By Michael L. Millenson
Sixteen years and two days after then-First Lady and Health Care Czar Hillary Clinton went before the American Medical Association’s House of Delegates to sell her vision of national reform, President Barack Obama is treading the same path. I’m not sure how much greater eventual success Obama will have with the AMA, but having covered the Clinton speech as a reporter for the Chicago Tribune, I have three lingering memories.
The first was the invocation given before Clinton arrived. Its gist was, “Oh, Lord, you have taught us it is impolite to boo our guests, particularly in front of hordes of reporters.” The second memory was that Clinton finished her speech to a standing ovation. And the third is that she spoke fluently and passionately for 50 minutes without a prepared text, much to the chagrin of a national press corps accustomed to being spoon-fed a follow-along text before filing their stories. Fortunately, being a mere “regional reporter” (as the White House called us), I had taken notes.
Obama’s visit promises at least a few contrasts. He runs virtually no risk of being booed. He’s not only the President of the United States, and a very popular one, he’s also a president who has eschewed the perceived doctor-bashing engaged in at times by President and Mrs. Clinton. Obama most assuredly will not be speaking from notes, being as attached to the teleprompter as Ronald Reagan was to his 3×5 cards, but in the Internet Age anyone who cares to will be able to hear him live, anyway. A standing ovation? We’ll have to see.
To the amazement of her audience in 1993, Hillary went out of her way to hit all their hot buttons. For example, she praised the doctor-patient relationship and lashed out at the “excessive oversight” of insurance company reviewers and government bureaucrats who second-guess medical decisions. She talked sympathetically of the need for reforming malpractice laws and amending antitrust laws to allow medical professional societies to discipline poor-quality doctors on their own. (Here, I’m relying on a copy of my story I grabbed from an electronic archive.)
Obama, by contrast, prides himself on seasoning the obligatory political pandering with a soupcon or two of hard, cold reality. While reducing red tape and the need for defensive medicine are sure to be high on his list of promises, I don’t think he’ll hesitate to invoke the harsh global economic challenges that make health care reform so urgent. Look for Obama to remind the doctors how many more uninsured patients they’re seeing today and how much more involved Medicare has become in setting doctor pay scales.
One more contrast: in 1993, the AMA shoved forward Nancy Dickey, the one woman on their nine-person executive committee, to be its public face during the Hillary visit. Today, the organization’s elected president is Nancy Nielsen, the second woman to head the group (Dickey went on to the top job) and, though not publicized, the first who came to the post after holding a senior position in one of those dread health plans.