Hillary and the Health Care Debate

President Obama's recent full-court press on health care began with an event in the Rose Garden last Wednesday featuring nurses. Obama had spent the previous week overseas and the previous days on other issues, so the White House was eager to kick off a sustained PR offensive. But it was noted by some that this kickoff was scheduled for precisely the same moment that Secretary of State Hillary Clinton, veteran of her own health care fight 16 years earlier, was attempting to jump start her new portfolio as the nation's top diplomat.

Such moments have fed nagging questions about just where Clinton fits in the administration of her one-time rival for the Democratic nomination for president. On Friday, the two sat down for a rare one-on-one lunch together as progress has slowed on Obama's top legislative priority. Did she weigh in?

“We talk about everything,” Clinton said Sunday during an interview on “Meet The Press.” She declined to say much more, citing her own policy not to “ever talk about what I talk about with presidents.”

Questions even putting "Clinton" and "health care" in the same sentence only seem to produce awkward reactions, or more often the case, deafening silence. Asked at one of his daily briefings this week if the two principals have ever discussed the issue thus far, Robert Gibbs said only: "I have not heard of any discussion recently on that."

A number of senators also professed to be unaware of whether Clinton and Obama have talked health care. "She's got her hands full with a lot of other things," Sen. Evan Bayh (D-Ind.) said. "Senator Clinton is busy trying to save the planet," Sen. Barbara Mikulski (D-Md.) added.

Asked how the current debate might be playing out had Clinton remained in the Senate, or been elected president, even those like Mikulski and Bayh who endorsed her in the primary were reluctant to answer. "That's speculation of no utility," the latter said.

More than a year ago, health care was one of the few substantive policy debates between the Democratic heavyweights in a campaign that otherwise was dominated by questions of electability, personality and delegate math. Clinton, aware that her past failure in this arena was still an issue in voters' minds, carefully rolled out a proposal in several stages, in full by September of 2007. Obama released his proposal in May of that year. In the months that followed, the two policies would be picked apart on air, in the mail and in multiple debates.

The primary difference between their plans was that Clinton's called for a mandate and pledged to cover all Americans.

"I have consistently said that Senator Clinton's got a good health care plan. I think I have a good health care plan. I think mine is better, but I have said that 95 percent of our health care plan is similar," then-Senator Obama said during a February debate in Ohio.

His campaign did spur a major confrontation over that 5 percent difference, though, in a direct mail piece that said Clinton's plan "forces everyone to buy insurance, even if you can't afford it." Her campaign and the candidate herself reacted furiously, prompting the famous, "Meet me in Ohio," declaration.

"My plan will cover everyone and it will be affordable. And on many occasions, independent experts have concluded exactly that," she said at that same February debate. "Senator Obama's plan does not cover everyone."

Despite the heated arguments, the campaigns would now acknowledge that the issue was not a decisive one. Now, White House aides say Clinton is busy with her own diplomatic portfolio, and profess not to be aware of whether the president and the secretary might touch on health care during occasional meetings.

But her influence is still being felt. Neera Tanden, who had a leading role in shaping Clinton's health care plan in the campaign, is now part of the Office of Health Care Reform in the Obama administration. And ironically, it now it appears that Clinton's mandate will be part of Obama's final health care bill.

"She was a little bit further to the left than he was on the mandate issue," a former Clinton campaign staffer said. "If anything she would have been pulling him more and more to the left if she had been in the Senate."

After Obama won the election, but before Clinton had been approached about a Cabinet post, she had hoped to play a lead role in the health care debate from the Senate. Sen. Ted Kennedy (D-Mass.), however, made clear he would be running the show. But he did announce three working groups to tackle specific components of a plan, and Clinton was chosen to work on insurance coverage.

Had Clinton been elected herself, it's unclear how she might have chosen to develop the legislation differently from the Obama path. The former campaign staffer said the debate might have unfolded largely the same way, but with one key difference.

"Obama enjoys significant personal approval ratings, which theoretically Hillary would not have had the comfort of," the staffer said. "It would have been a lot easier for the Republicans or the opponents of heath reform to tie to the issue of reform to the person of the president if Hillary had been in office. I think they're having a somewhat harder time demonizing the effort as an Obama-driven initiative."

But, the aide noted that in rolling out her plan during the campaign, she had emphasized the cost reduction component as much, if not more than the expansion of coverage.

"I think the White House, depending upon the week, have sort of been somewhat schizophrenic in terms of emphasizing one over the other," the aide said. "Hillary was very religious about emphasizing the cost issue. And Obama seems to be not as consistent - he does it, but just not as consistently as she did."

The unending parlor game that is speculation of the Clinton-Obama relationship will go on, much like, it seems, the reform effort itself.