During the debate over Clinton's health care overhaul in the early 1990s, McCaughey — then an academic at the right-wing Manhattan Institute — wrote an article for The New Republic called "No Exit," in which she claimed that Hillarycare would prevent even wealthy Americans from "going outside the system to purchase basic health coverage you think is better." Even though the bill plainly stated that "nothing in this Act" would prohibit consumers from purchasing additional care, McCaughey's claim was echoed endlessly in the press, with each repetition pounding a stake further into the heart of the reform effort.

McCaughey's lies were later debunked in a 1995 post-mortem in The Atlantic, and The New Republic recanted the piece in 2006. But what has not been reported until now is that McCaughey's writing was influenced by Philip Morris, the world's largest tobacco company, as part of a secret campaign to scuttle Clinton's health care reform. (The measure would have been funded by a huge increase in tobacco taxes.) In an internal company memo from March 1994, the tobacco giant detailed its strategy to derail Hillarycare through an alliance with conservative think tanks, front groups and media outlets. Integral to the company's strategy, the memo observed, was an effort to "work on the development of favorable pieces" with "friendly contacts in the media." The memo, prepared by a Philip Morris executive, mentions only one author by name:

"Worked off-the-record with Manhattan and writer Betsy McCaughey as part of the input to the three-part exposé in The New Republic on what the Clinton plan means to you. The first part detailed specifics of the plan."