CLINTON’S HEALTHCARE PLAN
INTRODUCTION
President Clinton, in his first year in the White House, proposed a health care reform in which he intended to insure all Americans had access to healthcare. Thirty-seven million Americans were without health insurance. Most modernized countries throughout the world had already instituted universal health care system. Clinton proposed the Health Security Act to the American people on September 22, 1993. The proposed legislation included more than one thousand pages laying the framework for implementation of a national health care system. Clinton sought to create a universal health care system where employers were mandated to contribute to the cost of its worker’s insurance premiums. The plan would guarantee health coverage for all Americans; yet instead, the plan failed before implementation. Interest groups influenced the opinion of Americans on this bill, had it not been for the amount of money and lobbying against the plan, it may have become law. I would have supported this proposal.
THE HEALTH SECURITY ACT
President Clinton assigned a task force when he took office in January 1993 to draft a proposal for universal healthcare. In September 1993, President Clinton made his speech concerning the proposal. The speech explained the principles of the proposal, and gained significant support by Democrats in Congress at the time. The majority of Americans also approved the proposal. The plan was created to rely on private insurance companies and employer mandates. A health insurance cooperative would also be established as part of the proposal.
The Health Security Act included provisions for the government to set national standards for benefits, quality healthcare and access to health care. Under the Act, States would have the ability to design and monitor a health care system within the framework of the federal plan. States would be required to choose agents for their regional alliance. Only those employers with over five thousand employees could opt out of the regional alliance; all others are required to pay eighty percent of an employee’s health plan premium if the employee is employed full time, or employers can pay 100% if it desires to do so. Individuals would be required to enroll in a plan and could not be disenrolled unless enrolled in another plan. Cost sharing schedules under the plan included HMO’s, PPO’s or fee for service plans. This plan was to ensure all Americans would have comprehensive health coverage..
PLAN PROBLEMS
Divided Democrats, confident Republicans, the Whitewater scandal, declining public approval, the complexity of the bill, and substantial spending by interest groups were the reasons the proposal ultimately failed. Each of these issues made a strong impact on the bill even though it had been supported by the majority of Americans. Republicans began to hit hard against the proposal alleging it was too complex, too expensive and too much government involvement. No consensus in congress was ever reached on the bill. Many members were making separate proposals for reform, with twenty-seven proposals advanced with over one hundred various names labeling them.
Toward the end of 1993, the press began releasing information that caused the Presidents support to decrease. The Whitewater development was a major scandal effected the views of the integrity of the President. This lack of trust bled into opposition of the proposed healthcare plan. The complexity of the bill only enhanced the declining public support of the plan. Premium caps, mandatory participation in cooperatives, and mandates that employers must purchase coverage complicated the proposal, although these were necessary to ensure universal coverage. American’s could not understand all these processes, and all they were sure of was that it meant further government involvement in healthcare. The complicated bill also had numerous complexities.
America’s healthcare system had government coverage through Medicare and Medicaid and private coverage through doctors and insurance companies. This dual system further complicated the establishment of universal coverage. Other concerns about the economic impact of the proposal also arose. Many feared the bill would cost too much, while others wanted a proposal that was initiated in increments. The complex plan and the inability of the general public to understand it, meant that they had to trust the government; and this is when interest groups mobilized.
INTEREST GROUPS AND KEY PLAYERS
A national effort on the part of interest groups ensued. This was the largest collaboration among interest groups in America since the proposal of the Social Security bill. Interest groups used grass roots efforts and advertising as their main strategies. Television ads, electronic message and modern technology were utilized wisely. Literature was distributed nationwide explaining the ill effects the plan would impose if passed. Phone banks were set up. The opposition claimed the proposal would increase insurance premiums and decrease healthcare choices. These groups alleged that healthcare is an issue that effects all Americans.
An assortment of interest groups lobbied against Clinton’s Healthcare Plan. The number of interest groups involved in the opposition of the Plan contributed significantly to its failure. The Project for the Republican Future opposed Clinton’s plan and some have even alleged it is mostly responsible for the plans demise. Anheuser Busch opposed the passage of the Plan because of the “sin” taxes proposed. IVAC Corporation, a manufacture of healthcare products opposed the bill and set up a phone bank to contact consumers to relay reasons the bill should be opposed. Pfizer, Inc. provided money to Congressman for opposition and publicly offered services that would provide an alternative to the proposed bill. National Association of Life Underwriters increased financial support for the opposition. The American Medical Association and the Pharmaceutical Manufacturers Association strongly opposed the bill. Pharmaceutical companies opposed bill because they feared profits would suffer. Business owners including restaurant owners and grocery store owners opposed. Doctors began warning patients about the proposal. Opposition include therapists, chiropractors and podiatrists. Health Insurance Association of America established a coalition of health insurers to lobby against bill. Along with the interest groups, the majority of Republicans opposed the bill. Republican members of Congress also used grass roots politics to demote the bill. These congressional members went to their districts to discuss the bill. Congress members engaged in televised speeches and public appearances, as well as appearances on talk shows. All of these efforts against the bill failed to focus on the real substance of the bill.
