HEALTH CARE REFORM
A Blueprint for What Not to Do When Planning Sweeping Reforms
By Jerry Geisel
ill Clinton’s election in 1992 and the crashing failure of his universal health insurance reform package—initially considered a near slam dunk—illustrate that predicting the impact of results of national elections is not a science.
The Clinton vision was for health care to be provided through government cooperatives, rather than through employers and insurers.
Mr. Clinton’s first step—naming then-first lady Hillary Rodham Clinton to chair the presidential task force that would develop the reform legislation—initially was considered a savvy move. Instead, it was a blunder, and the first of many that ultimately would derail the reform drive. While Hillary Clinton undoubtedly had great intellectual ability, unequaled access to President Clinton and a real interest in health-care reform, she was lacking in other areas. Except for a brief stint in Washington during the early 1970s as a staffer on a congressional committee during the Watergate scandal, Hillary Clinton had spent most of her adult life in Arkansas, where Bill Clinton served as state attorney general and, later, several terms as Arkansas governor. The result was she lacked contacts or close relationships with members of Congress who, in time, would control the fate of the reform legislation. Hillary Clinton also was responsible for the establishment of what became a more than 500-member task force to develop—in great secrecy—the administration’s health-care reform package. That decision was at odds with the way major pieces of legislation typically are developed: A small number of administration staffers produces a broad framework, while Congress, as the legislative branch, and working closely with the executive branch, fills in the pieces. That approach not only follows Congress’ role as the legislative branch, but also gives lawmakers ownership in legislative proposals. Yet another mistake—shared by both Clintons—was the appointment of longtime acquaintance Ira Magaziner to run the health-care task force. Business groups, for example, complained about how the imperious Mr. Magaziner ignored their views, while reporters and congressional staffers said they were kept out of the loop. Mistakes continued. Instead of producing a reform outline, the task force published a 1,362-page super-detailed bill, which quickly was derided for its bulk. Meanwhile, legislators, who were kept out of the drafting process, began to develop their own proposals, which quickly splintered the reform drive. Political misstepsThen, Hillary Clinton made perhaps the biggest mistake of all, violating a basic rule of politics: Either ignore or try to work with opponents. Instead, she chose to bash health insurers when the industry—provoked by what it said were unfair attacks by the administration—sponsored a series of ads in which a couple, known as “Harry and Louise,” discussed at their kitchen table the problems with the Clinton health-care package. Enraged, Hillary Clinton lashed out, giving the ad campaign publicity, recalled Bill Gradison, then-president of the Health Insurance Association of America, which sponsored the ads. This was publicity and attention no amount of money could buy. By coincidence or other factors, whatever support there was for the administration package dried up, and last-ditch efforts to develop alternatives ran aground. When it became clear as the congressional session was ending in October 1994 that the administration’s effort had failed, George Mitchell, then the Senate majority leader and a longtime Maine Democratic senator, blamed “special-interest” lobbying. But President Clinton, in a sentence, got to the real heart of the matter. Maybe, he said, “We bit off more than we could chew.” Applying that lesson, the administration’s involvement in health-care issues in the years following the collapse of the reform package concentrated on more modest objectives. Taking on health-care issues in smaller bites proved to be much more successful. Indeed, between 1996 and the end of Bill Clinton’s second term in 2000, federal legislators passed four modest health-care reform measures, including the Health Insurance Portability and Accountability Act, which made it easier for employees to change jobs without fear of losing health insurance and another—expanded at the end of the most recent congressional session—that banned discriminatory annual and lifetime dollar health plan coverage limits for mental health disorders.
—Crain's Benefits Outlook Online, November 2008
Jerry Geisel is a reporter for Business Insurance. To comment, e-mail
editors@workforce.com.
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