Debate promises: health care reform (1992)

For the next two weeks, the First Year Project takes a look at some promises made in past debates. Today, we explore Bill Clinton's quest for health care reform.

On October 11, 1992, in the first presidential debate held at Washington University in St. Louis, Bill Clinton addressed the heath care system.

You have to take on the insurance companies, the bureaucracies, and you have to have cost controls, yes. But keep in mind, we are spending 30 percent more on health care than any country in the world, any other country. Yet, we have 35 million people uninsured. We have no preventive and primary care.

The statistics were accurate. As measured by the World Health Organization, the United States spent roughly 12 percent of GDP on heath care in the early 90s, while countries like Canada, France, and Germany spent about 9 percent. Shockingly, infant mortality in the U.S. was more than 30 percent, compared to 4 percent in the other three countries. 

As soon as Clinton became president, he appointed First Lady Hillary Clinton to head the Health Care Reform Task Force. However, by April 1993, concerned by a large deficit and recession, Clinton made the budget the top priority and devoted additional focus to the North American Free Trade Agreement (NAFTA). The task force kept working, agreed on the basics of a national health insurance plan by April and began to fill in the details.

After eight months in office, President Clinton presented his plan to Congress on September 22, 1993:

If Americans are to have the courage to change in a difficult time, we must first be secure in our most basic needs. Tonight I want to talk to you about the most critical thing we can do to build that security. This health care system of ours is badly broken, and it is time to fix it. Despite the dedication of literally millions of talented health care professionals, our health care is too uncertain and too expensive, too bureaucratic and too wasteful. It has too much fraud and too much greed.

At long last, after decades of false starts, we must make this our most urgent priority, giving every American health security, health care that can never be taken away, heath care that is always there. That is what we must do tonight.

When the plan was introduced as legislation in November, opposition was strong and growing, especially among conservatives who saw it as an example of big government. The National Federation of Independent Business and the Health Insurance Association of America (HIAA) opposed the plan even before it was introduced.

By February 1994, groups such as the Business Round table and the Chamber of Commerce joined the opposition. The House Energy and Commerce Committee began to weaken the bill. In the House Ways and Means Committee, members were also concerned about the cigarette tax that would fund the law. The Senate was working on its bill, but there was no consensus between Democrats, let alone between the House and Senate versions of the proposal. House Minority Whip Newt Gingrich (R-GA) worked to stall the measure, and by September 1994, a year after the president had unveiled it, Senate Majority Leader George Mitchell (D-ME) declared health care reform dead.

From our William J. Clinton Presidential History Project, U.S. Trade Representative Michael (Mickey) Kantor remembers:

Hillary and I had to sit down and negotiate when they could introduce health care, when we could introduce NAFTA and how in the world this was going to work. Because they were contradictory in the sense we needed Democrats on health care, we were losing Democrats on NAFTA. So we came up with—it worked to a great degree but I’m not sure it was very smart. It was just like sausage being made, these kinds of compromises which everybody talks about, it’s old, trite but true. Introduce NAFTA, stop, don’t take the president’s time. Introduce health care, take the president’s time for one month, go back to NAFTA and try to get it done in November. It was probably—only people who are not familiar with Washington could have thought that would work, could have even believed it was possible to pull the Congress back and forth that way. It worked, strangely enough, it worked. And there was no genius on anyone’s part—it was probably from lack of experience we thought it would work. So we did that.

The process did work—for NAFTA. But health care reform was a promise left unfulfilled. And while the expenditures for other countries increased only slightly over the next 15 years, costs in the U.S. continued grew rapidly, rising to 16 percent of GDP by the election of 2008. (The infant mortality rate had fallen to 27 percent, still many times that of other industrialized nations.) And what did that increase of 4 percent, from 12 to 16 percent of GDP mean for the country? In 2008, it meant $590 billion in additional spending on health care.