Newly released documents from the Clinton White House reveal a candid assessment of the looming fight over the administration’s doomed health care plan, as advisers tried unsuccessfully to steer the sprawling legislation through Congress.
A series of 1993 memos and briefing notes shows how the Clinton White House anticipated -- but was ultimately overwhelmed by -- Republican lines of attack against the health care reform effort, which collapsed under criticism through 1993 and 1994. The documents also show the administration’s early defense of its decision to draft a bill that critics derided as overly complex, even as advisers acknowledged that it would need to be simplified.
“The potential exists for them to succeed if they convince the majority of Americans with good coverage that quality of care will deteriorate, rationing of care will occur, their costs will rise to finance the uninsured and the creation of a big government bureaucracy, [and] choice of doctor will be limited,” unlisted advisers warned in a lengthy strategy memo released Friday by the Clinton Library.
That same listing of critiques has been mirrored in continuing criticism of President Barack Obama’s health care overhaul, which was signed into law in 2010 but remains the target of GOP attempts for repeal today.
Laying out an early strategy for pushing the plan through Congress, the summary memo urged tight control by an elite group of White House officials – a strategy that ultimately drew criticism as one reason for the legislation’s demise.
“WE MUST SPEAK WITH ONE VOICE. A SMALL GROUP IN THE WHITE HOUSE MUST COORDINATE,” it reads.
Throughout the documents, the details of the administration’s attempts to woo members of Congress are laid out in painstaking detail, even including a list of which members were so crucial for the law’s success that they should be considered for invitations to accompany the president for golf, tennis or a show in the Kennedy Center box. Pages also list categories of members of Congress considered prime targets for individual targeting, including those in tough congressional races and those who “demand a lot of attention before they are supportive” of Clinton’s ideas.
Aides also warned of personal attacks against most – but not all – of the bill’s opponents.
“We should not attack Republican members, with the exception of the far right members like Senator [Phil] Gramm,” reads one undated memo. “But we should attack their principles and supporters.”
The documents also show Clinton’s concerns about the possibility that the health law would lessen Americans’ choice of doctors -- a problem that has dogged the Obama administration throughout the implementation of the president's signature legislative achievement.
“President noted that first concern of American people is losing health insurance and second is losing choice of physicians,” reads a summary of a March 17, 1993 briefing. “Doctors should be allowed to participate in multiple plans to ensure choice of physician.”
That concern is echoed throughout the documents; a memo from strategist and pollster Stan Greenberg advised that “We must be able to say, believably, that our health care reform will preserve, even expand choice. But those on Medicare or with fully-funded company polities will be very skeptical.”
Aides also warned regularly that the legislation had been successfully painted as overly complex and bogged down in regulations.
“The plan sounds and is too regulatory. We need to remove some of the powers of [the Department of Health and Human Services], the Board and the Alliances,” adviser Ira Magaziner wrote to the president and first lady Hillary Clinton in October 1993.
Greenberg also raised alarms about the public’s belief that the health care law would benefit illegal immigrants at the expense of working Americans. “This may sound like a crazy critique, but the subject was volunteered in 3 or 4 focus groups,” he wrote.