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Universal Coverage, Health Inequalities, and the American Health Care System in Crisis (Again)
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APSA 2004
U
NIVERSAL
C
OVERAGE
29
gress and difficult political choices, including raising taxes.
168
It passed by one
vote in the House and by the tie-breaking vote of Vice President Gore in the Senate.
169
Based on this experience and their professional backgrounds, Clinton’s
budget and economic advisors were far more knowledgeable than Hillary, Ira Magaziner, or any member of the Health Care Task Force about what was and was not politically feasible. But probably because of the tough questions they would have asked (and later did ask) about the health reform plan, Rivlin claims, they were largely excluded from the Task Force’s drafting process.
170
Their lack of
input, in Panetta’s opinion, damaged the plan’s political prospects:
[I]nstead of the careful work that went into developing the budget. . . [t]he health care thing became part of a political strategy. . . . The President’s plan was designed by a smaller group of individuals. . . [and] [o]nce it was done, it was very difficult to try to change it. And a lot of us . . . indicated our concerns with what would take place. I mean, I had kind of a double concern, which was not only the nature of what was being proposed, because it was so hard to understand, but, secondly, I said that the problem is that Congress is not going to be able to understand the implications here. Congress cannot digest this big a piece of legislation in one bite. . . . It didn’t have a lot of useful politics, so the problem is that they lost sight of the fact that without being able to sell it politically, it wasn’t going to happen. Unfortunately, of all the battles we’d been through to try to get the budget put in place, you know, all of those lessons just went out the window with the rest of health care reform.
171
Without the involvement of the administration’s key budget and economic
advisors, the plan’s ambitions were never cross-checked against what realistically could be passed in Congress. The end result, as Robert Rubin points out, was a politically impossible situation: “I think that partly it’s because it [the process] led into something that was too large to accomplish at one time. . . . [T]he reform of
168. C
LINTON
, supra note 156, at 179.
169. C
LINTON
, supra note 156, at 179.
170. Telephone Interview with Alice Rivlin, Founding Director, Congressional Budget Office
[CBO], 1975-1983; Director, Economic Studies Program at the Brookings Institution, 1983-1992; Deputy Director, White House Office of Management & Budget [OMB], 1993-1994; Director, Office of Management & Budget, 1994-1996 (August 12, 2002).
171. Telephone Interview with Leon Panetta, U.S. Representative, CA, 1977-1993; Chairman,
House Budget Committee, 1989-1993; Director, White House Office of Management & Budget [OMB], 1993-1995; White House Chief of Staff for President Clinton, 1995-1997 (August 13, 2002).
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APSA 2004
U
NIVERSAL
C
OVERAGE
29
gress and difficult political choices, including raising taxes.
vote in the House and by the tie-breaking vote of Vice President Gore in the
Senate.
Based on this experience and their professional backgrounds, Clinton’s
budget and economic advisors were far more knowledgeable than Hillary, Ira
Magaziner, or any member of the Health Care Task Force about what was and was
not politically feasible. But probably because of the tough questions they would
have asked (and later did ask) about the health reform plan, Rivlin claims, they
were largely excluded from the Task Force’s drafting process.
input, in Panetta’s opinion, damaged the plan’s political prospects:
[I]nstead of the careful work that went into developing the budget. . .
[t]he health care thing became part of a political strategy. . . . The
President’s plan was designed by a smaller group of individuals. . .
[and] [o]nce it was done, it was very difficult to try to change it. And a
lot of us . . . indicated our concerns with what would take place. I mean,
I had kind of a double concern, which was not only the nature of what
was being proposed, because it was so hard to understand, but,
secondly, I said that the problem is that Congress is not going to be able
to understand the implications here. Congress cannot digest this big a
piece of legislation in one bite. . . . It didn’t have a lot of useful politics,
so the problem is that they lost sight of the fact that without being able
to sell it politically, it wasn’t going to happen. Unfortunately, of all the
battles we’d been through to try to get the budget put in place, you
know, all of those lessons just went out the window with the rest of
health care reform.
Without the involvement of the administration’s key budget and economic
advisors, the plan’s ambitions were never cross-checked against what realistically
could be passed in Congress. The end result, as Robert Rubin points out, was a
politically impossible situation: “I think that partly it’s because it [the process] led
into something that was too large to accomplish at one time. . . . [T]he reform of
168. C
LINTON
, supra note 156, at 179.
169. C
LINTON
, supra note 156, at 179.
170. Telephone Interview with Alice Rivlin, Founding Director, Congressional Budget Office
[CBO], 1975-1983; Director, Economic Studies Program at the Brookings Institution, 1983-1992;
Deputy Director, White House Office of Management & Budget [OMB], 1993-1994; Director, Office
of Management & Budget, 1994-1996 (August 12, 2002).
171. Telephone Interview with Leon Panetta, U.S. Representative, CA, 1977-1993; Chairman,
House Budget Committee, 1989-1993; Director, White House Office of Management & Budget
[OMB], 1993-1995; White House Chief of Staff for President Clinton, 1995-1997 (August 13, 2002).
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