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Who Killed National Health Care?


Books

WHO KILLED NATIONAL HEALTH CARE?

THE SYSTEM The American Way

of Politics at the Breaking Point

By Haynes Johnson and David S. Broder

Little, Brown -- 668pp -- $25.95

BOOMERANG Clinton's Health Security

Effort and the Turn Against Government in U.S. Politics By Theda Skocpol

Norton -- 230pp -- $27.50

It's hard to imagine why anyone would want to read a 668-page book--or even a mere 230-pager--chronicling the battle to enact President Clinton's health-care reform. That failed struggle featured some of the ugliest campaigning, stupidest political blunders, and grossest misinformation--from both sides--that the nation has ever been subjected to. Even those of us who watched the two-year ordeal close up have largely erased it from our memories and might wonder why authors would expect to find a market in resurrecting it.

Both of these volumes try to escape their ennui-inducing subject by claiming larger themes. Their books are not about health-care reform, the authors say, but the transformation that it illustrated, and advanced, in American politics. In The System, veteran journalists Haynes Johnson and David S. Broder expound their long-held ideas about the decline of political parties, the pervasive influence of money politics, and the Right's power to mobilize its well-organized economic and culturally conservative forces.

In Boomerang, Harvard University sociologist Theda Skocpol proposes a simpler thesis. Health-care reform was the victim of "Reagan's revenge"--the corrosive federal deficits that limit and weaken government, thus turning Republican rants about Uncle Sam's uselessness into self-fulfilling prophecies. Both books arrive at the same conclusion: The 1994 electoral triumph of Newt Gingrich and his GOP revolutionaries rose directly from the ashes of Clinton's Health Security Act.

But their routes to that destination are sharply different. The System is a classic Washington book, stuffed with miniprofiles of key players and details such as what Senator John D. Rockefeller IV (D-W.Va.) told First Lady Hillary Rodham Clinton in closed-door meetings. The formula requires authors to deliver at least one piece of headline news, and Broder, columnist and political reporter for The Washington Post, and TV commentator Johnson oblige with two. First, they quote Bill Clinton admitting that he erred in trying to overhaul the $1 trillion health-care system in one bill rather than laying out a multiyear reform strategy. Second, they report that Gingrich claims to have predicted in 1991--a year before Clinton's nomination--that health care would be "the next great offensive of the Left" and resolved then to kill reform at any cost.

These revelations landed The System a plug on the Post's front page--where readers could have gleaned the same information, if not from the President's and Speaker's own lips, two years ago. Washington watchers might find more interesting the account of how, during the critical summer months of 1994, the House's Democratic barons sparred over whose committees would eventually oversee the new health system--a battle that delayed the bill and thus helped doom the spoils they were contesting. But readers outside the Beltway might find such an exhaustive recounting merely, well, exhausting.

More disturbing is The System's casual one-sidedness. Johnson and Broder obviously didn't set out to write a pro-reform screed, and they are at times harshly critical of the Clintons and their allies. But they apparently felt little need to report on the other side--the coalitions of business, conservative, and health-care interests that mobilized to fight the Clinton plan. The authors devote far more time to one pro-reform lobbyist, John Rother of the American Association of Retired Persons, than they give to all of the opposition's organizers.

Indeed, the opposition is most often portrayed as one large, usually angry, self-interested mass. The authors don't pause to consider whether, for example, upstanding corporate citizens such as IBM, DuPont, and American Express would have good reason to fear seeing their innovative and efficient health-care plans swept into the untested bureaucracies that Clinton's plan required.

As a result, The System sometimes reads like a wistful Southern account of the Glorious Cause. The one-sidedness is all the more puzzling since, as Johnson and Broder point out, the real news in 1993 and 1994 was the maturation of the political-action tools of the Right. The authors might usefully have spent less time mourning the hollowing-out of the Democratic Party and more reporting on the bulking-up of the GOP and its allies.

Skocpol's spare account in Boomerang forgoes the bunting and personality profiles. Her story, too, reveals that her sympathies and most of her sources were with the Clinton camp. (A historian of social policy, she met the Clintons during their dark days after the 1994 election and got access to internal White House memos during her research.)

Still, Skocpol compellingly lays out her case: Trapped between the public's demand for security and its suspicion of government activism, Clinton probably could not have designed a reform that would both guarantee universal coverage and cut costs. He certainly didn't help his cause by pretending that his expensive, highly regulatory scheme was a cheap, private-sector solution. But he was pinned down by the politics of the 1990s, Skocpol argues, in a middle ground where he pleased no one.

Both of these books portray Clinton's health-security effort as Pickett's Charge--the last chance for a triumph of 20th century social policy. But the same historical forces that stymied Clinton are making the terrain almost as uncomfortable for Gingrich & Co. Democrats have discovered the joys of opposition by skewering the GOP in the health-care battles--over Medicare and Medicaid cuts and insurance portability--of the 104th Congress. The events of the past four years show that the American people still haven't decided how much government they can live with--or without.BY MIKE McNAMEEReturn to top


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