A Walk Down Memory Lane: What Went Wrong With Clinton's American Health Security Act of 1993

THE HEALTH CARE DEBATE: What Went Wrong? How the Health Care Campaign Collapsed -- A special report
Published: Monday, August 29, 1994

In March 1993, two months after his inauguration, President Clinton appealed to Robert C. Byrd, the presiding officer of the Senate, to let national health insurance legislation be considered as part of that summer's budget bill. It was, at first glance, a move of remarkable hubris, a President elected with 43 percent of the vote expecting Congress to allow him to rearrange one-seventh of the American economy under the streamlined, fast-track procedures of a budget bill. But it reflected the concern of the President and his allies that his power would never be greater than it was in his first months in office, that what was hard then would be supremely difficult a year later, and that a window was open, perhaps only fleetingly, to pass a major health care bill.

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The Administration's biggest tormentor, after small-business lobbyists, was probably the Health Insurance Association of America, which began running television advertisements ridiculing the Clinton plan in September 1993. The "Harry and Louise" commercials featured a couple agonizing over details of the Clinton plan in exchanges like this one:

Louise: This plan forces us to buy our insurance through these new mandatory Government health alliances.

Harry: Run by tens of thousands of new bureaucrats.

Louise: Another billion-dollar bureaucracy.

Professor Jamieson of the University of Pennsylvania said the available evidence suggests that "the ads had a negligible impact on the public" and were intended primarily to influence opinion makers in Washington and New York. But Mr. McInturff, the pollster who analyzed the commercials for the insurance industry, says they did influence the public. In any event, the Clintons' criticism of the advertisements provoked far more public interest in them than Harry and Louise would ever have commanded on their own. The supporters of Clinton-style health care legislation proved no match for the groups opposing Mr. Clinton...

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Many advocates of health care restructuring were perplexed by the position taken by big business. After all, they had reasoned, big corporations generally paid for their workers' insurance -- and what they paid also subsidized health care for millions of people who were uninsured. For years, business executives had complained about the soaring cost of health care. But many corporate executives had a visceral reaction to the complexity of the Clinton plan and the expansion of Federal authority that Mr. Clinton was proposing. They said they could control costs much better than the Government could, and they feared that under the Clinton plan they would lose the right to tailor health benefits to their employees' needs. Small Business to the Fore

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...Mr. Clinton's allies continually qualified their support by expressing concern about specific parts of his plan. Labor unions worried that Mr. Clinton was going to tax some of the benefits they had won in collective bargaining. Doctors specializing in internal medicine supported much of Mr. Clinton's plan, but objected to the proposed cutbacks in Medicare and to the idea of Federal limits on private health insurance premiums.

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In his State of the Union Message on Jan. 25, 1994, President Clinton waved a pen before Congress and threatened to veto any health legislation that did not guarantee insurance coverage for all Americans.
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The struggle for universal coverage began to collapse in the committees. Again and again, members tried to reach consensus on how to cover everybody without antagonizing the small-business lobby...

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There is general agreement that Mr. Clinton would have got closer to his goal if he had acted faster, before the opposition had mobilized and his own standing had weakened. But beyond that, even perfect hindsight produces no consensus on what could have been done to bring the nation closer to the universal health care it seemed to want 11 months ago.