August 28, 1994
"A Health Care Deal was Achievable, But Clinton Blew It - Good Diagnosis, Bad Medicine"
San Jose Mercury News
By Timothy Taylor
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THE finger-pointing is about to start. As the chances for significant health care reform this year dwindle away, who's to blame?

The list of possible villains includes big business, the health care industry, and some medical care providers. It includes obstructionist Republicans who want no change, obstructionist Democrats who want socialized medicine, and the institutionalized inertia of American politics.

But when Bill Clinton starts parceling out the blame, he should first look in the mirror. A health care deal was there to be had, and he messed it up.

Remember, everyone supported health care reform in the 1992 presidential race. All the Democratic candidates had their proposals. Even George Bush, not exactly a wild-eyed government activist, had a health reform plan on the table.

There was widespread agreement that the United States was spending far too much on health care -- almost $1 trillion this year! -- while leaving far too many people uninsured, or in fear of losing their insurance. Through 1993 and early this year, polls showed that Americans were ready for substantial health care reform, and were even willing to pay a bit more in taxes if necessary.

The momentum was there. But when served all this lemonade, Clinton proceeded to turn it back into lemons.

His first major blunder was deciding to let his wife and his old buddy Ira Magaziner write a health care plan from scratch. They produced the Frankenstein's monster of health plans, a theoretical mind-experiment run amok. In their deliberations, Hillary Clinton and Magaziner didn't see fit to include anyone from Congress. Nor anyone tainted by holding a leadership position in the health care professions. Nor anyone representing large or small business. They even largely left out the best-known academics who had been working on health care issues for decades.

Instead of building consensus from the start by choosing a sympathetic bipartisan panel of government, business and labor, the president let two earnest gadflies flutter about. As it became clear that their plan had almost zero support, and didn't deserve much more than that, Clinton made his second blunder.

Rather than defending what was called "the Clinton plan," or involving himself in the details of any plan, Clinton simply said that he would sign any plan that assured universal coverage, and veto any plan that didn't.

Ignoring the tough details of universal coverage -- like cost control, and who should pay for what level of health care -- was a peculiar strategy for a president who had run for office bragging about his mastery of the details of policy. But at the time, the strategy probably seemed like good politics. Clinton could hold well-staged photo opportunities with unfortunate people who had suffered from a lack of health insurance. Moreover, he didn't have to openly repudiate the health reform plan from his wife and his old friend.

But this strategy was not leadership. High cost and universal coverage are Siamese twins, inseparably connected. After all, if the cost of medical care wasn't a problem, then expanding insurance coverage wouldn't be so difficult, either. The extraordinarily high U.S. health care costs are also a problem in themselves, stressing government budgets and eating up corporate and individual resources, without providing any measurable gain in the overall health of Americans.

At this point, Clinton had forfeited any leadership role in health care reform, but at least he was playing a useful subsidiary role, by insisting -- quite rightly -- that meaningful reform must guarantee universal coverage. In January, he waved his veto pen at Congress and a national television audience, and declared:

"If you send me legislation that does not guarantee every American private health insurance that can never be taken away, you will force me to take this pen, veto the legislation, and we'll come right back here and start all over again."

Clinton's third blunder came last month, when he backed away from that veto threat, and said he would accept less than universal coverage. At that point, the health reform debate in Congress began to resemble piranhas dividing up a side of beef.

Maybe an airy promise of insurance coverage for 90 percent of Americans by the year 2000, a few sweet nothings about cost controls, and a commission, to be appointed in 2000, to deal with any problems? Write it up. If the bill doesn't literally deprive people of health insurance, Clinton will sign it and call it a victory.

Supporters of the need for serious health care reform, myself included, have been too soft on Clinton. We have given him credit for "raising the issue" and "heightening public awareness" and generally having fought the good fight. Now, that support seems like sentimentality. After 20 months in office, Clinton no longer demands universal coverage, nor any particular method of cost control, nor any actual plan of his own. When the going got tough, he folded like wet cardboard.

In the politics of health care reform, as everywhere in life, opposition and enemies may hinder you. But only inept and well-meaning supporters, like the Clintons, can do you in completely.

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