This excellent book documents the political context and politics that ultimately led to the failure of President Clinton's health care reform proposal in 1994. It is essential reading for social workers and social policy analysts seeking to understand the dynamics of the national social policy process.
The author presents a powerful analysis of the political process surrounding the Clinton health care reform proposal. However, the study is weaker with respect to the substantive debate among reformers as to the approach to be taken toward reform. Although Skocpol argues that Clinton's failure to adequately explain the reform contributed to its defeat, she is too kind in not noting the serious substantive and political weaknesses of the proposal.
In the 1990s health care costs have been rapidly increasing, and coverage has been eroding, particularly for working-class families and children. The public's concern with the erosion of health insurance protection seemed to create an opportunity for a public policy initiative in this area. The upset victory in a special senatorial election of Democrat Harris Wofford over Republican Richard Thornburgh seemed to turn on the central issue of national health insurance reform. Skocpol succinctly re-creates this context and notes some of the health reform proposals being floated at the time.
Skocpol mentions a number of broad-based, employer-mandated proposals developed by groups such as the U.S. Bipartisan Commission on Comprehensive Health Care (the Pepper Commission); the National Leadership Coalition for Health Care Reform, which consisted of large corporations such as Chrysler, Ford, and Bethlehem Steel; a number of labor unions and a variety of interest groups; and the American Medical Association. It seemed at this time that a "window of opportunity" existed for health care reform. Skocpol notes that reform proponents such as the Physicians for a National Health Insurance Program who advocated a Canadian-style single-payer system that would have eliminated the high costs associated with multiple insurance companies and hospital duplication of expensive capital costs were not taken seriously by the political insiders in the Clinton administration or the majority of national legislative officeholders.
The key to the eventual Clinton Health Security proposal was the so-called Garamandi-Zelman-Starr approach, which Skocpol summarizes. "Health purchasing alliances," such as a state or a more...