The Problem That Won't Go Away: Reforming U.S. Health Care Financing.

• Author: Birenbaum, Arnold

edited by Henry J. Aaron / The Brookings Institution, 1996, pp. 298, $42.95

Reviewed by ARNOLD BIRENBAUM Medicine & Health Editor, USA Today, and Professor of Pediatrics, Albert Einstein College of Medicine, Bronx, N.Y.

Why did the Clinton health care reform campaign fail? Who were the killers? The various contributors to the first part of this interesting work--the result of a conference sponsored by the Brookings Institution--suggest that part of the answer rests with a targeted fear campaign aimed at a public that was not that well-informed about how health care is paid for and why coverage for all is a good idea. Educating the public to these issues failed to take place, so the attacks on the Health Security Act never were answered.

The Clinton commitment to cover the uninsured by either public or private insurance plans--whether through borrowing money and increasing the deficit, a transfer of income from the affluent to the subaffluent, or an employer mandate that says it is the obligation of all, not just big employers, to help pay for the group coverage created for their employees--raised the specter of more taxes. The emphasis on managed care as an extension of government was used by fearmongers in the Republican Party to pull support away from the proposed Health Security Act.

Beyond the public arena, the strategy the Clintons followed suggested that their plan was the beginning of negotiations. However, nobody came to the table. The stakeholders remained on the sidelines during the public debate, while some employer-based interest groups formed an alliance with conservative voluntary associations and talkshow hosts to exploit fear of change, Hundreds of millions were spent in 1993 and 1994 on advertisements (remember Henry and Louise?) and in donations from political action committees to incumbent legislators.

Particularly apropos was the pungent description of former Rep. Fred Grandy (R.-Iowa) that the operating policy in Congress in 1994 was "Don't just do something stand there!" Grandy's comments on how the various House...