Boomerang The Clinton Health Care Plan That Failed

Title: Boomerang

Author: Theda Skocpol

Data: 230 pages, Norton; $27.50

Autopsies are never fun and are usually messy. Boomerang, a post-mortem of the Clinton administration's failed health-care plan written by Harvard professor Theda Skocpol, falls into this category. With new health-insurance regulations and the creation of Medical Savings Accounts (MSAs), future historians are likely to view the President's plan as having a been a catalyst for future government control of medicine.

There are compelling reasons to understand the forces shaping America's hodgepodge of a health-care system. For starters, most experts agree that Medicare is going belly up. The 30-year-old program may not be able to cover baby boomers, and Generation Xers seem to believe that they can kiss their Medicare “contributions” good-bye.

Moreover, employees are increasingly herded into lunchrooms for a process called ``open enrollment,'' during which everyone flips through publications the size of a telephone book, listens to a few sales pitches and then selects a health plan—in California, that usually means an HMO—and picks a doctor from a list. While health care is a matter of life and death, lately it is also a bureaucratic nightmare.

In short, health-care reform matters.

As Skocpol writes in the introduction, understanding why Clinton's plan died “takes us into the thick of the partisan and institutional forces shaping—and rapidly transforming— U.S. politics today.''

In the ashes of Clinton's failed plan, Skocpol could have written a kind of pre-apocalyptic primer for the coming generational war on health care. She doesn't. Part of her problem stems from the topic itself. A cartoon on Page 73 highlights the dilemma. A pollster asks a middle-age couple if they know about Clinton's health-care plan and they respond: ``Sure ... We've already joined an HBO.''

Initial response to Clinton's notion of ``health care that can never be taken away'' was overwhelmingly favorable. Momentum had been building in Congress. Then-Senate Minority Leader Bob Dole had embraced the philosophical root of the plan; a concept called ``universal coverage.'' For better or worse, pundits had declared, America could expect Clinton's plan to become law in at least a modified form. By fall 1994, his much-ballyhooed plan was dead, left in a legislative junk heap of compromises.

Why did it fail? Unconvinced that ``the era of big government is over,'' Skocpol claims people didn't understand it. She asserts that Clinton should have admitted his plan was bigger government and offered a better sales presentation.

By blaming everything from advertising to a New Republic editorial, she ignores another key possibility: that the public understood the essentials of Clinton's plan and didn't like it. She assumes that the current health-care system is flawed but offers no explanation for how it happened. Instead, she argues for more government involvement, which is what the President's Task Force on Health Care Reform did.

The Task Force took months to develop the plan and, as they did, an intense grass-roots effort organized to fight it. Political high drama surrounded its evolution. Restructuring one-seventh of the U.S. economy is rather dramatic, but Boomerang offers neither drama nor details. It's like reading about the bombing of Pearl Harbor as a mere military maneuver.

Missing is a chronology of the plan's development—from the moment Clinton held up a plastic ``Health Security Card'' to the instant it was pronounced dead.

Weeks went by with the American people in the dark as the appointed group wrote a blueprint for virtually every aspect of health care. Nevertheless, there is hardly a mention of the unprecedented secrecy by which this massive proposal was composed, (nor the First Lady's role on the task force) much less a simple chronology.

Boomerang has its assets, however. Skocpol properly observes that many Republicans who were against Clinton's plan because it would advance managed care now encourage it. She offers a rare glimpse behind the scenes of the largest proposal for government health care since Medicare, which led to a Republican takeover of Congress and left in its wake closer scrutiny of managed care, HMO contracts, discussion of Medicare reform and recent congressional approval of tax-free MSAs.

Skocpol makes no secret of her liberal credentials; she embraces the idea of government intervention and disdains free-market solutions to the crisis in medical financing. When it comes to health reform, as she puts it, ``What matters is the kind of government involvement any plan proposes ...'' (emphasis hers). At the tail end of Boomerang, she admits she favors socialized medicine and higher taxes. At least she's honest.

Finally, Skocpol's all-or-nothing ideology of government involvement in medicine casts doubt on our new law. Her warning that ``minor regulatory changes in the existing private insurance market ... may leave more and more middle-income Americans facing ever higher premiums for the same, or less, coverage'' could describe the Kennedy-Kassebaum legislation Clinton signed just weeks ago. What she recognizes as harmful to the middle class is the direct descendant of a health-care plan the goals of which she champions. Americans may be affected by this ``boomerang'' for a long, long time.

This 1996 book review was published in the Los Angeles Daily News.

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