Why Centralized Health Care Failed (AKA)

Why Centralized Health Care Failed (AKA; How I learned to Hate the System) An old woman wakes up to the sound of coughing next to her. Her husband has been sick for weeks now, and his raspy wet choking seems to be only getting worse. She tries to go back to sleep, but she can't; her thoughts are filled with uncertainty and fear; they have no insurance, and they cannot afford to go to the hospital. This is just one casualty of America's war with itself over Health care. As of this writing, American's health care system is a mess. Millions of American's currently live without health insurance, doctors seemed to be swamped with bureaucracy, and health care costs throughout the nation are skyrocketing out of control. The reasoning behind
the continued existence of this failed American health care enterprise is simple and disgusting; America has slowly chosen to enact governmental policies in order to protect us from ourselves. It is these systematic "checks and balances", along with a heavy involvement in corruption, which have effectively doomed centralized health care in America. The Clinton Years The early 90's was a time of fundamental change within governmental power in America which began when the Democratic party gained control of the presidency. Elected after a 1992 campaign promising health care reform, President Bill Clinton seemed to be the magic bullet to make universal health care in America a reality. President Clinton's service in office saw two proposals which pose a great significance to health care. One, a broadly implemented health care reform package in 1993, and the 1996 Welfare Reform Act. In 1993, Bill Clinton's administration proposed a significant health care reform package. Announced by President Clinton in an address to Congress on September 22, 1993, the package was anything but simple; running more than 1,000 pages. The core elements of the reform bill consisted of both a belief in simplicity and business practice. By creating a universal insurance form, the Clinton administration hoped to simplify and reduce many of the bureaucratic costs associated with hospital expenses. Business wise, Clinton's proposal included an enforced mandate for employers to provide health insurance coverage to all of their employees through competitive but closely-regulated health maintenance organizations (HMOs). At its introduction, the plan seemed likely to pass through the Democratic-controlled Congress, After all, the bill was originally intended to be a bi-partisan effort. However, Conservatives and the insurance industry staged an effective and well-organized campaign opposing Clinton's "Health Security" plan and criticized it as being overly bureaucratic and restrictive of patient choice. The effort included extensive advertising criticizing the plan, including the famous Harry and Louise ad, which depicted a middle-class couple despairing over the plan's bureaucratic nature. In the 1994 election, the Republican revolution gave the GOP control of both houses of Congress, ending prospects for a Clinton-sponsored health care overhaul. Comprehensive aims at achieving universal health care in the United States have not been seriously considered by Congress since. Reeling from the defeat of their health care reform bill, in 1996, the Clinton Administration showed a renewed interest in cooperation with the GOP controlled congress and senate. The welfare reform movement reached its apex on August 22, 1996, when President Clinton signed a welfare reform bill, officially titled the Personal Responsibility and Work Opportunity and Reconciliation Act of 1996. The bill was hammered out in a compromise with the Republican-controlled Congress, and many Democrats were critical of Clinton's decision to sign the bill. One of the the main provisions in Clinton's welfare reform bill was a time limit. Under the law, no person could receive welfare payments for more than five years, consecutive or nonconsecutive.
Another controversial change was transferring welfare to a block grant system, i.e.
one in which the federal government gives states "blocks" of money, which the states then distribute under their own legislation and criteria. Some states simply kept the federal rules, but others used the money for non-welfare programs, such as subsidized childcare (to allow parents to work) or subsidized public transportation (to allow people to travel to work without owning cars). Critics made dire predictions about the consequences of welfare reform. Many claimed that the five-year time limit was needlessly short, and that those who exceeded the limit through no fault of their own might turn to begging or crime. Others criticized the block grant system, claiming that states would not be able to administer the program properly, or would be too motivated by cost. Finally, it was claimed that although the bill might work in a booming economy like that of the 1990s, it would cause significant harm in a recession. Supporters of the bill held that the five-year limit was a necessity, that allowing states to experiment would result in improving welfare, and that the number of people affected by the five-year limit would be small. These controversies have not been fully
resolved. The consequences of welfare reform are still being debated today. Welfare rolls dropped significantly in the years immediately after the passage of the bill. The original bill was set to expire in September of 2002; as of July, 2004, Congress had passed 7 temporary reauthorizations, generally of 3 months. Debate continues over Republican attempts to increase the amount of hours that recipients should be required to work.
Why Effective Policy was Impossible When looking back at the history of failed health care reforms in America, one starts to wonder if health care really is in turmoil, but, when one looks at the actual statistics, another theory emerges. In the essay "It's the Institutions, Stupid! Why Comprehensive National Health Insurance Always Fails in America", two leading political theorists, Sven Steinmo and Jon Watts, point out the harsh reality of the health care crisis faced by the Clinton administration.
More than thirty million Americans were without health insurance and tens of millions more were seriously worried about losing their insurance, and thus even the middle class saw a clear need for reform.
Still, despite this apparent crisis, the problem was not addressed.
Johnathan Oberlander, a leading political theorist, points to his reasoning why policy failed in his article "The Politics of Health Reform: Why Do Bad Things Happen to Good Plans". He writes,
Unlike a British-style parliamentary system, US constitutional arrangements provide no assurance that the president will represent the same party as the congressional majority; divided government is a regular feature of US political life. Moreover, even if the president's own party holds majorities in the House and Senate, Congress may rebuff the presidents priorities; partisan majorities do not necessarily produce policy majorities in American politics.
A similar idea is reflected by Watt's and Steinmo, who write, The original design of a fragmented and federated national political system serving and increasingly large and diverse polity has been fragmented by a series of political reforms beginning with the Progressive era and culminating with the congressional reforms of the mid-1970's. This institutional structure yields enormous power to intransigent interest groups and thus makes efforts by progressive reformers such as President
Clinton" (pg 4. "It's the institutions, Stupid! Why Comprehensive National Health Insurance Always Fails in America.")
It is perhaps this last statement which is most intriguing; the very design of the system in America is ineffectiveness. By hoping to limit radical changes on a governmental level, we have broken our own government. This is the essential reasoning behind Medicare's near elimination and the failure of centralized health care; the only thing that both parties can agree on is that the government is filled with bureaucratic nonsense. Perhaps Steinmo and Watts put it best:
The failure of the president's health care plan is neither a failure of this president nor a failure of his specific plan. Rather it is a failure of American political institutions with which he has been forced to work through which the plan had to be passed. ("It's the institutions, Stupid! Why Comprehensive National Health Insurance Always Fails in America.") As of this writing, it is the year 2006, and we are no closer to having centralized health care in America. The health care problem is not going away, but neither are the flawed governmental policies which cause it to fail. What America needs is true governmental reform, starting with how we think about action, after all; we can only blame ourselves for creating and supporting an in-effective government. Will people demand accountability? Only time will tell.

Sources: In-class lecture and reading material.