Why Clinton's Health Plan Was Unsuccessful

Introduction 

Universal health care took a central stage of each the administrations in power in the US, and President Bill Clinton’s was no exception. Clinton’s health care plan was preceded by heavy campaigns advocating for the same during the 1992 presidential elections. Clinton’s administration sought to address the one perennial problem that has bedeviled the American health care system – the rising cost of care. The debate on health care reform is an ever-present discourse in the American mainstream media. According to Kim et al. (2015), the problem of the American health care is often presented in terms of high and rising costs. The consensus is that patients, healthcare providers, pharmaceutical companies, insurance companies, and the government are the responsible parties in driving up the cost of healthcare. President Clinton’s 1993 health care plan was a typical response to the media’s documentation of the numerous ills of the American health care system. Marmor and Oberlander (2018) attributed the eventual demise of Clinton’s plan to a number of political and administrative factors that influence policy and policy environment. The factors include the federalist option, the pincer strategy, and the singer-payer approach. Marmor and Oberlander (2018) contended that the omnipresence of health reform on the political agenda has a link to the strong institutional barriers to comprehensive health care reforms. The barriers have made it impossible to realize universal healthcare insurance without enacting constitutional reforms that would radically alter the federal governance structure. President Clinton’s administration was culpable of failure to institute constitutional changes, thus failed to offer a compelling vision for the future of the ailing American healthcare system. The paper reviews critical aspects of Clinton’s health care plan and analyses the contributions of various stakeholders in influencing policy and policy environment that resulted to demise of the plan.

Features of the Clinton Health Care Reform Plan 

The appointment of the health care reform task force in 1992 by President Clinton was intended to formulate the way forward by developing a proposal for providing healthcare benefits for all Americans. The role of the task force culminated in the introduction of the Health Security Act in November of 1993. The key features and provisions of the Clinton’s plan were universal coverage and basic benefit package, health insurance reform, consumer choice of health plans, regional alliances for restructuring competition among health insurance plans, provisions of Medicaid beneficiaries. The proposed bill introduced to Congress would provide a “health care security card” to every citizen, irrevocably entitling him or her to medical treatment and preventative services. The requirement was for every citizen to enroll on qualified health plan individually or programs approved to provide such services. The plan provides for subsidies for those who were too poor to afford the coverage, including complete ones for those below a given category of income level. Consumers were required to choose plans from regional health alliances to be established by each state. The alliances were to purchase insurance coverage for residents and set fees to be charged by doctors per procedure. The state was to receive funding for administration of the plan, and was estimated to start with $ 14 billion in 1993 and rise to $38 billion by 2003. Clinton’s plan also:

Stated the benefits to be offered,

Specified a National Health Board to oversee the quality of health care services,

Enhanced physician training,

Development of model information system,

Federal budget to cater for potential insolvency of state programs,

Rural health programs,

Long-term care,

Coverage of abortions with exceptions,

Fraud prevention steps,

 Integration of public mental health and substance abuse services into the full range of health services offered by local health plans,

Malpractice and antitrust reform, and

Prescription drugs benefits.

The Clinton plan was the health equivalent of reinventing governance, proposing creation of new institutions, new relationships, and new responsibilities for stakeholders in the private and public sectors. The plan was supposedly founded on the principles of universality, savings, choice, quality, simplicity, and responsibility. Its main objective was to merge competing interests and constructs including competition and regulation, federal and state roles, and public accountability and private delivery. The plan sought to cast its net wide and bring all stakeholders on board, a move that served to increase its opposition.

Why the Plan Failed – Policy Process and Policy Environment 

Understanding why Clinton health care plan never materialized requires revisiting the strong relationship between constitutional reform, and comprehensive health care reforms (Marmor & Oberlander, 2018). To begin with, Clinton’s plan was largely perceived to be an array of individual and institutional interests, which certainly made it a political document developed based on the assumption that Congress would likely approve a plan for universal health coverage if it does not impose broad-based taxation to finance it. The assumption was flawed base on the understanding that universality, the founding pillar of the plan, is largely dependent on funding. Therefore, a multibillion-dollar program that did not specify its sources of funding was doomed to fail. Universality as a principle is plausible for its intention to ensure Americans have irrevocable access to medical care. It is more than an ethical imperative that assumes coverage for all will produce improved health outcomes and wellness for the society, hence achieving efficiency that the existing system at the time. Nevertheless, universality also served as a fundamental dividing line between the proposal and those who did not commit to it, or failed to define the means of achieving universal healthcare coverage. Those who opposed the plan advanced the argument that commitment to universality is defined by an understanding of the responsibility in relation to the party responsible for funding the program, how much would they commit, for what, and to what, and the limits. Funding was a major issue that permeated the debate on the plan. Clinton’s plan failed because it could not amass a firm and credible commitment to its goal, an outcome associated to its approach to ignore, postpone leave ill some of the difficult decisions. In the healthcare reform debate, universality is right that is an enormous luxury.

