Useful reminder from an insider at the time:
Quote:By the time Hillary became involved in health-care reform in late January 1993, Bill Clinton's thinking about the problem was already well advanced. The previous September during his campaign, he had settled on the basic model for reform -- a plan for universal coverage based on consumer choice among competing private health plans, operating under a cap on total spending (an approach known, in the shorthand of health policy, as "managed competition within a budget").The Hillarycare Mythology
Though the media scarcely registered it at the time, Clinton had described this approach in a speech and referred to it in the presidential debates. Moreover, he saw health-care reform through the prism of economic policy, believed that reducing the long-term growth in health costs was a national imperative, and insisted that even while making coverage universal, health-care reform had to bring down future costs below current projections for both the government and the private economy.
Among Clinton's close advisors, Ira Magaziner championed the view that these aims were achievable. When he became the director of the health-reform effort and Hillary the chair, their job was not to choose a policy, but to develop the one that the president had already adopted.
My knowledge of this process is first-hand. Magaziner first brought me into the internal discussions of health policy during the 1992 campaign after reading the manuscript of a book I had written, The Logic of Health Care Reform (Grand Rounds Press, 1992), which developed the idea of managed competition within a budget. As a senior White House health-policy advisor working under Magaziner, I took part in the decision meetings and presented some of the issues to the president.
The first lady was an active force in these discussions, but there was never any question that the president was in charge. We took our guidance from him. That, of course, was how it should have been (who else but the president ought to make such decisions?), except that many reporters and the public thought that Bill Clinton had handed over the policy to Hillary and that she would report back to him, which was not the case.
Presidents often downplay their own direct involvement in decision making to put some distance between themselves and policies that may eventually prove to be unsuccessful. Part of the job of cabinet members and advisors is to take the blame when things go wrong. Clinton's appointment of his wife to chair the task force did not, however, create the necessary distance and deniability.
Not only did the fiction of Hillary's personal responsibility for the health plan fail to protect the president at the time, it has also now come back to haunt her in her own quest for the presidency. According to recurrent accounts -- most recently in Carl Bernstein's shoddily researched biography A Woman in Charge -- it was supposedly Hillary's secretiveness and rigidity that led to fatal decisions about the White House health plan and political strategy.
Careful reporting after the failure of the health plan showed these charges were false, but Bernstein and other writers continue to recycle them. Misunderstanding the politics behind the plan, they give a distorted account of why it was defeated. The health-reform debacle was critical in framing Hillary's public image, and despite her years of accomplishment in her own right, she still carries the burdens of that failure. It is time to get the facts right and clear the air for the discussion of health-care reform in what may be another Clinton administration.