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As I continue to read the ongoing debates in health care, I keep coming up on references to “HillaryCare” and the 1994 health care reform plan proposed by the Clinton administration. The spin now is that, hated as it was by all ends of the political spectrum, it was a “missed opportunity”. Those of us who were in health care at the time may recall a different history depending on where you sat.

But that’s old news really because that was then, and this now, and a new history will be once again re-forged to suit contemporary political purposes (see my “Essaying about Wonks and Hacks”). “HillaryCare” will be held up as an example of too much, or too little, or too expensive, or too federal, or too managed care, or too generous or too something or other.

So in an effort to defend against the upcoming spin onslaught, I went to the book shelf and pulled out my original copy of the proposed “Health Security Act” which I ‘ve been keeping for sentimental purposes for over a decade now. This ponderous tome of 1342 pages, weighing in at over 4 and one half pounds, containing 11 Titles, 60 Subtitles and hundreds of sections was the epitome of health care wonkiness; a frankenstein corpus born of lawyers, lobbyists, policy freaks and politicos.

All of health care’s “best and brightest” seemed to have had a go at it. Every consultant peddling their wares laid claimed to have worked on this or that task force putting the bill together. The health care friends of Bill and Hillary were legion and everywhere. Analysis upon analysis was heaped on an unsuspecting and wary public. Everyone, and I mean everyone, who could gain an financial advantage, a benefit, a contract, a consulting gig was in Washington pushing their thing. It was a heady time although chaos reigned among the righteous.

Now one impact of that experience was the historic formation of hundreds of new lobbying and special interests groups in health care; new groups that built surprisingly effective grass roots organizations in local communities, some that continue to exist today. Health advocacy groups, professional unions, industry associations and others all got serious about the politics of health care. And for good reason. Everything, it seemed, was at stake. In the end it was just all too much for the American public to take in. They were afraid and rejected the whole damn package.

If the “Health Security Act” would have been enacted in 1998 as the bill required, I suspect we’d still be arguing about how to implement it. If we think that installing the Medicare Part D Drug benefit was difficult — and it was — bringing Hillary’s 1990s vision into being would have been a monstrous undertaking fraught with possible “black swans” and other disruptions.

You would think that with all that talent the proposal would at least be prophetic of the future of health care.Yet for the most part it failed to deliver on quality outcomes, preventing medical errors, transparency, personal responsibility, health IT as well as other critical issues we now see in health care delivery. No it was an old school kind of proposal — cold war style — not a ‘before its time’ intellectual product.

So here on my desk sits the past or possibly the future of health care. Scary thought really. But I’ll take a tour through it just the same, if for no other reason than to pay homage to one of health care’s most interesting battles, and make sure if there were lessons to be learned here we actually remember what they were instead of depending on the reconstruction of others.