1. The System Haynes Johnson and David Broder

2. Clinton and Health Care Intersecting Political Careers: Reagan, Clinton, Gingrich All came from poverty, troubled families. Clinton experience tuned him into the challenges of poor and working class people, particularly with regards to the issue of health care.

3. Politics of Health Care: 1990s What was the Political Context of Clinton Health Care Reforms Clinton’s health care reforms came as little surprise to a Congress that been debated the issue for years. Health Care a Major Issue: 1991 PA Senate Race One indicators of exactly how important health care had become as an issue was the 1991 race to fill the PA Senate seat left open by the death of John Heinz. Democratic Harris Wofford defeated the favored a Republican Dick Thornburgh after making health care an issue.

4. Politics of Health Care: 1990s Harris Wofford Message: Health Care Should be a Right National Democrats Seize on Wofford Message Sensing an opportunity, the Democratic leadership in Congress talk about pushing national health care reform. Results: History of Failed Health Care Legislation The Democratic proposals failed to materialize, as had previous efforts in the 1980s.

5. Politics of Health Care: 1990s Defining Issues in American Politics The authors identify four: 1) War and National Security 2) Race Discrimination and Inequality 3) Economic Inequality 4) Social Safety Net

6. Politics of Health Care: 1990s Social Safety Net: The Challenge of Health Care The need to provide some type of health care system in the US has been a vexing, and costly issue. Two Issues: 1) Cost 2) Coverage

7. Politics of Health Care: 1990s Social Safety Net: The Challenge of Health Care 1990s: Cost: 1 out of every 7 dollars spent on Health Care Coverage: 37 Million (15% 0f pop) uninsured (in 1996 alone, 1.2 lost health care coverage) 2000s: Cost: (2007) 2.2 Trillion, (2016) 4.1 Trillion Coverage: 47 Million (16% of pop) uninsured

8. Politics of Health Care History of Health Care Reform in the US 1930s: FDR removed Health Care from 1935 Social Sec. bill due to doctor opposition 1940s: Democrats Push National Health Insurance, AMA led opposition 1950s: Rise of employer-based System. 1960s: Great Society programs: Medicare 1970s: Nixon introduced HMO legislation

9. Politics of Health Care Clinton Reforms: 1992 Election Competing Democratic Plans 1) Bob Kerrey: Type of Single-Payer Plan 2) Paul Tsongas: Managed Care, Jackson Hole Plan 3) Bill Clinton: Pay or Play

10. Clinton Reforms: 1992 Election Details of Democratic Plans Managed Care 1) Employers pay a Portion of Health Care costs 2) Government Sets Standards of Care 3) State administered “Health Insurance Purchasing Cooperatives” (HIPCs) 4) Community-Rate pricing Unmanaged Care: 1) Individuals buy insurance in the private market.

11. Clinton Reforms: 1992 Election Details of Democratic Plans Pay or Play: 1) Employers pry for health insurance 2) If they don’t, they must pay into a federal pool

12. Clinton Plan Modified Clinton Plan After considerable internal debate, and both Kerrey and Tsongas dropped out of the race, the Clinton adopted a modified managed care plan. Details of Clinton Plan 1) Employers pay a Portion of Health Care costs 2) Government Sets Standards and Flat Rate for Care 3) State administered “Health Insurance Purchasing Cooperatives” (HIPCs) 4) Federal Health Budget to cap costs

13. Health Care: 2008 Obama and McCain on Health Care: Managed v. Unmanaged

14. Obama Ad

15. McCain and Obama Ads McCain Ad: http://www.johnmccain.com/Informing/Multimedia/Player.aspx?guid=68f a68ac-e57e-41ef-861e-879aa5442b7e http://www.johnmccain.com/Informing/Multimedia/Player.aspx?guid=68f a68ac-e57e-41ef-861e-879aa5442b7e Obama Ad: http://www.youtube.com/watch?v=jnk8minM3Qg