As I pointed out in a previous post, Theda Skocpol’s wonderful book, Boomerang, provides many telling details about Bill Clinton’s futile efforts to reform the U.S. health care system in the early ’90s. The book details many of the mistakes that the Clinton team made in drafting and promoting the legislation. But the failure of health care reform does not rest solely at the president’s feet. Instead, we, the general public, are also to blame. We ultimately got the policies we deserved.
Skocpol relates a powerful anecdote that nicely captures the sense of public confusion surrounding the general public during the Clinton reform efforts. It was March of 1994, and the Clinton team was trying to convince reluctant legislators to craft a bill consistent with its general approach to health care reform, which was a politically moderate bill that shunned the single payer plan preferred by liberals in favor of a bill based on “managed competition,” an idea embraced early on by moderate Republicans. Around this time, a Wall Street Journal/NBC news poll asked people what they thought of a plan that would “guarantee a standard private health benefits package… and promote competition… and require employers to buy insurance” for their employees. This description fit the Clinton plan to a “t,” and 76 percent of the public viewed it favorably. The dude had found the policy sweet spot!
Only one problem. When that same poll asked people if they approved of the “Clinton plan,” only 37 percent demonstrated support.
Public contradictions over health care reform run even deeper than antipathy to anything Clinton-esque. In its own polling, for example, the Clinton team learned that any plan they crafted that emphasized guaranteeing people “standard or basic” health care benefits would fail, because people wanted “comprehensive benefits,” feeling like it was only these more generous benefits that would be relevant to their own lives. (The administration also learned that the words “plan” and “program” were, ahem, program killers!) At the same time that the public clamored for comprehensive benefits, people also expressed their skepticism that a Democrat like Clinton could craft a health care reform bill that wouldn’t burden the taxpayers with a huge new expense. Well, of course Clinton couldn’t do that. It’s kind of hard to give everybody a Lexus at Hyundai prices!
Then of course there was the public clamor for: 1) Clinton to lay out the specifics of his plan while, 2) being ready to work with Congress and health care experts on the details, never forgetting, 3) not to compromise on his principles. They wanted specific details that could change as needed, but no flip flops. After all, a flip-flopper is almost as bad as someone who is so stubborn he won’t listen to anyone else’s ideas!
Keep your eyes open for these kinds of inconsistencies in the days ahead, as we suffer through another presidential campaign. We will no doubt hear much about Obama’s inconsistencies: remember when he said he would close Gitmo? If he runs against Romney, we will also be inundated with reminders of that gentleman’s flip-floppy ways.
But before we criticize each candidate too sharply for his capriciousness, we should take a long hard look in the mirror and face up to our own inconsistencies. If we, the public, don’t get our own act together, we’ll get the president we deserve.
Peter Ubel is a physician, behavioral scientist and author of Pricing Life: Why It’s Time for Health Care Rationing and Free Market Madness. He teaches business and public policy at Duke University. Peter’s new book, Critical Decisions will be available in the fall of 2012. You can follow him on his personal blog.