Clinton's attempt

When most Americans think of health care reform, they think back to the first term of the Clinton administration—and they remember as a huge failure.

During the election against then-sitting republican president George H. Bush, Bill Clinton tried to define himself as a New Democrat, who favored the principles of the Democratic Party yet was adverse to big government. He promised health care reform, pledging to introduce legislation to Congress within the first 100 days of his presidency.

After entering office, he quickly formed an Interagency Task Force, chaired by his wife, Hilary Clinton. Doing so drew large criticism from Republicans—there was no precedent for such a move. The Task Force was meant to be small, identify key policy and deliberate in secret to provide a unified front when legislation was eventually introduced.

Instead, the Task Force wound up with 630 members, including representatives from all the Democratic Senate and House members as well as representatives from relevant government agencies. With a group that size, leaks were inevitable. The Administration refused to talk officially about plans, giving those with little knowledge or say in the outcome room to talk, and the opposition a head start at organizing.

The Task Force did finish its job, and the Administration used its recommendations to write the bill, evaluate costs and prepare a political strategy. The bill didn’t reach Congress until Sept. 7, 1993.

The resulting plan was a complicated hybrid of sorts that looked promised universal coverage mostly through worker mandate. Costs of plans would be controlled by creating competition between insurance companies, a sort of managed market. Clinton presented the plan to a joint session of Congress on Sept. 22.

At this point the reform proposal was well-received. Even Republicans were jumping on board, asking for coverage of pre-existing conditions and consumer based decision making, including knowledge of efficacy and cost effectiveness.

That’s where the honeymoon ends. The bill was insanely long, 1,342 pages of highly technical policy. The complexity along with the following problems plagued the bill for another year.
Various associations who had a stake in the bill, most notably the National Federation of Independent Business and Health Insurance Association of America, began to voice concerns of price caps and lost business. Small business associations worried the mandate would bankrupt their members. Throughout the attempt to pass reform, opponents spent $147 million in today’s dollars, while supporters only spent roughly $7.4 million in today’s dollars. The most famous example of this is the “Harry and Louise” ads, where a middle-aged, presumably middle-class white couple complains about their lost of choice in insurance providers.



To add to the mess, foreign policy issues distracted the Administration. The Battle of Mogadishu (the Blackhawk incident in Somalia) delayed the introduction of the bill in the first place, giving less time to promote the bill to the public and more time to opponents to craft a counter-strategy. The ratification of the North American Free Trade Agreement (NAFTA) in 1993 angered unions, a key support for the reform.

Bi-partisan support began to erode and some democrats were introducing their own bills, like the single-payer plan in part from Minnesota Sen. Paul Wellstone that garnered lots of union support, a traditional Democratic voting block. Another democrat introduced a purely market/competition plan, with no universal guarantee. When it was clear support was winding down for reform, the GOP even introduced the “scorched-earth policy” in the summer of 1994, telling Republicans to vote down reform of any kind.

The bill officially died on Sept. 26, 1994. Former South Dakota senator Tom Daschle wrote in his book Critical, “the great health-care debate of the early 1990s expired with barely a whimper.”