to the measure's passage, suffered a pretty stinging defeat.

So labor, understandably, was in no great rush to help Clinton. And neither, it turns out, was the American Association of Retired Persons (AARP)--the other group the Clinton administration had hoped would come to its side. The AARP balked after some early leaks indicated the administration might cut Medicare spending in order to help pay for its universal coverage scheme. Although the AARP did endorse the Clinton effort, it didn't do so until well into 1994--by which point Clinton's opponents had already framed the debate on their terms and killed whatever chances it had.

Today, the landscape looks a lot different. The plans the top three Democratic candidates have proposed are, in the grand scheme of things, less ambitious than what Bill Clinton tried more than a decade ago; they seek to get everybody covered and encourage more cost-effective care, but they don't try to reengineer the entire health care system in one fell swoop. And they still envision most Americans getting coverage through private carriers.

At the same time, though, these plans offer single-payer advocates something that wasn't part of the mainstream debate last time. All three candidates would create a new public program, perhaps modeled on Medicare, into which anybody could enroll. These plans would operate alongside the private plans, competing with them for business. If they prove as efficient as single-payer advocates claim, they should attract more and more people--in effect, evolving into a single-payer system naturally.

It might not happen that way, of course. And some groups, like the California Nurses Association, are as disappointed with these plans as single-payer advocates were last time. But the mere prospect of getting to single-payer eventually--coupled with the promise of covering everybody, albeit under mostly private coverage, right away--has been enough to other organizations on the left. Consider the Campaign for America's Future, an unabashedly liberal group based in Washington. Although it supports single-payer reforms, it has given its strong endorsement to the new Democratic plans--and signaled its determination to fight for them.

More support will come from the Service Employees International Union (SEIU), which is probably the single most powerful union in America today. SEIU's president, Andy Stern, is a longtime advocate of universal health care. But as committed as he is to the goal of covering everybody, he's not so committed to any one model of reform. On the contrary, he has gone out of his way to make common cause with anybody willing to say good things about universal health care--even, controversially, Wal-Mart. It's virtually unthinkable he wouldn't support any plan the Democrats might put forward in 2009--and put SEIU's considerable political resources behind it.

None of which will matter much if the supporters of universal coverage can't mobilize people to action. But that's where groups like MoveOn may come into play. It's hard to know whether the pro-universal forces could have matched their opponents in organizing last time around--if, say, the AFL-CIO really had put all of its energies into fighting for the Clinton plan, rather than NAFTA. But their chances certainly seem better this time, now that groups like MoveOn have developed a grassroots infrastructure that simply didn't exist in 1993 and 1994. And while MoveOn's efforts to push S-CHIP past a Bush veto isn't a perfect proxy for the debate to come, it's not difficult to imagine MoveOn deploying the same tactics in 2009 if, say, a Democratic president and Democratic Congress were trying to push universal coverage past a Republican filibuster in the Senate. (Which, as it happens, is almost certainly what would happen if a Democrat wins the presidency.)

Granted, MoveOn's support can be a mixed blessing, as the critics of the war found out after the infamous "Betray-us" ad. And, let's face it, health care may never be the kind of galvanizing issue that war is. But the fact that Bush's S-CHIP veto is already sparking protests suggests this may be the beginning of something new--and, for the supporters of universal coverage, something promising. By galvanizing universal health care's advocates, Bush's veto might do a lot more to make universal health care likely than expanding S-CHIP ever would have.