Why did Clinton’s Health care reform fail?
Clinton’s health care plan focused on transformation and building of the mixed private and public health care system (Oberlande, 2007). The plan advocated for universal coverage that would have all employers contribute significantly towards insurance premiums costs for their workers. The insurance market was expected to shift to managed care as Americans would choose from the various available insurance plans. Finally, the plan focused on cost control by limiting any unexpected growth in terms of the insurance premiums.
During 1990s, including 1993, opinion polls from the public indicated that Americans valued involved of the government in the provision of health care. As such, the 1992 presidential election had both Republicans and Democrats supporting health care reform. Further, many trade organizations and businesses; unions and workers also supported government engagement in the health care. Business, which engaged in the provision of health insurance to their employees, saw an increment in costs (increase in premiums) during 1980s. This compelled such businesses to turn to the federal government in order to create their cost controls, regulate health insurance and have a spread of the health care cost.
Despite this support, Clinton’s health care became a victim of several political factors. This includes involvement of Clinton government, various insurance lobby groups, and intense partisan opposition (Gostin, 1993). Further, several businesses stopped supporting the health care reform. This is because they established that private health insurance had an annual growth of its premiums that was positive. Between 1990 and 1992, it fell from 17% to 10% and further to 8% in 1993. Several businesses realized that the insurance industry was in the process of self reform such that it could control its costs and have a managed care. This made such business to back off from supporting the reform of the health care. This was a significant support loss, which affected public opinion, political battle resources and political debate. Public opinion disappeared and weakened with the loss of the advocacy.
Clinton’s health care plan was characterized of complexity. This is an element, which contributed significantly towards the defeat of the plan. This is because, irrespective of their being well set goals for the plan, the implementation process of the plan suffered significant challenges. Thus, the complexity was a major role towards the failure of the plan (Coleman, 2011). Complexity was felt in the proposed changes for the plan. The changes would have altered the United States economy by approximately one-seventh. Such an alteration would have resulted in the developed of several unintended consequences. Despite the fact that majority of the plan package elements existed in known forms like HMOs, managed care, cost control and employer health insurance provision among others, combination of these elements would have led to a sweeping overhaul that could not be accepted in the economy of United States including its political system.
Clinton lost approval ratings when the public started losing confidence on his leadership. This was based on the allegations, which were allayed to Clinton in December 1993 (Gostin, 1993). These were the Whitewater development investment by Clinton and possibility of illegal or shady activities in Arkansas backed by Clinton. In addition, the administration of Clinton was accused of not being able to handle spring scandals. This includes inability to defuse the allegations. As such, these allegations affected the health care plan proposed by Clinton significantly, despite the fact that they were not proved.
The Republicans labeled the health care plan for Clinton as too much government, too costly, too complex and too large. This indicated a loss on one of the advocating group for the health care reform. Public opinion regarding health care begun declining with majority that seemed to have approved the plan shifted to being the minority in 1994 spring. A consensus on fixing of the health care plan was needed, but there was no strategy on how such fixation would take place. The complexity indicated that Americans had to trust the judgment of the President that it was good for the nation (Pfiffner, 1994). Therefore, when the Republicans had the ability of framing trust issue for President Clinton with regard to policy issues and implementation issues for the federal government, the public had one answer. This favored mobilization of interest groups towards Clinton plan opposition. Clinton administration was criticized based on the facts of adopting partisan approach with regard to the bill of health care. Although the criticism was legitimate, it was not clearly highlighted if bipartisan coalition supported the passing of a bill, which had resemblance of Clinton’s principles as it was in September 22, 1993 speech.
The United States Senate did not have more than 50 votes with regard to health-care reform as Clinton had proposed. This meant that the Democrats could not pass any bill since their priority was on Arkansas teaching hick. In contrast, Republican Senate leadership from Robert Dole had 80 votes for his proposed health care reform (Oberlande, 2007). Dole wanted to make America a better place since he was not amoral, cynical or cruel man. He was conversant with the problems and issues related to healthcare. Furthermore, Dole knew exactly how the financing system of American health care had been broken down and the process, which would be adopted in the fixation of the problem. Therefore, the presence of the two health care reforms as proposed by Clinton and Dole led to a conflict with Dole health care reform overshadowing Clinton health care plan.
Most of the Americans tended to develop a notion that their independent health care arrangements were better than the reforms being introduced. This made such individuals lack interest in these reforms. Further, there were minimal campaigns from the reformers to encourage people to focus on accepting these reforms. This made it complex for individuals to develop a trust on the reforms. Further, expansion of the government authority to the health care system meant that the economy would be affected significantly (Pfiffner, 1994). On the same note, the payment for the health care reform was a formidable challenge. This led to the collapse of the plan since Clinton administration did not have the ability of seeking for support from employers with regard to the financing of the health care reforms.
Moreover, the political institutions in America limit the powers of the president, create several opportunities for people with self interests, encourage divisions within the congress and complicate the process of health care reform adoption (Brady, & Kessler, 2010). This shows that the prevailing political institutions in U.S played a significant role towards the failure of the health care plan as proposed by President Clinton. Furthermore, the room for enacting and developing comprehensive health care reform plan cannot remain open for a long period of time. This means that failure finds its way through a high price, which is lack of the political will to engage in any activity, which is meaningful.
