The collapse of the Clinton health care plan is the story of a failure — but whose? In “The System” (Little, Brown, 668 pages, $25.95), an account of “American politics at the breaking point” (as the grim subtitle puts it), two of Washington’s most eminent journalists lay the blame squarely on a corrupt and dysfunctional system of national politics.
“The story,” Haynes Johnson and David S. Broder conclude, “shows how private interest can triumph over the public interest, how a powerful minority can manipulate opinion to defeat a reform desired by the majority, how hope for needed change can result in more cynicism about the workings of The System.”
As Mr. Johnson and Mr. Broder tell it, the machinations of congressional conservatives combined with the ideological rigidity of congressional liberals to doom a moderate, reasonable plan of change. All the while, they complain, special interests were spending hundreds of millions of dollars to convince voters (falsely, in the authors’ view) that the bureaucratic apparatus of the Clinton health plan would kill jobs and wreck American medicine.
It is among the many merits of this intensely reported book that it presents most of the information a reader will need to reach precisely the opposite conclusion.
In retrospect, it is amazing that some sort of health plan was not adopted in 1993. Mr. Clinton had made universal health insurance a central election plank. He entered office with both houses of Congress in the hands of his party and with more than 70% of Americans in agreement that government should require all employers to provide all employees with health insurance. How could he have thrown away this spectacular opportunity?
Blame not The System, but Gennifer Flowers. Bill Clinton allayed the first of his recurring sex scandals by appearing on “60 Minutes” and holding his wife’s hand as he denied all Ms. Flowers’s charges. That night he contracted an enormous debt, and Mr. Johnson and Mr. Broder strongly imply that he repaid it by putting Mrs. Clinton — a woman who had never been elected to any office, had never administered any organization and had scant previous familiarity with health care issues — in charge of the most important agenda item of his presidency. Unsurprisingly, she bungled the job.
First, she hired as her deputy Ira Magaziner. Working inhuman hours, presiding over dozens of working groups, Mr. Magaziner took upon himself the responsibility for the most complete demolition and reconstruction of a national economy since George C. Marshall first flattened Germany and then rebuilt it. But Gen. Marshall never dreamed that his job extended to laying out the streets in suburban Bremen and deciding the permissible fat content of postwar knockwurst.
Mr. Magaziner, on the other hand, appointed himself the Sultan of Health Care. One morning he would decree that postal workers might remain outside his system of health care alliances; the next, that state and county workers must join. Another afternoon he would give the nod that would have forced every American employer to pay for his workers’ mental health treatments, while turning an imperious thumbs-down to dental benefits. Congressmen pleaded with the Clinton White House to draft some incremental reform that might have made health insurance marginally more available to the hardest pressed of their constituents. But modesty was the one restriction that Mr. Magaziner and Mrs. Clinton rejected from the beginning.
Their colossal ambition — and the killing 18-hour days, seven-day weeks they devoted to it — are reminiscent of nothing so much as those old Stalinist movies about farmers working through the night to harvest the crop: “Bolsheviks storm the wheat harvest!” Like the crop-storming Bolsheviks, the Clintons ended in predictable and entirely avoidable disaster.
Mr. Johnson and Mr. Broder themselves draw a contrast between the failure of the Clinton health plan — which never even came to a vote in Congress — and the success of the Reagan tax reform in 1986. They note (admiringly) that Mr. Reagan assigned the initial drafting of the plan not to some old hut-mate from the Bohemian Grove but to the professionals in the Treasury Department. The plan was logical and easy to explain. Winners dramatically outnumbered losers. Congress was brought into the process early. The president himself remained aloof from the plan until presented with a final version, thus preserving his freedom to walk away undamaged until near the end.
Mr. Johnson and Mr. Broder conclude their book with some alarming observations about the American political system. They list a series of worrying domestic problems and wonder how the system that failed to “solve” health care will “solve” inner-city crime or middle-class economic insecurity. But after finishing this meticulously reported, briskly written and impressively fair book, many of Mr. Johnson and Mr. Broder’s readers may instead prefer to fete a political system that — despite very real anxieties about the troubles in its health care market — was somehow able to disregard the Clintons’ manufactured hysteria, assess the demerits of their vast and statist remedy for the health care problem and reject it.