Study Guide #6
Boomerang

The demise of the Clinton health plan is one of the most studied moments in the history of American public policy at least since the Nixon Administration, and rightly so: If the Clinton proposal had been enacted into law it would have fundamentally reshaped health care politics and policy. Moreover, its failure helped usher in a “Republican Revolution” that took away Democratic control of the U.S. House for the first time in nearly 40 years. It is impossible to understand the politics of health policy without first learning the Clinton health reform story, for policymakers and politicians today are still deeply influenced by what happened to the Clinton plan.

Theda Skocpol, a past president of the American Political Science Association, has her own explanation about what happened, and you can learn a lot about American politics just by absorbing her theory. But beyond that I want you to think about the “lessons learned” from the Clinton episode. What mistakes did the Clintons make? Did they pick the best path to health reform? How could they have presented their proposal to the public better? What interest groups were crucial to the outcome, and what tactics should the Clintons have performed to get their support? When would the timing be right to introduce a sweeping health care reform proposal—or are incremental policies always better? Under what conditions, if any, could a sweeping reform be enacted into law?

When you finish the reading, see if you can answer the following.

Introduction (1-20)

What exactly boomeranged? Why?

What common explanations did journalists advance for the demise of health care reform? Why does Skocpol reject them?

On pages 14-15 Skocpol compares the Clinton health care plan to another huge moment in the history of American public policy. What is it? (Pay attention because Skocpol returns to this comparison later.)

Why according to Skocpol is it unfair to complain that Clinton had a "big government" approach to health care?

At the end of the first chapter, Skocpol previews her explanation for the demise of the Clinton plan. What is it?

A Way Through the Middle (20-47)

What focusing event brought health care onto the policy agenda?

What three schemes of health care reform got onto the agenda? Which did Clinton initially endorse?

Why did Clinton turn away from pay or play? What did he turn to?

Who exactly developed "inclusive managed care"? How did it develop in the policy stream?

Designing Health Security (48-73)

What process did the Clintons decide to use to develop their proposal? What alternatives strategies might they have considered?

What is corporatism and why doesn’t it work in the United States? (Hint: veto points undercut it)

Who participated in the Task Force? Who did not? Why did the composition of the Task Force become a problem?

Why was planning and discussion of the plan put on hold between May and September of 1993?

How was the Cooper plan different from Clinton’s? Why couldn’t Clinton simply endorse the Cooper plan?

What is “paygo”? What is the CBO? How did they affect the Clinton plan? (Why was the CBO an even bigger problem for Cooper?)

The Clinton plan relied on competition among insurers to drive health care prices down. But if competition didn’t work, what did the Clinton plan do to guarantee no large increases in price for health care?

How might Kingdon analyze Clinton’s decision to forge a “new path” in health care? (Why might Clinton’s choice reduce the chances of passage in Kingdon’s model?)

Democrats in Disarray (74-106)

When did public support for the Clinton plan ebb? (Why did the Clinton campaign for health care reform lose momentum after early September?)

What changes in American politics over the past decades made Clinton’s task harder? What makes liberal groups so bad at mobilization?

Why did AARP hang back and fail to campaign vigorously for the Clinton plan?

In what sense did “Congress Make it Worse”? How did single-payer advocates contribute to the problem?Marketing an Ambivalent Message (107-132)

What is the trend in trust in government and how did it affect the Clinton plan?

What about the Clinton plan particularly troubled voters?

What key feature of the Clinton plan was left unexplained in the publicity campaign in favor of the plan? Why was it left unexplained?

Skocpol rejects the notion that Clinton was too poll driven. Why?

Skocpol from time to time compares the Clinton plan to the creation of Social Security in the mid-1930s. Clinton himself analogized his proposal to social security, but Skocpol says the analogy is “thin.” Why? (122)

How has electoral and interest group politics changed over the past 30 years. How did these changes affect the Clinton plan?

How did the media cover the Clinton proposal?

“ President Kennedy committed this country to going to the moon. He did not say we’ll use a three-stage Saturn V rocket.” Why does Skocpol consider this a poor analogy?

Mobilization Against Government (133-172)

How did the insurance industry split?

What did HIAA do to beat Clinton? What other groups got involved?

What was the attitude of big business?

What strategy did Kristol suggest for handling the Clinton plan?

How was Hillary portrayed?

What happened to moderates who were inclined to compromise with Clinton? What is reverse lobbying and cross lobbying?

What conclusions does Skocpol draw from comparing the Clinton plan to Social Security?

Legacies and Lessons (173-188)

What is “Reagan’s Revenge”? (Might a future president face “Bush’s Revenge?”)

Clinton tried to develop a plan that didn’t expand government and raise taxes. Why did that goal actually lead to a highly regulatory, complex proposal?

Could Clinton have won with single-payer? Pay or Play? Or was he, according to Skocpol, doomed from the start?