Hillary Clinton's Health Care Diva

(Laurie Rubiner, Legislative Director in the Office of Senator Hillary Clinton)

Hillary's foreign policy team has some of the mega-stars in the national security business. She has Madeleine Albright, Richard Holbrooke, Sandy Berger, Wesley Clark, William Perry, and a good number of their acolytes -- but her counselors are about as top-heavy as George W. Bush's team was with Dick Cheney, Colin Powell, Condoleezza Rice, Donald Rumsfeld, Richard Armitage, Paul Wolfowitz and others on board.

Having a lot of big guns as advisers doesn't mean that they will all shoot the same direction. In fact, rumors continue to slip out of the Clinton camp that there are substantial tensions between Holbrooke, Albright, and Berger who all are trying to define the key features of Hillary Clinton's foreign policy persona. To give Hillary some credit that John Kerry's campaign doesn't deserve, I think she has more a sense of her own views than Kerry might have -- and is willing to knock back the counsel of her advisers and is willing to tell them to cease the bickering, elbowing, and theatrics between these competitive camps.

But in health care -- there is one voice who dominates the policy work in "Hillary Land" and that is Laurie Rubiner. (and yes I know, Hillary knows a lot about health care policy but I'm not counting her.)

Imagine a diva who was not haughty and spoiled -- but just emanated total confidence and knowledge of some skill or issue -- like quantum mechanics, or magazine editing, or health care. That is Laurie Rubiner.

Yesterday, the New York Times profiled Rubiner and her significant contributions to Hillary's much talked about health care proposal. The Washington Note profiled Laurie Rubiner's work this past January -- and today John Fund at the Wall Street Journal takes on Rubiner (and of course, Hillary).

Rubiner doesn't only do health care policy; she runs Hillary Clinton's entire policy shop in her Senate office. In fact, in my view some of the major power brokers in Hillary Clinton's political machine sometime forget that the actual Senate staff Hillary has hired are mostly better in their ability to project tomorrow's policy needs than the White House-hungry policy advisers she has brought in to the campaign.

I should probably disclose that Rubiner and I had one serious argument that had to do with communication, honor, and who said what to whom -- but her husband told me later that what I saw was a mild breeze compared to what was possible. But I have learned from several sources that Hillary Clinton and Rubiner have the kind of gritty give-and-take relationship that few have with the Senator and would-be President of the United States. They can argue about some serious policy difference, tell each other to go to hell, and then laugh it off.

Rubiner headed the health care policy program of the New America Foundation where I have worked for the last nine years. Before joining New America, Rubiner worked in a number of key policy and advocacy roles -- but it was her work for the late Senator John Chafee (R-RI) where she conceived under the Senator's name and at his direction a health care plan that would maintain private sector deployment of health care services as the backbone of America's health system, avoid the single payer debate that divides that policy community, and be universal.

Rubiner brought her work to New America -- and the DNA of her efforts exists in all of the significant "test efforts" of comprehensive health care coverage -- including in Republican Arnold Schwarzenegger's proposal for California, Democrat Gavin Newsom's in San Francisco, and Republican Mitt Romney's in Massachusetts.

Now, Hillary Clinton has brought the sensibility of the Chafee/Rubiner health care proposals into her own plan for the country and demonstrated considerable political bravery and sensitivity in doing so. I think it takes a lot for someone like Hillary Clinton to abandon her former approach on health care coverage in which she drilled down into the fine and messy details -- and change course, rather than doing what many people who acquire power do -- and that is just yell more loudly or force more strongly a posiition they previously held.

Rubiner does a killer impersonation of Senator John Chafee, and it's so compelling that on one occasion when I was quite upset with the vote of his son, the no-longer-Republican former Senator Lincoln Chafee, on John Bolton's UN confirmation, I advised the younger Chafee to go spend time with his dad via Laurie Rubiner. I can just imagine Rubiner channeling John Chafee for Hillary Clinton and giving the Senator the secrets to making this universal health care coverage work.

