Your e-health future

In 1993, then-First Lady Hillary Clinton chaired a health care task force that met behind closed doors, crafted a labyrinthine proposal that topped 1,000 pages, and then asked the U.S. Congress to approve it.

We know what happened next. Democrats excluded from the secretive drafting process attacked from the left, a mostly unified Republican opposition rallied in opposition, and health insurers dealt "Hillarycare" the final blow through the so-called Harry and Louise television ads.

President Obama's plans to reshape the nation's health care system are no less ambitious. Last week, at a meeting with Speaker Nancy Pelosi at the White House, he said to expect the House of Representatives to vote on legislation by July 31--which is, by Washington standards, a turbocharged schedule.

One difference between the 1993 and 2009 approaches, of course, is that the current administration has hardly made this topic its first priority. (It has the longest recession since the Great Depression to thank for that.)

The more striking difference, however, is that Obama doesn't appear as insistent as Clinton on spelling out details. So far, at least, he's insisting on broad principles. Those are, as the president said last week: "first, that the rising cost of health care has to be brought down; second, that Americans have to be able to choose their own doctor and their own plan; and third, all Americans have to have quality, affordable health care."

In political terms, that's approximately as difficult as endorsing Mother's Day, apple pie, and baseball. The tricky part will come when drafting the legislation, especially when it comes time to answer questions like: Won't costs spiral out of control as surely as other entitlements have? Will costs be kept down by rationing, as Canada does?

A side effect of any "Obamacare" bill is that it may rally a disorganized and dispirited opposition party. To prepare for the conflict, Republican pollster Frank Luntz already has drafted a set of talking points for his party members. (This prediction happens to poll well: "That it will be government-run, bureaucratic-controlled, and special interest-driven.")

"How can they expect to get costs under control by doubling the government's role in health care?" asked Jim Demint, a South Carolina Republican. "The answer is by rationing care. If government wants to cover 230 million Americans and bring down costs, the only way it can possibly do it is denying care to people whose health care is deemed--you guessed it--not in the public interest."

And the Harrys and Louises are back, sort of. A group called Conservatives for Patients' Rights has already posted videos warning of the dangers of following Canada's lead, which, given the wait times for surgery, should make plenty of us leery.

Then again, if you're completely uninsured, a little bit of Canadiana might sound like a very good idea.