Interest groups, instead of informing the public, imposed fear and anxiety with their ads. Over half of the ads were alleged to be misleading.. Opposed bill rather than providing answers for the creation of an effective bill. Focus was not placed on substantive issues of the bill, never mentioning any areas of the bill that Republicans and Democrats agreed upon. All of this led to skepticism by the American public. Interest groups allegedly spent more than one hundred million dollars. The money used by the interest groups stalled the policy process and destroyed an environment that had initially been rip for passage of a universal healthcare plan.
POLICY PROCESS AND ENVIRONMENT
Policy process occurs in a cycle of stages. Included in these stages are problem identification, agenda setting, policy making, budgeting, implementation and evaluation. The first stage is problem identification. Presidents prior to Clinton had proposed universal health care systems without success. The problem was clear to the President, the rest of government as well as the American People. Yet, after a year of committee hearings, committee reports, negotiation and arguments led to the demise of the bill in early period of the policy process. The policy process never proceeded past the stages of agenda setting and policy making. Once the was put on the agenda where congress, the president, and other bureaucratic offices had to consider the relevance and adequacy of the proposal, the majority of supporters the bill once had diminished. It is at this stage that the interest groups became extensively involved and the media began to express its opinions concerning the issue.
At the policy making stage the proposed bill is introduced, and often times reorganized and rewritten. At this stage of the policy process, the bill is debated extensively while it may sit for up to a year. Once the policy passes this stage, budgeting for the bill begins to be discussed. Typically, this occurs in committee and involves discussion over how much the policy will cost the government. Once the budget for the policy is finalized, implementation of the policy begins. Although the policy environment initially appeared to be ripe for the passage of President Clinton’s universal healthcare act. Soon after the policy process began, dissension arose and overtook. The political environment must ripe for a controversial bill to become law. Political and economic forces were not in line for the Act to reach implementation, much less passage in both houses of Congress.
CONCLUSION
President Clinton presented America with a great plan – a national universal healthcare system. He had hoped to insure the millions of Americans who did not have healthcare coverage. The United States was behind other countries in this area; being one of the last to adopt a universal system of health care. The plan was supported by the majority of Americans until the interest groups dumped millions and millions of dollars into opposition of the bill. Large amounts of money was spent on advertising in every manner possible. Billboards, newspaper and magazine ads, commercials, electronic messaging, phone banks, and public speeches were all in the arsenal. All of the information disseminated to the public regarding the bill concerned the negative effects that the bill would have on Americans. Since the issue of healthcare was a concern of nearly every single American, people listened. Contributing to the interest groups was the bipartisan split on the bill, the decline of Clinton’s popularity and alleged scandals, and the complexity of the bill. With these hurdles to cross, there was no possible way this bill could ever had passed in 1994.
I would have supported President Clinton’s proposal. Although the proposal was very complicated, I believe that it would have been in the best interest of the majority of Americans to support it. As in any political process, however, the time has to be right. And, the time was not right for the plan in 1994. This same dilemma played out with President Obama. However, instead of losing support, he managed to maintain support and eventually signed a bill that passed both houses of Congress. The largest difference between the two plans is that Obama’s plan involves an incremental process of expansion and change in the system rather than a complete overall, which Clinton proposed. A few of the major differences include mandatory coverage and the extent of the government’s involvement in healthcare. However, cost remained an issue in both proposals. Clearly, Americans needed a universal healthcare system. It may have not been the right time for President Clinton, but the time ultimately came with President Obama.
REFERENCES
Bok, D. (1998, June). The Great Health Care Debate of 1993-94. Public Talk. Retrieved from http://www.upenn.edu/pnc/ptbok.html
Clymer, A., Pear, R., & Toner, R. (1994, August 29). The Health Care Debate: What Went Wrong and How the Health Care Campaign Collaped. Retrieved from http://www.nytimes.com/1994/08/29/us/health-care-debate-what-went-wrong-health-care-campaign-collapsed-special-report.html?pagewanted=all
Pfiffner, J. P. (n.d.). President Clinton's Health Care Reform Proposal of 1994. Executive-Legislative Relations. Retrieved from Third Way: http://cspc.nonprofitsoapbox.com/storage/documents/President_Clintons_Health_Care_Reform_Proposals.pdf
Randall, V. R. (1994). Does Clinton's Health Care Reform Proposal Ensure Equality of Health Care for Ethnic Americans and the Poor? Brooklyn Law Review, 60, 167-235. Retrieved from http://academic.udayton.edu/health/02organ/clinton.htm
Starr, P. (1994). What Happened to Health Care Reform? Retrieved from https://www.princeton.edu/~starr/20starr.html
