WASHINGTON -- Hillary Clinton and Bernie Sanders remember the history of health care reform in the 1990s and the 2000s very differently. In a sense, they're both right.
The way Clinton sees it, Democrats like her fought for years to achieve health care reform, a battle that scarred her and President Bill Clinton in the 1990s and culminated in President Barack Obama signing the Affordable Care Act in 2010. From that perspective, it was politicians further to the left, like Sanders, who wouldn't let go of their single-payer dream -- making it more difficult to rally liberal voters and overcome conservative resistance to reform.
That's why Clinton has attacked Sanders, the independent senator from Vermont who's challenging her for the Democratic presidential nomination, as being AWOL -- even hostile -- during the Clinton and Obama health care debates. "I don't know where he was when I was trying to get health care in '93 and '94, standing up against the insurance companies, standing up against the drug companies," Clinton said on Saturday.
Sanders thinks Clinton has it all wrong -- that he has been a loyal advocate for reform, even as he has pushed for a more liberal version of it. To prove the point, the Sanders campaign responded to Clinton’s latest jab with a video of a 1993 health care rally. In it, Clinton is speaking about the plan she and then-President Clinton crafted -- and Sanders, then a junior House member, practically couldn't be closer to her.
Pundits and Sanders supporters quickly seized on the video as proof that Clinton was, once again, twisting the truth. And it’s true that Sanders, a consistent and relentless proponent of single-payer reform, has never shied away from fighting against insurance companies -- or crusading for greater access to health care.
But his presence at that speech -- like a gracious letter Clinton sent him in 1993 -- isn't proof that Sanders was a major ally of the Clinton health care effort. Sanders wasn’t even endorsing the Clinton plan, unlike another member of Congress who attended the rally.
And an internal memo from the Bill Clinton administration shows that the White House was worried that Sanders might hold out. "Given his reputation for independence and his more combative style [he] may be of the more difficult members to get on board the Administration’s proposal,” the memo said.
In fact, Sanders opposed the proposal throughout the process, his campaign confirmed to The Huffington Post. As late as August 1994, while Democrats were making a last-ditch effort to pass Clinton’s plan, Sanders held a press conference opposing it -- and touting single-payer, according to his campaign.
Sanders' commitment, or lack thereof, to the White House plan wasn't a cause of its failure, considering staunch resistance from the health care industry, Republicans and conservative Democrats. But Clinton clearly hasn't forgotten it.
This contretemps over what Sanders did and when reveals fundamental differences between Clinton and Sanders, their respective politics, and how they may govern as president. Clinton prizes pragmatism over idealism, while Sanders believes in the converse.
The pattern established in the 1990s would repeat itself in 2009 and 2010, when Congress was debating what would become the Affordable Care Act. Sanders by then was a senator, with a seat on one of two committees writing reform legislation.
Clinton's involvement in the process was minimal; she left the Senate to join Obama's cabinet in early 2009. The trove of Clinton emails since released show she did some work behind the scenes cajoling Democratic lawmakers to support the initiative.
One of the most contentious issues dividing congressional Democrats was whether to include a "public option" that would compete with private health insurance companies in the bill's exchange marketplaces.
Sanders was among a cadre of liberal senators who withheld their support from the health care legislation because it lacked a public option. They were countered by then-senators, including Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.), and other conservative lawmakers who flatly refused to vote for a measure that included a public option, which was strongly opposed by the health care industry.
Less than two weeks before the Senate's Christmas Eve vote on the bill in 2009, Sanders was still protesting the absence of a public option -- and threatening to withhold his vote at a time when all 58 Democrats and the two independents allied with the party were needed to overcome a Republican filibuster.
"I have real concerns with this bill as it stands right now," Sanders said on Dec. 16, 2009. "So I’m not on board yet. At this moment, I am an undecided," he said. "We’re working hard to try to make this bill be a better bill. I would like to support it, but I’m not there yet."
In the end, the "moderates" won and the liberals lost. And Sanders' gambit to present single-payer legislation as an amendment to the bill failed when then-Sen. Tom Coburn (R-Okla.) cited Senate rules and demanded Sanders read the whole thing aloud. Sanders instead withdrew his amendment.
Sanders and the 59 other members of the Senate Democratic caucus voted for the bill anyway. The Democratic leadership offered Sanders a face-saving amendment providing additional funding for community health centers, a priority any Democrat would have supported.
In other words, when push came to shove, Sanders set aside his principled stand for single-payer health care and instead helped enact the biggest expansion of the safety net since the Great Society.
That's just the kind of political realism that typifies Clinton, and just the kind of compromise Sanders' campaign rhetoric indicates as harmful. Maybe these two candidates aren't so far apart, after all.