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.

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7 Responses for “It’s We, the Public, Who Are Flip Floppers”

  1. tom finn says:

    Peter,

    May I re-post this post of yours –which I thoroughly enjoyed by the way. Naturally, I will provide full accreditation and a link. Please let me know, Tom
    tgfinn@gmail.com

  2. Samuel Stenes, MD says:

    Computerization of politics and the transformation of the people into robots will solve your problem, eh?

    We need EPRs (electronic political records) with brain-tongue management and political decision support.

    The taxpayters should fund this.

  3. Peter1 says:

    We have met the enemy and he is us.

  4. Nate Ogden says:

    “Public contradictions” is nothing but an excuse of ivory tower experts and propagandist that don’t know enough about healthcare to grasp why the public opposes their plans. Try this next time you think the public is contradicting it’s self; ask, what common sense answer that is clear to the majority of the public am I missing. When you find the answer to that question you will see the problem is your ideology not the public. Few examples;

    COBRA, a half decent idea that the majority of the public supported and would still support overwhelmingly if you polled on the basic premise. The problem is liberals never right bills that accomplish the basic premise and after 45 years of failures the public is well aware liberals can’t accomplish what they claim they are trying to. Because COBRA was so poorly written and implementation given so little though employers spent the next 2 decades getting sued trying to figure out how to comply with the ambiguous law. What happens when offering insurance gets to risky, they stopped offering it, uninsured rate increases.

    Guarantee Issue and health insurance for children. It use to be you could buy a great individual policy for a healthy child for $60 a month. As long as you bought while they were healthy it was almost impossible to lose that coverage and rates increased minimally. A 20% rate increase was still only $12 a month. So ACA passes and coverage for kids under 19 is guaranteed, kids under 19 getting coverage was a very minimal issue, underwriting was even lower on the list of causes. So HHS implements the bill and instead of a couple thousand kids not being able to buy individual health insurance policies now the entire market is gone, no kids can buy individual policies.

    This shows the ignorance of articles like this.

    Pool question;

    “Do you favor guarantee issue for kids under 19?”

    Respone 99.9% yes we do

    Reality;

    “Do you favor guarantee issue for kids under 19 which will eliminate the entire market making it so no kids, healthy or sick can buy a policy?”

    Response 20-30% still a lot of liberals out there without any common sense.

    The author would have you believe the public is “contradicting” itself. How can you be in favor of all kids being guaranteed coverage then oppose our bill? What’s wrong with the public? Nothing is wrong with the Public Peter, they are just far smarter then you. HillaryCare as written would never have accomplished anything meaningful it claimed it was being passed to do. It only took an ounce of common sense to know that. While the majority of the public do support the goal they aren’t so stupid to blindly support any liberal bill that claims it will accomplish them. That is why this country has never got behind single payor, we know the government can’t deliver it.

    Every major Democrat Healthcare reform since 1965 has failed miserably to accomplish what it claimed it would.

  5. Nate Ogden says:

    Simple test for you Peter;

    http://www.kff.org/kaiserpolls/upload/8156-F.pdf

    more than seven in ten would retain the provisions that close the Medicare doughnut hole, provide subsidies to help low and moderate income people get insurance, institute the new voluntary long-term care insurance program known as the CLASS Act,

    The vast majority support the outcomes proposed in the CLASS Act. Everyone, including democrats and Obama, know it was so poorly written and designed it wouldn’t accomplish any of what it claims it would, is unsustainable, and would be a complete failure.

    The question, is the Public contradicting itself by supporting the goals of the CLASS Act but opposing the bill as written? The CLASS Act is typical Democrat legislation, long on promise and no chance of success. Lucky for the American public the right and those with common sense stopped the left from implementing it.

    These claims of Public Contradiction are nothing but propaganda trying to get the public in line.

  6. Peter1 says:

    “These claims of Public Contradiction are nothing but propaganda trying to get the public in line.”

    Strange how your link contradicts your conclusion, unless of course you cherry pick sentences to “prove” your point of view.

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