The Obama reforms would push the U.S. health care system in this direction a lot more slowly than the Clinton plan would have: Among other things, if Obama gets his way, insurance arrangements for the vast majority of people won't change, at least right away. (Under the old Clinton plan, almost every working person would have changed plans.) This is undoubtedly because pushing more quickly risks the sort of patient backlash that helped kill reform last time. But Obama also has the benefit of time--and, perhaps, a slightly smarter electorate. In the early 1990s, everybody feared managed care in part because it was still pretty unfamiliar. Today, the basic concepts are at least familiar- -as is the idea that our health care system is awash in expensive, sometimes harmful excess. Americans, in short, may be a little more receptive to the idea of managed care than they were a decade ago. Just as long as nobody calls it by that name.
The news about health care is a little confusing these days. While polls show that Americans still support the key elements of health care reform that President Obama and his allies are trying to enact, there have been numerous reports of conservative activists showing up at congressional town halls across the country, protesting those same plans with an energy not matched by the other side.
The imbalance may simply reflect the media's preoccupation with conflict and confrontation. Liberal rallies in favor of reform have garnered no similar attention, although they've attracted hundreds, and in some cases thousands, of people. But I suspect the enthusiasm gap is at least partly real--that the hate for the plans moving through Congress runs much stronger than the love, that the people fighting to stop these bills feel more intensely, and have more determination, than those fighting to pass them.