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• W2115824398 abstract "From the Editor-In-Chief Health AffairsVol. 13, No. 5 The Subterranean Role of Health Care ReformJohn K. IglehartPUBLISHED:Winter 1994Free Accesshttps://doi.org/10.1377/hlthaff.13.5.5AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSHealth reformCosts and spendingPublic opinionMedicareTaxes America's failure to enact comprehensive health care reform reflects a history of equivocation on this matter that long has been a feature of our democracy, regardless of who occupied the White House. Thus, what Bill and Hillary Rodham Clinton were challenging when they put forward their ambitious health care reform plan was not only today's growing conservatism, but a general skepticism about enlarging the role of government as a health insurer. Congress's preferred pattern of health policy making has always favored incremental change in a system that is an array of poorly coordinated private and public programs. This pattern led to the enactment of Medicare and Medicaid, plus countless other smaller programs targeted at defined problems. As a consequence, government (including the congressional committee structure, which has a substantial influence on the shape of policy) has built a categorical policy framework, rather than the more comprehensive one that was envisioned by the Clinton plan. Neither politicians, most private interests, nor the majority of the voting population were comfortable with this far-reaching prescription, and it fell to an ignominious defeat in the closing weeks of the 103d Congress. Shortly after the 8 November election, pollsters of public opinion reported that Clinton's reform plan, though only rarely discussed during the campaign, played a powerful subterranean role in the Republican victory. An election-night survey of voters, conducted under the aegis of The Henry J. Kaiser Family Foundation and the Harvard School of Public Health, found respondents strongly in favor of incremental solutions to the problems facing the health care system and opposed to any significant expansion of governmental control. While many factors determine how a person votes, respondents to the Kaiser-Harvard survey reported that health care was the most decisive consideration for the largest number of voters (33 percent), ahead of crime (29 percent) and taxes (23 percent). On the other hand, according to Public Opinion Strategies, surveyed Republican voters identified different priorities, citing taxes as most important (49 percent), crime (45 percent), welfare (26 percent), health care (21 percent), and abortion (18 percent). Commenting upon the results of the Kaiser-Harvard survey, Bill Mclnturff, a Republican pollster, said: “I think health care was enormously pivotal in this election.” The perception that Clinton had proposed a “big government plan” helped to strip away his image as a “new Democrat” among many voters. But Mclnturff said that it is important that Republicans enact their own health care bill in the 104th Congress, which they will control. A second poll of voters, this one conducted for the Democratic Leadership Council (DLC) by Clinton's own pollster, Stan Greenberg, confirmed the results of the Kaiser-Harvard survey. Of 54 percent of voters who said that they had been disappointed by Clinton, half cited the fact that he offered a health care reform plan that favored big government. Commenting upon the results of the Greenberg survey, Al From, president of the DLC (which Clinton once headed), said: “It is impossible to underestimate the amount of damage the health care bill did in shaping the image of President Clinton as a big government proponent.” With Republicans assuming control of Congress, health care reform will slip as a priority on Capitol Hill because many GOP legislators believe that the system is being reformed by changes in private-sector behavior. Thus, in their thinking, government action now would only inhibit the rapid transformation of a system already undergoing major change. Certainly one of the most telling measures of the perceived success of this movement is how successful private payers, providers, and consumers are in constraining the growth of medical spending. Given the importance of this question, Health Affairs is devoting substantial space in this volume to trends in health care spending. Societal concern over rising costs diminished during the reform debate for several reasons, as economist Henry Aaron points out in his overview paper. The authors who have contributed to our section on health care spending provide the latest available data on the subject, speculate on whether the moderating trend will last, and address the more technical issue of how economists arrive at their conclusions. Before anyone rushes to judgment on the matter of spending trends, he or she would do well to recall the announcement of a former Republican health and human services secretary, Margaret Heckler, who announced with great confidence in 1984 that government, through Medicare's prospective payment mechanism, had ended the medical inflation spiral. As it turned out, the spiral continued, and medical spending consumed 13.9 percent of U.S. gross domestic product in 1993. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 January 1994 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF download" @default.
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