How Would President Hillary Do It Differently?

The counterfactual on health care reform

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The longest-running political battle of 2008, the Democratic presidential primary fight between Senators Barack Obama and Hillary Clinton, cemented Obama's more sweeping presidential victory that November. But what if it had worked out differently, with Clinton defeating Obama in the primary and, quite possibly, going on to win the presidency? There are many ways that a President Hillary Clinton might have governed differently, but writers are focusing on health care reform. How would Clinton's second stab at reforming the health care system have gone as president?

  • No Health Care Reform  In a long essay arguing that conservatives should have supported Clinton, Forbes' Bruce Bartlett thinks that, if she had won, she "probably would be governing significantly more conservatively than Obama. For one thing, given her disastrous experience with health care reform in 1993-1994, it's reasonable to assume that she would have stayed away from that issue at all costs."
  • Much Less Health Care Reform  The New Republic's Jonathan Chait suspects that "any significant adversity would probably have caused her to retreat. In the wake of Scott Brown's victory, her chief political strategist, Mark Penn, urged Democrats to abandon health care reform." Penn's January 2010 argument that Dems pursue only very modest and popular reforms is "probably the sort of strategy Clinton would have followed if she had won."
  • Better Health Care Reform  Mother Jones' Kevin Drum dissents. "I think Hillary was, if anything, more dedicated to healthcare reform than Obama, and I think she would have taken it on more vigorously than he did. What's more, my guess is that her better feel for the Senate and past failure with healthcare reform would have made her more effective at getting a package passed," he writes. "we might have gotten healthcare reform last fall instead of last month."

  • Wouldn't Be That Different  Columbia Journalism Review's Greg Marx explains that the debates were never really about specific policies, they were about personality and "moral character." On the one big health care policy debate, the issue of a mandate, Clinton argued for a mandate. Obama argued against a mandate. But, in 2010, the actual Obama-backed bill included that mandate. So clearly policy was never the big issue, and wouldn't have been pursued that differently.
  • Whole Debate Proves Primaries 'Unprescient'  Matthew Yglesias sighs. "I think the fact that we’re having this conversation at all is an illustration of how bad a job primary campaigns do of accomplishing what activists want them to do." Since winning office, the health care bill Obama pushed "was closer to Clinton’s proposal than to his own. So what was accomplished by all those Clinton-Obama debate exchanges? Not much."
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