How Hillary Won Over the Health-Care Industry

She has also worked hard to win her former critics over—soliciting their views and taking their advice. In July she invited several prominent health-care-industry officials to meet with her and members of her campaign and legislative staff, says Dr. Bruce Bagley of the American Academy of Family Physicians, who was one of the attendees. Bagley noted how different things seemed. "Back in '93 it was a fairly closed process. It seemed like this big black box that finally came up with a plan," he says. This time she asked the group what her health-care quality message should be—and spent two hours listening to their ideas, key elements of which ended up in a health-care speech she subsequently delivered in New Hampshire. "For the most part, it was consistent with what we were trying to promote," he says of the speech. After the meeting Bagley got a personally signed thank-you note from the senator. And after the speech he got a hand-written note on her own stationery thanking him for having vetted her remarks beforehand. "As you know, improving the quality of health care that patients receive is fundamental to a reformed healthcare system, and I am committed to ensuring it as part of my agenda for covering all Americans," Clinton wrote. Bagley says hasn't heard from any of the other presidential candidates.

The American Medical Association also reports a warming trend. The group was frustrated by how she handled the process in '93 but now finds her staff regularly reaching out to consult. In a speech she gave to the AMA in early 2006, the group was pleasantly surprised to hear her give voice to many of its top priorities. "Physicians should have a payment …" she said, before being interrupted by thundering applause. "Physicians should have a payment structure that doesn't result in year after year of significant and unsustainable cuts when we all know health-care costs are increasing." Fighting cuts in Medicare payments was a priority for the AMA in 2006 and remains so today.

But Clinton isn't just talking the talk. Health-care groups say they have been encouraged by her work in the Senate—where she's taken a more restrained and incremental approach. In the '90s she thought she could elbow past members of Congress. But since becoming one herself, she has made a point of joining forces with Republicans on health-care issues. Together they've worked to expand coverage for veterans and children, as well as to modernize the system with electronic, rather than paper, medical records. Her former foes in the industry have taken note. "Since becoming a senator, she's been focused on quality improvement, safety improvement, comparative effective analysis. We support all of that," says Karen Ignagni, CEO of American Health Insurance Plans, the health-insurance industry trade group. This year AHIP, whose lobbyists are in constant contact with Clinton's staff, put forward its own plan for universal coverage, which Ignagni says got a positive response from the senator's office.

She's made nice with the pharmaceutical industry, too. Big Pharma's lobbyists are constantly engaged with her staff, as they are with other members of Congress. "Hillary recognizes the important role of employer-provided health insurance and the important role of private markets in insuring the people in the country," says Billy Tauzin, the president of PhRMA (the Pharmaceutical Research and Manufacturers of America, a trade group for the industry), who voted against her first plan when he was a member of Congress. "I take comfort in that."

Clinton has also benefited from a growing public appetite for reform. There are now 47 million people without health insurance in America, compared to 40 million in 1993. Those who are covered have seen their insurance premiums double. Voters are now much more anxious—and better informed—about health care, making it a potent issue in the coming election. "In the 1990s, when Hillary first came out with the plan, the average Joe thought, 'I'll always get health care.' Right now there's scarcity," says Mary Kate Scott, of Scott & Co., which does health-care consulting. "We actually feel the pain."

The industry does too. In the last decade and a half, its own costs have ballooned, and the legions of uninsured people are an ever-increasing burden on the system. Health-care groups say they're now looking for solutions, and ready to talk. "The sun and moon have aligned," says Kahn. Adds Mike Bromberg, a lobbyist who helped kill the Clinton plan in the early 1990s: "There's a shift in the health community. There are more people in health care who don't seem as concerned about government program expansion anymore. When they're facing bad debts and all the uninsured patients, they'd rather have something than nothing."