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When the American Medical Association Cheered Hillary

Screen Shot 2016-08-03 at 5.09.46 AMAs Hillary Clinton’s motorcade sped toward the Chicago hotel hosting the American Medical Association’s annual meeting in June 1993, the clergyman giving the invocation made a jarring request of God: that the audience not boo the speaker.

Those weren’t his exact words, of course, but the prayer pointedly included reminders about the obligation to be polite to guests, particularly when a national TV audience was watching. An AMA official made a similar plea without involving the Deity.

In the current presidential campaign, Hillary Clinton has faced repeated questions about her likability, speaking skills and overall political agility. As a Chicago Tribune reporter covering that 1993 speech, what I remember most was how quickly she won over a crowd that had good reason to be suspicious; how fluently she spoke for some 50 minutes without either text or teleprompter; and, most of all, the standing ovation some 2,000 doctors and their spouses gave her when she finished.

If God smiled on Hillary before the AMA, who knows what He (She?) might do for her when she debates Republican presidential candidate Donald Trump?

The headline on my June 14, 1993 Trib story read, “Mrs. Clinton Tries to Soothe Wary MDs.” It was a well-deserved wariness. Hillary, who held no official title other than First Lady, had been placed in charge of the White House Health Care Task Force by her husband, Pres. Bill Clinton. Their plan’s specifics would not be unveiled until the president gave a primetime televised address to a joint session of Congress on Sept. 22, but the broad outline was already clear.

Clintonian reform was based on “managed competition,” an idea championed by Stanford economist Alain Enthoven and colleagues that had substantial support from conservative Democrats and moderate Republicans (back when there was such a thing). The basic idea, though modified by the administration, mandated a standardized benefits package and then incented health plans to compete based on price and quality.

Doctors worried they’d end up as cogs in giant insurance company networks. Those concerns were undoubtedly heightened when a group of five companies insuring more than 60 million Americans formed the Alliance for Managed Competition.

Yet the same Hillary Clinton who’d earlier in the year railed against fee-for-service physicians who “ripped off” the system spoke earnestly and directly is this venue to issues close to her audience’s heart. She mentioned her gratitude to the doctors who’d treated her father as he lay dying in Little Rock earlier in the year. She lashed out at the “excessive oversight” of insurance company reviewers and government bureaucrats who second-guessed medical decisions. She endorsed malpractice reform and, responding to an AMA wish list, seemed sympathetic to amending antitrust laws to allow medical professional societies to discipline poor-quality doctors. Her speech was repeatedly interrupted with applause.

(As I would later discover when transitioning from journalist to policy wonk, the idea that doctors ever effectively disciplined the miscreants among them is just one of the “Golden Age” myths to which physicians cling.)

Meanwhile, sending a signal to the audience beyond the ballroom, Clinton said the administration planned to cover prescription drugs for all Americans, including Medicare beneficiaries, in the national benefits package.

There was, I wrote, “none of the lawyerly-like focus on the fine print of various financing mechanisms” that often characterized White House discussions of reform. Instead, taking an approach that today seems eerily similar to the strategy Clinton used in her acceptance speech at the Democratic National Convention (DNC), she repeatedly linked healthcare reform with family values, a theme with broad emotional appeal. For instance, she said the average 80 hours monthly a doctor currently spends on administrative paperwork instead could be time devoted to counseling a child or teenager.

“What we need is a new bargain,” she said, offering to reduce red tape and give doctors more autonomy.

However, there was also a warning. Without reform, she said, traditional medical practice might be “gone forever” as large corporations increasingly dictated where their employees could go.

As everyone knows, the administration’s health care reform plan ultimately failed, not least because of a wonky complexity that befuddled allies and a refusal by Hillary Clinton to accept compromise, thereby turning political opponents into go-for-broke enemies.

Hillary’s recent speech to the DNC wasn’t delivered as well as the one I heard in 1993. However, her core message–“We have to decide whether we all will work together so we all can rise together”–was not at all dissimilar.

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Steven FindlayPeterWilliam Palmer MD Recent comment authors
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Steven Findlay
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Steven Findlay

Nice piece of history…and tying it to today, Michael. Thanks! Hillary has put good and specific ideas on the table. When she becomes Prez, there’s little doubt healthcare will be a priority — preserving Obamacare and fixing some of its flaws. Rx drug $$$. A possible medicare buy-in (“public option”). Paid medical and parental leave. Some possible changes to MACRA, if they can’t in regulation. And long term: costs. Reform in the 90s and through 2010 with ACA passage was focused on access and expanded coverage and to experimenting with delivery system changes (private sector and gov) to improve quality… Read more »

William Palmer MD
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William Palmer MD

The last presentation of her plan to Congress was a huge complicated spaghetti graph that no one could understand. Do you recall seeing this? It was as if her plan grew beyond comprehension. People couldn’t vote on it because it ceased being real….it sort of faded away–like college math into the functions of a complex variable. They did not even know whether they liked it or didn’t like it. Wasn’t there a famous quote by a physicist…something like “your ideas are so off-base they aren’t even wrong.”

The ACA was worse.

Peter
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Peter

“The ACA was worse.”

The ACA gave INSURANCE to a broader group of people through subsidies than had it before, it also got rid of pre-exist and offered real policies, not faux insurance.

What it did not do was control costs (cause no provider (donor) wants that) or did it rid us of ever increasing co-pays and deductibles. It’s subsidy plan is also unfair.

But, with all the players in health care wanting their piece to make money, how could it be negotiated to be perfect?