Thirteen years later, most other people find it hard to recall the trauma of that period. Veterans of Bill Clinton’s White House often speak of themselves as having been a “modernizing force” in the Democratic Party, one that swept out the old interest-group-driven factions that had long held sway. Their guiding idea was that a more pragmatic, results-oriented approach to governing held greater promise for achieving traditional liberal goals. This was coupled with a self-confidence that was at a peak in the heady days after the 1993 inauguration. The Clintons saw themselves as reformers empowered to abolish the old ways of Washington. Bill Clinton’s decision to make Hillary the head of the task force that would write the health-care bill set off grumbling in some quarters of the administration from the outset. She had never been elected to office or served in a formal policy position in government. But as first lady of Arkansas she had led a successful commission on education reform, the centerpiece of her husband’s second term. No one doubted that she would get a prominent role; rather, the president’s political advisers worried that she would get too prominent a role, and the public would grow to resent its unelected “copresident.”
As a discrete but important issue, health care seemed to finesse this problem. It also became the main element in Hillary Clinton’s effort to recast the role of first lady into something far more substantial than what had been bequeathed to her—something more along the lines of a senior White House adviser. What made this seem plausible, even wise, was her formidable record quite apart from her service as the first lady of Arkansas. Clinton had cochaired the Children’s Defense Fund and earned a national reputation as a pioneering theorist on children’s law. Also active in women’s issues, she had compiled three editions of the Handbook on Legal Rights for Arkansas Women, and was the first woman partner at the state’s most prestigious law firm. Twice in the five years before her husband became president, The National Law Journal named her to its list of America’s most powerful lawyers. She was blue-chip talent through and through.
She didn’t shy from the job. Clinton assumed a high public profile, declaring that health-care reform would be “the Social Security Act of this generation and the defining legislation for generations to come.” She approached her assignment much as she had the earlier one in Arkansas—like a good lawyer—this time bearing down and learning the mind-numbing intricacies of the health-care system.
Clinton shines in precisely the sort of situation where she is called upon to master a distinct body of knowledge. “Both Clintons are intensely smart, but they have different ways of approaching issues,” says John Podesta, the White House chief of staff in Bill Clinton’s second term and now an adviser to Hillary Clinton. “I’d describe him as a horizontal thinker, whose broad-ranging mind is always connecting one thing to another. She tends to drill down deep into a single subject. One feels, at some level with her, more tightness, discipline, and focus.” These skills she eagerly applied to the problem of health-care policy.
Clinton acquired an early patron in Senator Jay Rockefeller, the West Virginia Democrat whose career was then at its apex. Rockefeller was viewed as presidential material, but had opted to pass on the 1992 election. Health care was his major interest. The agony of watching his mother’s lengthy battle with Alzheimer’s had made him a crusader for universal health insurance, and in the years before Bill Clinton was elected he had organized labor and health interests toward that goal.
After a series of dazzling performances testifying about health care on the Hill, Clinton quieted many of her critics. Friends describe this period as her happiest in the administration. “When I think of Hillary I have one enduring image,” says Maggie Williams, her close friend and former chief of staff. “It’s of her after a day of events and meetings in an elevator, her arms bursting with books and papers and briefings, all about health care, on her way to the residence. She looked extraordinarily happy.”
It’s hard to imagine today, but press coverage at the time generally took the view that Hillary, not Bill, was the more dynamic and impressive Clinton. Her congressional testimony made her the administration’s first star.
National health care was a dream that had eluded U.S. presidents since Franklin Delano Roosevelt tried to include it in his plan for Social Security. Special interests always beat it back. Roosevelt had to drop the medical benefit from the legislation when doctors protested the idea of government intrusion. Pharmaceutical and insurance companies helped kill subsequent attempts. Only Lyndon Johnson’s landslide victory, in 1964, created the fleeting conditions that allowed Medicare and Medicaid to pass.
Mindful of this history, the Clintons thought they could prevail by rigidly shielding the process from the established interests—excluding even key Cabinet members. When presidents want a bill, they typically assign it to the relevant Cabinet member or put forward a set of principles and let allies in Congress write the legislation. Both strategies offer the advantage of warding off potential political problems and building a base of support: everyone gets an early sense of the important details and a chance to speak up.
But that includes those interests likely to oppose the legislation, who may seek to influence its outcome. Assessing the historical record of how major reform had been stymied in the past, Bill Clinton doubted that even his own Cabinet could fend off such pressure. And so the president and his counselors devised an end run around Washington’s normal way of doing business. They chose their good friend Ira Magaziner, a business consultant without Washington ties, to manage the task force with Hillary. The Clintons and Magaziner shared a certain hubris, as well as an often articulated disdain for (in what was then the president’s favored phrase of opprobrium) “the traditional Washington views” on health care.
So the Clinton White House made the audacious decision to write the whole thing itself, in a task force shrouded in secrecy, consciously shutting out Congress and the health-care community. They would simply outsmart the Washington establishment.