The policy environment at the time of the plan was poisoned due to lack of understanding among stakeholders. What happened to the Clinton’s health care reform plan can be described in a number of ways. Critics of the plan have advanced that it was killed by the republicans, failure by reformers to unite, failure of the center, and misfiring of the house strategy. At first, the setting up of the task force set in progress optimism in President Clinton administration. Analysts observed that given the detailed approach of the plan, Clinton would move the country. During the initial polls, days after the launch of the proposal showed Clinton was winning public approval by two thirds. Observers concluded that debate of the details were insignificant because the president had established the right principles and challenged Americans to a great, historic mission. The principle of universality of health coverage was heralded as an achievement. Kriner and Reeves (2014) observed that support for healthcare reforms at the time was driven by racialization of the health reforms and party ID, which was also the single most important predictor of for reform support and the president’s capacity to handle it. Demographic characteristics are at best the weak predictors of support for reform. On the other hand, modest fluctuations in support of reforms were attributed to the ebb and flow of the elite rhetoric.

Kriner and Reeves (2014) contended that Clinton’s plan failed because the president courted public opinion before seeking consensus among their party’s elite and other narrower interests. It is evident the president banked on the assumption that their proposal would receive ready approval from party elites just like it did with the public. However, a year down the line, the Senate Majority leader pronounced the health care reform plan dead. Despite opinion polls continued show of strong support for the ingredients of reform, the complexity of plans and onslaught by critics left many supports uncertain. Opponents of Clinton’s plan focused their attention on its detriments to those with an existing good health care plan. They turned on the president, accusing them of leading the country into a blind alley with using the grandiose reform plan. The plan was criticized for its funding approach that required all employers and individuals to contribute towards the health insurance. In addition, it proposed cost control to be attained by the switch from identity care to managed care, with the insurer receiving capitated payment to manage the health cover of subscribers. Burns and Pauly (2012) contended that the framework on using insure service providers encountered difficulties while trying to integrate delivery networks of the 1990s. Overall, the plan encountered an extremely hostile policy environment that created uncertainty over its benefits, hence contributing to its ultimate demise.

The Influence of Various Stakeholders 

Clinton health care plan faced fierce opposition from the conservatives, the libertarians, and the health insurance industry. The industry, in particular, sponsored series of television advertisement that were highly effective in driving opposition of the plan. The infamous "Harry and Louise" advert that was paid for by the Health Insurance Association of America depicted a middle-class couple displeased with the plan’s bureaucratic approach and complexity. Partisan politics and industry lobbying defined the influence of stakeholders towards death of the plan. The critical elements and guiding principles notwithstanding, the plan was criticized for being overly bureaucratic and restrictive of patient choice. The conservative wing of the opposition expressed displeasure with the lack of consultation of stakeholders. It accused Clinton of using a top-down, command and control system to enforce a host of systemic and institutional changes that would have dramatic effects on stakeholders.

As a result, opponents of the bill organized against it before its presentation to Congress. They drew on the complexity of the bill, specifically the provisions that would make it mandatory for employers to incur insurance cover costs for their employees. The opposition policy groups such as the Project for the Republican Future orchestrated the defeat of the plan by faxing ‘policy memos’ to Republicans. In addition, the media played a crucial role in creating the impression that the plan was unnecessary and irrelevant. Media outlets ran campaigns questioning the validity of thee plan by asking whether indeed thee health care crisis that was to be solved by the plan existed. The proposal was labeled as a document suffused with coercion and political naivety owing to its provisions that sought to control the conduct of public and private players in the healthcare system. The plan was ridiculed for its failure to recognize and address pertinent issues such as insurance crisis, and focusing on misleading the public by creating an impression about there being a health crisis. Democrats who did not out rightly oppose the president’s proposal expressed their discontent by drafting their own competing proposals.

Conclusion 

In conclusion, Clinton health care plan cannot be faulted for failing to address the basic principles of universality, choice, responsibility, savings, quality, and simplicity in the healthcare system. Its premature death before arrival to the floor of the house can be attributed to failure of the task force to engage other public and private stakeholders in consultations. The bureaucratic approach was interpreted as coercion, and being a political policy, created a toxic policy environment for it to succeed.

References

Brandon, W. P., & Carnes, K. (2014). Federal Health Insurance Reform and" Exchanges": Recent History.  Journal of Health Care for the Poor and Underserved ,  25 (1), xxxii-lvii.

Burns, L. R., & Pauly, M. V. (2012). Accountable care organizations may have difficulty avoiding the failures of integrated delivery networks of the 1990s.  Health Affairs ,  31 (11), 2407-2416.

Kim, S. H., Tanner, A. H., Foster, C. B., & Kim, S. Y. (2015). Talking about health care: News framing of who is responsible for rising health care costs in the United States.  Journal of Health Communication ,  20 (2), 123-133.

Kriner, D. L., & Reeves, A. (2014). Responsive partisanship: Public support for the Clinton and Obama health care plans.  Journal of Health Politics, Policy and Law ,  39 (4), 717-749.

Marmor, T. R., & Oberlander, J. (2018). The path to universal health care. In  The Next Agenda  (pp. 93-125). Routledge.