Ezra Klein: The three reasons the Clinton administration's health care reform effort failed, and how the next Democratic president can get it right
[Ezra Klein is a Prospect staff writer.]
In the best of circumstances, presidential libraries are a strange combination of leftover campaign literature and newfound architectural ambition. Even so, the Clinton Presidential Library, in Little Rock, Ark., is notable for approaching its subject with all the depth of a coloring book. Eight years of policies, political battles, and world events are sorted into 20-odd "policy alcoves," each headlined by a slogan from the campaign. In the alcove labeled "Putting People First," behind reinforced glass tattooed with inspirational excerpts from Bill Clinton's speeches, the administration's entire record on social policy is condensed into a couple of blown-up photos and capsule summaries. And right there, between "Caring for Children" and "Welfare Reform," is the library's exhibit on the 1994 health care battle. It gets 144 words.
Uncharitable observers would sneer that this is all it deserves. They would be wrong. The 1994 health reform fight was a tremendous, courageous undertaking that the nascent Clinton administration approached seriously, substantively, and disastrously. Their defeat, which preceded an election in which the Democrats lost 52 House seats and control of Congress, inflicted an enormous psychic trauma on every level of the Democratic establishment -- the politicians, the political consultants, the advocacy community, and the hundreds of wonks and experts who participated in the plan's creation. It taught many that health care is simply too big, too complicated, too dangerous to touch. Since the drubbing, Democrats have been afraid, as former Sen. Bill Bradley put it, "to go back into that room where that bad thing happened."
For reformers, that attitude is the foremost impediment to change. Much talk centers around the specific contours of the ideal policy solution, but though important, such conversations are like agonizing over the wedding band before anyone's agreed to join you for dinner and a movie. For policy to matter, policy-makers must be willing to advocate it. But many remain timid, scarred by past failures and disappointments, certain that any attempt will end in electoral catastrophe.
The moment has, after all, looked propitious for change before, and failure has been all the harsher for it. Health care, which now comprises a full one-seventh of the economy, is notoriously difficult to reform. Harry Truman failed, as did Richard Nixon and Bill Clinton. Franklin D. Roosevelt didn't even try, believing any attempt would not only fall short, but take down Social Security, too.
And the system has only grown larger and more entrenched in the years since. Heath care is now a multi-trillion dollar industry that generates billions in profits for all manner of powerful actors. Medical coverage is a source of acute anxiety for Americans in general and voters in particular -- where about 84 percent of the population has health insurance, 94 percent of voters do, and they are deeply afraid of losing what they already possess. Finally, the arithmetic of the Senate remains unfriendly, with the creation of a 60-vote supermajority appearing the only way to move major legislation.
Together, these forces and factors doomed health reform in 1994. Or so goes the story. But the collapse of the Clinton reforms was also a product of bad timing, political misjudgment, and human error. The Clinton administration did not prioritize health reform upon entering office, and so lost whatever window of opportunity might have existed; they mistook good policy for good politics, and created a bill better suited to a Brookings seminar than the political process; and they failed to appreciate the need for a national strategy to sell the plan to the American people,
Luckily, today's reformers have one thing yesterday's didn't: The lessons of 1994. And the degree to which they've learnt them -- which increasingly appears considerable -- may decide whether the next president finally succeeds where so many others have failed....
Read entire article at American Prospect
In the best of circumstances, presidential libraries are a strange combination of leftover campaign literature and newfound architectural ambition. Even so, the Clinton Presidential Library, in Little Rock, Ark., is notable for approaching its subject with all the depth of a coloring book. Eight years of policies, political battles, and world events are sorted into 20-odd "policy alcoves," each headlined by a slogan from the campaign. In the alcove labeled "Putting People First," behind reinforced glass tattooed with inspirational excerpts from Bill Clinton's speeches, the administration's entire record on social policy is condensed into a couple of blown-up photos and capsule summaries. And right there, between "Caring for Children" and "Welfare Reform," is the library's exhibit on the 1994 health care battle. It gets 144 words.
Uncharitable observers would sneer that this is all it deserves. They would be wrong. The 1994 health reform fight was a tremendous, courageous undertaking that the nascent Clinton administration approached seriously, substantively, and disastrously. Their defeat, which preceded an election in which the Democrats lost 52 House seats and control of Congress, inflicted an enormous psychic trauma on every level of the Democratic establishment -- the politicians, the political consultants, the advocacy community, and the hundreds of wonks and experts who participated in the plan's creation. It taught many that health care is simply too big, too complicated, too dangerous to touch. Since the drubbing, Democrats have been afraid, as former Sen. Bill Bradley put it, "to go back into that room where that bad thing happened."
For reformers, that attitude is the foremost impediment to change. Much talk centers around the specific contours of the ideal policy solution, but though important, such conversations are like agonizing over the wedding band before anyone's agreed to join you for dinner and a movie. For policy to matter, policy-makers must be willing to advocate it. But many remain timid, scarred by past failures and disappointments, certain that any attempt will end in electoral catastrophe.
The moment has, after all, looked propitious for change before, and failure has been all the harsher for it. Health care, which now comprises a full one-seventh of the economy, is notoriously difficult to reform. Harry Truman failed, as did Richard Nixon and Bill Clinton. Franklin D. Roosevelt didn't even try, believing any attempt would not only fall short, but take down Social Security, too.
And the system has only grown larger and more entrenched in the years since. Heath care is now a multi-trillion dollar industry that generates billions in profits for all manner of powerful actors. Medical coverage is a source of acute anxiety for Americans in general and voters in particular -- where about 84 percent of the population has health insurance, 94 percent of voters do, and they are deeply afraid of losing what they already possess. Finally, the arithmetic of the Senate remains unfriendly, with the creation of a 60-vote supermajority appearing the only way to move major legislation.
Together, these forces and factors doomed health reform in 1994. Or so goes the story. But the collapse of the Clinton reforms was also a product of bad timing, political misjudgment, and human error. The Clinton administration did not prioritize health reform upon entering office, and so lost whatever window of opportunity might have existed; they mistook good policy for good politics, and created a bill better suited to a Brookings seminar than the political process; and they failed to appreciate the need for a national strategy to sell the plan to the American people,
Luckily, today's reformers have one thing yesterday's didn't: The lessons of 1994. And the degree to which they've learnt them -- which increasingly appears considerable -- may decide whether the next president finally succeeds where so many others have failed....