The Clinton Health Care Plan: Fundamental or Incremental Reform?

Just when it seemed it would never happen, the long-awaited Clinton Health Plan, the Health Security Plan, was announced in mid-September 1993. The announcement followed an unprecedented 8-month planning process, punctuated by rumors, leaks, special-interest group lobbying, and almost daily results of public opinion polls. The delay in announcing the plan stemmed from some hard choices the President faced. He had campaigned on four promises: to provide health care coverage for all Americans; to slow runaway medical care cost inflation; to minimize governmental intrusion; and to avoid harm to most special-interest groups. Not surprisingly, the plan reflects the many political compromises that resulted from trying to reconcile these promises. When and if legislation eventually is enactedand the smart money now predicts that it is most likely to occur in the fall of 1994it undoubtedly will reflect further compromises. Nevertheless, the American fascination with the politics of health care reform should not obscure the importance of this sweeping plan nor the historic opportunity for fundamental reform that it presents. That opportunity builds on growing dissatisfaction with the increasing costs of medical care, the insecurity resulting from basing health care insurance on employment, and the national disgrace of 37 million uninsured Americans. As a result, a new coalition of big business, labor, some elements of the health care professions (including, notably, the American College of Physicians), and the general public clamors for the politicians to fix health care. Of course, the consensus on the need to fix it is not matched by consensus on what to fix, much less how to do so.