The task force quickly metastasized into a herd of more than 600, whose inescapably slow pace, along with continual interference from other administration priorities, kept pushing back the timeline for a bill. Eventually, as the months went on, members of Congress introduced competing plans. Some of these, notably that of Representative Jim Cooper, a Democrat from Tennessee, enjoyed broad bipartisan support. Bob Woodward’s book The Agenda, which details this period in the White House, notes “an increasing self- righteousness in Hillary” as frustration led to “a new, deeply anti-Washington flavor in her tone.” In his memoir, All Too Human, George Stephanopoulos describes her as “inflexible.” When “Hillarycare” finally arrived, in late October, the draft was a monstrous 1,342 pages long (Cooper’s was about 300). Hillary’s original star turn was all but forgotten.
The Clintons considered several legislative options before settling on a clever, but risky, strategy that seemed by then to be their best hope of getting a bill through Congress. An anonymous administration official quoted in a Time column had earlier belittled the petulant chairman of the Senate Finance Committee, Daniel Patrick Moynihan (“We’ll roll right over him if we have to”), who should have played a critical role. The decision was made to try to attach health care instead to the annual budget reconciliation bill. Theoretically, this offered a number of advantages. The reconciliation bill is the single most important piece of legislation Congress passes each year, because it locks in the spending and legislative changes in the budget—it simply must pass, or the government shuts down. As such, it is accorded special procedural shortcuts: it requires only a simple majority vote in both chambers of Congress, and, tantalizing from the administration’s standpoint, Senate rules permit just twenty hours of debate, so the bill can’t be filibustered. (Ronald Reagan used the reconciliation bill of 1981 to drastically shift spending from domestic programs to defense.)
What this strategy didn’t account for was the considerable ego of Senator Robert C. Byrd, the West Virginia Democrat who was then chairman of the Appropriations Committee, through which the reconciliation bill would pass. Byrd worships the Senate the way some cultures worship their ancestors, believing that the Founders’ ideas live on in its arcane rules and procedures. He has a flair for windy oratory—nothing clears the Senate floor like his annual perorations celebrating Mother’s Day or the first day of spring. The author of a four-volume history of the Senate, he holds strong views about what should, and should not, be permitted. And he has the means to impose them on others.
Byrd felt the Clinton strategy violated the spirit of the budget reconciliation bill by trying to attach something to it that had nothing to do with the budget. In the mid-1980s he had established the “Byrd rule,” which forbade just this sort of tampering with the bill. Health care “was a big piece of legislation, it was important—it ought to have been debated,” he told me recently. “I certainly was abhorrent of the idea of ramming this piece of legislation through by that mechanism.” A succession of eminences led by Jay Rockefeller pleaded with him to relent. The president called him. Byrd wouldn’t budge. The elaborate plan to circumvent the establishment collapsed under the stern gaze of its senior member. “I was the bear trap,” Byrd told me, with a twinkle of defiant pride.
It is now widely accepted that the legislative strategy for health care was fatally flawed. Clinton’s White House never really understood the Senate. (Of the Clintons’ inner circle, Stephanopoulos, Leon Panetta, and Howard Paster all came from the House, and Al Gore had always been an outsider in the Senate.) Hillary Clinton is neither entirely wrong, nor especially charitable, to blame others for the bill’s demise. In her 2003 memoir, Living History, she singles out another House veteran, Majority Leader Richard Gephardt. But many administration officials had harbored serious misgivings from the outset, and many more grew to share them as the year went by. In All Too Human, Stephanopoulos charges that “her position stifled healthy skepticism about our strategy,” causing “quiet resentment.” By autumn President Clinton himself seems to have sensed the premonitory signs of failure, and maneuvered to cut a face-saving deal.
The best option now lay with Representative Jim Cooper, who, after first offering his own bill to the Clintons and being rebuffed, had introduced it in early October, stopping short of the universal coverage Clinton insisted upon but featuring many of the managed-care ideas she later came to embrace. That summer, a longtime friend of the Clintons named Thomas Schneider mentioned to them that Cooper had been a law-school classmate and remained a close friend. Schneider offered to broker a meeting.
One Saturday in late September, Schneider, Cooper, and Bill Clinton set out for an early-morning round of golf at the Army-Navy Club. Discussion soon turned to health care. Ever the deal maker, Clinton started probing Cooper for the possibility of a compromise. “Clinton was an artist at negotiation,” says one member of the group. “There was a lot of common ground there, and he had a good sense of the public mood about health care.”
It started to drizzle, so Clinton invited the group back to the White House, where the talk continued into the afternoon over beers. Cooper canceled a trip to Tennessee and kept listening. By the time he left that evening, says the source, “it was very close to a handshake.” Clinton’s parting words were, “Look, I think we can make this work. But Hillary’s leading this, and you’ll need to have a meeting with her.” Cooper agreed.
But when he met with the first lady shortly thereafter, it was as if the golf outing had been just a dream. “She was looking for Jim to surrender 100 percent,” says one source with knowledge of the meeting. “It was brutal,” Cooper told me. Things collapsed quickly, and no deal was struck. Hillary Clinton’s major initiative died ignominiously many months later, without even coming to a vote.
A close friend of the Clintons offers this diagnosis: “She was focusing on the delivery of health care. She was utterly and totally tone-deaf to the politics.”