Opportunity lost.

• Author: Waldman, Amy
• Position: How health care reform failed

The Clintons hid the details of their health care reform plan; their opponents turned ignorance to their advantage. And a rare chance for major change was squandered

Christopher Lasch's obituary was written before the Health Security Act's was--he died in February 1994, the health care reform effort some six months later--so there's no knowing how he would have viewed the undertaking. But from his writing, notably the posthumously published The Revolt of the Elites, it's not hard to make an educated guess. Our have and have-not health care system epitomizes the "two-class society" he abhorred, in which "the favored few monopolize the advantages of money, education, and power." That monopoly of advantage threatens not just equality of opportunity, Lasch believed, but quality of life. In the case of health care, it can threaten life itself.

But it also seems likely that Lasch would have found the effort to reform the health care system equally disturbing. "Having effectively been excluded from public debate on the grounds of their incompetence," Lasch wrote in The Revolt of the Elites, Americans "have become almost as incompetent as their critics have always claimed." As several new books(1) show, the health care "debate"--the word seems overly generous given the quality of the exchange--affirmed his tautology.

To start, the Clintons deliberately obfuscated the details of their plan, keeping the discourse of the debate as vague as possible. Their opponents--whether Rush Limbaugh, the small business lobby, or GOP strategist Bill Kristol--saw the public's ignorance as a weapon, not a problem. And journalists did too little to fill the breach of understanding.

The result was a confused, then fearful, public. In March 1994, in one of the press's more enlightening moments, The Wall Street Journal's Hilary Stout published a story headlined "Many Don't Realize It's the Clinton Plan They Like." Polls showed that most Americans opposed the Clinton bill; but a focus group indicated that may have been because they didn't understand it. "No one [in the focus group] expresses support for Mr. Clinton's sweeping proposal," Stout wrote. "In fact, no one can explain it." (Among their misimpressions: Under the Clinton plan, using a doctor other than the one you'd been assigned would land you in jail.) When asked to evaluate an unnamed plan with the Clinton plan's features, however, poll respondents--and the focus group--were overwhelmingly approving, even preferring it over rival proposals in Congress. There were few starker illustrations of the failure, by all sides, to educate the public or argue the issues on their merits.

Health care reform was one of the most ambitious legislative undertakings in the history of American government; its success could have bettered the lives of millions of Americans. And in an age of mass media and perpetual polling, public opinion was destined to play a major role.

Yet those conducting and reporting the debate deliberately ducked their responsibility to create an informed public--not just on the specifics, but on the broader issues (such as spiraling costs) and choices (such as how to finance the new system) that underlay reform. The result, of course, was not dramatic change, but the entrenchment of a flawed system.

The tragedy of failure was twofold: Quality, affordable health care is still out of reach for millions of Americans, and their numbers are growing. What's more, we damaged an already fragile democratic process--and thus our ability to confront serious societal ills. By combing through the wreckage of health care reform's ignominious end, perhaps we can avoid being condemned to repeat its mistakes.

Word Games

In retrospect, it might seem impossible for the Clintons to have succeeded in passing a sweeping health care reform package. They were seeking massive change in an industry that generates billions in annual income. Thousands of businesses had a life-and-death stake in the status quo. Meanwhile, trying to legislate reform in the rabidly partisan political environment of 1993 was something akin to dancing in quicksand. When the Clintons tried to compromise, their opponents grew coy. ("Every time I start in the middle, Bob Dole moves the middle to the right," Clinton lamented at one point.) The famous Bill Kristol memo--which instructed the GOP to oppose any reform proposal sight unseen--was proof of their disinterest in debating an honestly defined statement of the Clintons' facts and logic.

In researching their book The System, Haynes Johnson and David Broder had unequaled access to the charismatic, volatile, and ego-driven personalities who were driving the process. By promising not to publish until the debate was long past, they were able to elicit an honesty that day-to-day coverage could not. Among the revelations: Long before Clinton even launched his plan, Newt Gingrich was telling Broder and Johnson that he had no intention of letting any reform through. Behind the scenes, he bided his time, then stepped in to help organize the congressional-business coalition that would first defeat health care reform and then drive the Contract with America.

Events also conspired against Clinton with Job-like intensity: the public relations fiascoes of gays in the military and Whitewater; the bloody Somalia intervention; an unexpectedly protracted battle over his deficit-reduction plan. As a result, Johnson and Broder, and Theda Skocpol in her new book Boomerang, conclude that Clinton never...