If this plan did not perish because it had been designed in intolerable
secrecy, or because its designers knew nothing about politics, or because
it was full of unacceptable new ideas, or because it was so much more
complex than any predecessors, then what happened to it?
The Administration's view, for which, again, there is ample evidence, is
that it went down because of two zero-sum games, one political and one
economic. Health
care reform became a battle in which some would win and others would
lose—and Clinton lost.
Through most of 1993 the Republicans believed that a health-reform bill
was inevitable, and they wanted to be on the winning side. Bob Dole said
he was eager to work with the Administration and appeared at events side
by side with Hillary Clinton to endorse universal coverage. Twenty-three
Republicans said that universal coverage was a given in a new bill.
In 1994 the Republicans became convinced that the President and his bill
could be defeated. Their strategist, William Kristol, wrote a memo
recommending a vote against any Administration health plan, "sight
unseen." Three committees in the House and two in the Senate began
considering the bill in earnest early in the year. Republicans on several
committees had indicated that they would collaborate with Democrats on a
bill; as the year wore on, Republicans dropped their support, one by one,
for any health bill at all. Robert Packwood, who had supported employer
mandates for twenty years, discovered that he opposed them in 1994. "[He]
has assumed a prominent role in the campaign against a Democratic
alternative that looks almost exactly like his own earlier policy
prescriptions," the National Journal wrote. Early last summer conservative
Democrats and moderate Republicans tried to put together a "mainstream
coalition" supporting a plan without universal coverage, without employer
mandates, and without other features that Republicans had opposed. In
August, George Mitchell, the Democratic Party's Senate majority leader,
announced a plan that was almost pure symbolism—no employer mandates,
very little content except a long-term goal of universal coverage. Led by
Bob Dole and Newt Gingrich, Republicans by September were opposing any
plan. "Every time we moved toward them, they would move away," Hillary
Clinton says.
"We always knew that in the end people's trust of the President and First
Lady would be crucial," Ira Magaziner says. "The debate was going to be
complicated, and that trust factor was very important." Whitewater eroded
the trust factor. The President looked beatable, and he lost.
Economic factors counted too. Doctors had fought bitterly against Medicare
in the early 1960s, but for the most part they sat this battle out. If
they weren't controlled by the government, they would be controlled by
insurance companies, which in some ways were worse. But other interest
groups had more to lose. Health-insurance agents would be put out of
business. Health-insurance companies could have their premiums capped.
For-profit hospitals thought they would lose money. Manufacturers of
medical equipment thought that market growth might slow. Large businesses
that did not already offer health care for workers knew the employer
mandate would cost them money. (These were mainly corporations like
PepsiCo and General Mills, which own restaurant chains whose part-time
workers are uninsured.)