Health care reform has remained front and center for the Democrats in a nomination fight that has been taking place for over a year now, and Ezra Klein has a web-only article on the American Prospect's website that mines the Clintons' bold debacle of 1994 for lessons for the current roster of candidates.

While the Clinton and Obama campaigns have sparred over the details of their health care plans, Ezra's piece should serve as a reminder that it is the political process and the approaches the candidates will bring to the White House that will determine the future of health care reform in the next (fingers crossed) Democratic administration.

Ezra writes:

Far too much of the process took place within the administration's various task forces and executive committees, and far too little of it within the halls of Congress...

By handing over the bill's writing to the wonks, the Clinton administration got a bill that addressed the wonk's concerns. But accurately reflecting the anxieties of health economists and policy specialists does not mean you've sufficiently channeled the fears of voters. Where the 1990-1991 recession left most Americans terrified that they could lose the health care they had, the Clinton bill promised they would lose that care. The sort of comforting lines reformers offer today -- "if you like your current care, nothing will change," or "you'll get the same health care members of Congress have" -- couldn't be uttered because they weren't true. The line the Clinton campaign did use, "health security that can never be taken away," foundered because, before the plan offered that security, the health security that Americans currently trusted would be taken away.

There's evidence in the public statements of Obama and Clinton that they've internalized the lessons of 1994. The importance of a transparent and inclusive process for round two of the fight for health care reform is clear, but Ezra's article contains another historical lesson that doesn't always make it into present-day exhumations of the 1994 battle.

He writes:

The progressive movement as a whole exposed its unreadiness for battle -- an unreadiness that was both tactical and psychological. Reformers were still operating under the assumption that the rules of bipartisanship were still in effect and a collection of public-minded Senators would eventually come together to successfully complete the process. They were wrong. The forces advocating reform weren't prepared for a Republican Party animated by William Kristol's famous memo, "Defeating President Clinton's Health Care Proposal," which darkly warned that a Democratic victory would save Clinton's political career, revive the politics of the welfare state, and ensure Democratic majorities far into the future. "

...

And the Democratic strategy to aggressively sell the plan? There was none. Clinton asked the Democratic National Committee to create a grassroots campaign in favor of health care reform in the summer of 1993. But their effort fell apart amidst media scrutiny of their proposed "educational foundation" and after that stumble, never found the funding to seriously continue. In July of 1994, the administration sought to recapture momentum with a bus trek across America, the so-called "Reform Riders." At every stop, they were met by better-organized, better-funded conservative protesters. Enormous amounts of energy and time had gone into the construction of an ingenious health care plan. It's as if no one realized, though, that they'd still have to sell it.

Their allies, however, should have known better. Where was Labor, the progressive movement, AARP? Essentially, nowhere. "Labor was split because it wasn't single-payer, and they were mad because of NAFTA," says one insider deeply involved in the process. "They held back on any kind of dedicated resources or substantial commitment to defending health care in the fall of '93. They came in later, but we were already taking on a lot of water. And the progressive movement, because it wasn't single-payer, ended up not really embracing the bill, and that lack of support really contributed to a one-sided, White House versus the world, dynamic."

Serious reform will require a broad-based progressive coalition that's ready to rumble.

Ezra sees considerable hope for optimism that the candidates and the progressive movement-at-large have learned from the past, and so do I.

Today, there is a convergence of forces that place far-reaching health care reform within reach: public appetite for health care reform, greater savviness on the part of advocates of reform, and widespread agreement--overheated rhetoric from the campaign trail aside--amongst the major candidates concerning the elements of a workable reform plan.

Ezra's article should remind reform advocates that familiar pitfalls can emerge again for the next Democratic president, but 2009 is shaping up to be the best shot at real progress on health care we have had since the Great Society.