Interested Groups
Large businesses were among the major interested groups for the health care reform. This is because they wanted to have a reduction in the cost of health care for their employees. The situation emerged since most businesses were paying higher premiums for the health insurance of their employees. Businesses argued that the government should play a role in regulating the health and insurance sector so that they would have a clear platform for paying the cost of health care for their employees (Gostin, 1993). Standardization of insurance premiums was also a key argument for the businesses. Moreover, the businesses wanted to have an equality of all businesses in contribution towards health care of their employees. This is because smaller businesses rarely paid for the insurance premiums of their employees while the large businesses were paying such premiums whose costs kept on increasing significantly. The public was also interested in this reform. This is because the citizens were interested in having a reduction in the cost of health care. They argued that the government should play a significant role in ensuring that the members of the public have access to quality and affordable health care.
Composition of Clinton’s health care plan
Clinton’s health care plan was focused on attainment of a universal coverage of health to all citizens in America. However, such coverage was expected to be expensive and the poor would find it costly while receiving treatments in emergency rooms. But the integration of the cost control and universal coverage entailed some coercion (Pfiffner, 1994). This was based on the regulations in terms of having all the employers buying the coverage, participatory mandatory for the cooperatives and buying of the premium caps. These factors contributed significantly towards an increment in the bill, as well as the complexity and sweeping scope of the bill.
The system of health care in United States was mixed up with private sector having insurance companies and doctors while the federal government focused on the financing activities for the Medicaid and Medicare. Clinton accepted these realities and incorporated them in the cost containment and universal coverage goals (Gostin, 1993). This resulted in attainment of government coercion and inherent complexity for the plan. Therefore, having a simpler approach would mean that major elements would be abandoned. Hence, complexity complaint, through true, was not considered as a significant issue as it was considered for the plan. Furthermore, nobody else generated ideas, which would aid in accomplishment of the Clinton plan.
Legislative Process
The legislation of the Clinton’s health care reform plan involved the introduction of the bill to the Senate members. However, Clinton obtained assistance from health policy committee has he led the cabinet-level task force. The Senate members heard the bill, but the approval process led to attainment of unexpected results (Pfiffner, 1994). This is because the bill did not even score more than 50 votes from the Democrats. This was the beginning of challenges of the Clinton health care reform plan. Attempts to reconcile the differences experienced did not yield any benefits as most of the Democrats focuses on supporting the Republicans with regard to their view on health care reform in United States.
The regulatory approaches as indicated in the plan targeted only the health care sector. As such, there was no effective integration between the market-based competition and government regulation on cost control efforts (Gostin, 1993). This influenced the process of decision making significantly with the proposed health care plan being seen as a costly one that would impact the prevailing economic conditions of America in a negative manner.
Demanders and Suppliers
The Democrats and Republicans were the main stakeholders in the provision of health care reform in U.S. For the Democrats, the health care plan should create an effective insurance marketplace, which would facilitate effective exchange such that consumers have the ability and potential to explore insurance plans and prices with an aim of aiding them to make effective decisions that best suits their needs (Oberlande, 2007). This was based on the fact that competition would lead to attainment of fiscal fronts, better quality and improvement in the efficiency of the health care plan. Further, the Democrats had a consideration for the public option in the health care reform. This would act as a means of involving the government in the field of health care insurance.
In contrast, the Republicans believed that the health care plan should enable all people who are uninsured to get into contact with insurance companies. The Republican plan focused on ensuring that small businesses, associates and states would collaborate in the process of provision of health insurance (Brady, & Kessler, 2010). Universal coverage would take place effectively through giving of modest and low income Americans tax credits.
Health Policy
Tow intrinsic factors tend to influence health policy. These factors are the suppliers and demanders of health policy. However, there are other factors, which play a role, but these two are the most significant in influencing the success or failure of health policies. Examples of demanders of health policies include the interest groups, organizations and individuals. These are individuals who need to have better health or take advantage of the economic condition (Pfiffner, 1994). Interest groups depict organizations comprised of people who share common policy goals. These interest groups are quite significant with regard to enabling the process of policy making since they act as rooms for individuals to make their demands with regard to health policies. Clinton health care plan had such groups with private insurance companies, Republicans and the public being the demands of the health policies.
Health policy suppliers include legislators, judiciary and bureaucrats. The juries and judges have the role of law interpretation and determination of the constitutionality of the law. Consumer demands influence policy makers. Policy tools, which are used in the supply side in affecting health policies, include global budgets, manpower and technology controls, practice guidelines, utilization review, diagnosis-related groups and capitation (Gostin, 1993). As such, these policies are geared towards improving the effectiveness of suppliers rather than the demanders. Clinton’s health policy had several issues. These issues include the advantage of the government being involved in attainment of health care efficiency, equity delivery of health care services, and establishing mechanisms, which would warrant the government and the markets to work in unison in order to have one superior health care system.
References
Brady, D. W., & Kessler, D. P. (2010). Why Is Health Reform So Difficult? Journal of Health
Politics, Policy & Law, 35(2), 161-175.
Coleman, R. (2011). The Independent Medicare Advisory Committee: Death Panel or Smart
Governing? Issues in Law & Medicine, 27(2), 121-177.
Gostin, L. (1993). Foreword: Health Care Reform in the United States- The Presidential Task
Force. Retrieved from: http://scholarship.law.georgetown.edu/cgi/viewcontent.cgi?article=1758&context=facpub
Oberlande, J. (2007). Learning from Failure in Health Care Reform. N Engl J Med. 357: 1677
1679.
Pfiffner, J. (1994). President Clinton’s Health care Reform Proposals of 1994. Retrieved from:
http://www.thepresidency.org/storage/documents/President_Clintons_Health_Care_Reform_Proposals.pdf