Interestingly, John Fund today hardly scrapes the policy framework or nuts-and-bolts of the Hillary/Chafee/Rubiner health care plan -- but rather the optics and the politics of it. He slams Clinton's plan for being like Schwarzenegger's -- and then asserts that this plan will lead to new bureaucracies, open up tensions on coverage for illegal aliens, and fail to generate needed bipartisan support.

The fundamental, underlying problem that exists in America's health care sector is getting people with financial means who elect not to get health care to do so. If a mandate were generated that everyone needed to be in health care, not only would the nation as a whole become healthier but the costs of subsidizing those in real need or without financial means declines on a relative basis. I hope John Fund and other critics of Hillary Clinton's new proposal don't believe that the less well off should just stay that way and should get nothing at all from America's health care system.

Clinton's (and Rubiner's) proposal maintains a vibrant private sector backbone for the provision of health services; there is no "socialization" of providers and no single payer requirement.

John Fund may revisit this issue of how to get to a healthier health care system in the United States, so let me share with him and others what conservative libertarian Ronald Bailey wrote in 2003 in Reason Magazine about the New America Foundation's health care proposal (as hatched and incubated by Laurie Rubiner). This from Bailey's "Mandatory Universal Health Insurance? Perhaps It's a Better Idea Than You Think It Is":

Since it's unlikely that Americans will allow their improvident neighbors to expire without medical care in the streets, is there a politically palatable alternative that can preserve and expand private medicine in the United States? Yes: mandatory private health insurance.

Should the federal government require all Americans to buy private health insurance? This intriguing proposal is being pushed by the New America Foundation, a liberal policy shop in Washington, D.C. "Universal coverage in exchange for universal responsibility," is how the NAF characterizes it.

Before rejecting the proposal out of hand, stop and consider that it may be a second-best alternative for relieving the growing political pressure to create some sort of nationalized single-payer health care system modeled on the nearly bankrupt and increasingly shabby health care schemes in Canada and Western Europe. Make no mistake about it--private health care is imperiled in the United States, given that all of the Democratic presidential hopefuls want to expand existing government health care programs and/or create some sort of universal government-run system. The NAF proposal could derail this pernicious political dynamic.

The devil is in the details, of course. Still, the NAF plan offers some interesting possibilities. For example, mandatory health insurance coverage might be combined with desirable features such as medical savings accounts, which would encourage people to save and invest for future medical emergencies.

The NAF proposal preserves private insurance and allows consumers to choose among competing insurance plans and coverage options. Most intriguingly, NAF offers a way out of the dysfunctional employer-financed third-party-payer system that is so grievously distorting our current health insurance system. Employers would eventually devolve responsibility for health insurance to their employees by giving them the money the companies currently pay out to insurance agents. Employees would then have a strong incentive to shop around for the best health care deals, putting pressure on insurance companies to keep costs low.

While I think the New America Foundation is more "radical centrist" than "liberal", I completely agree with Bailey's general take on how to get Americans covered by health insurance without tipping towards inefficient socialized bureaucracies or the alternative, manic market provision of health care which assures humanitarian nightmares for the tens of millions and growing in the United States who have little prospect of securing health insurance.

If the libertarians in addition to Democrats like Gavin Newsom and Hillary Clinton and Republicans like Mitt Romney and Arnold Schwarzenegger can sign up for what John Chafee launched some years ago -- then this deserves serious national scrutiny at all levels of government. Next to America's deteriorated national security and foreign policy standing in the world, the absence of strategy to credibly broaden health care in this country is our largest problem.

Kudos to Hillary Clinton for having the confidence of self to allow a "Senate staffer" in her employ to get some of the media credit for her proposal. This alone says something about Clinton that I haven't noted before. Staffers aren't supposed to get credit, and they certainly can't angle for it.

Rubiner is getting credit not because she wanted any of this -- but because to connect the dots in the political history of what is the most likely universal health care plan to come into being -- one must tell the story of Laurie Rubiner.

-- Steve Clemons is Senior Fellow and Director of the American Strategy Program at the New America Foundation and publishes the popular political blog, The Washington Note