ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, May 12, 1996 TAG: 9605100002
SECTION: HORIZON PAGE: 1 EDITION: METRO
The president's admission that he "set the Congress up for failure" on health care appears in "The System: The American Way of Politics at the Breaking Point," by Pulitzer Prize-winning political reporters Haynes Johnson and David S. Broder. This is the first of three excerpts from the book
``The System: The American Way of Politics at the Breaking Point'' By Haynes Johnson and David S. Broder. Copyright 1996 by Haynes Johnson and David S. Broder. Reprinted by permission of Little, Brown and Company Inc.
Excerpts: PART ONE
SEPT. 22, 1993, 9:10 P.M. - The president made the discovery while he stood at the rostrum gazing at the scene below. He glanced at the TelePrompTer and was astonished. In the most important speech of his life, the moment that would launch a titanic battle affecting the lives of every citizen and a seventh of the U.S. economy, that could define his presidency, restore badly eroded public faith in the political system's ability to serve the people and redeem a promise more than 60 years in the making to provide universal health care, the president found the wrong speech displayed on the screen before him.
Not only that, he didn't even have his reading glasses to help with the written text in the binder resting on the rostrum. To compound his problem, that text was not the easily readable big-type script customarily provided on such major occasions: the president's own big-type version was a casualty of the chaotic round of strategy meetings and draftings and redraftings that had lasted virtually until the last seconds before he left the White House.
It was as if, the president thought, God were testing him. For a moment, he was seized with sharply conflicting emotions. Is God trying to tell me I shouldn't be doing this? Is this a message to change the subject?
But as he began, the president was riven no longer with doubts. His confidence surged. He knew what he wanted to say and told himself: If I can't convince these people that I know this cold, and that I care about it and they can trust what I say about it, I don't have a prayer anyway. So, as he recalled later, ``I just sort of whipped back and did it.''
Seven minutes elapsed before frantic aides placed the correct speech in the TelePrompTer. But the speech was a smash, the presidential delivery superb, powerful, compelling. Never had the president been better. Response to his words was overwhelmingly favorable.
What no one knew - or could imagine - was that this was the high point of the battle for the Clintons and their plans. The bobbles that plagued the president and his unhappy TelePrompTer operator were but a small symptom of the problems that would continue to bedevil the project. And no rescue squad would be standing by to solve these crises in seven minutes flat.
Already, the health plan was dangerously behind schedule. Clinton had promised in the 1992 campaign to have his proposal ready within the first 100 days, but even as he spoke, five months after he had hoped to begin, there was no bill for Congress to see. The task force led by Hillary Clinton and directed by Ira Magaziner had labored in secrecy for months - sometimes employing as many as 600 people to analyze what should be done. But the president's own decision-making had been delayed until the last minute, just like the speech revisions. Another two months would elapse before the Clinton bill - all 1,342 pages of it - would be sent to Capitol Hill.
There, many traps awaited. Despite the cheers that filled the House chamber on the night of the speech, the Democrats were deeply divided over what constituted real reform. Some wanted government-run health care, financed by an addition to the payroll tax. Others would rely on market competition. And on the Republican side, some key leaders came with a steely determination to deny Clinton the political and policy victory he was seeking.
None was more determined than Newt Gingrich of Georgia, the second-in-command of House Republicans. Gingrich already had devised a private strategy to kill the Clinton plan. His idea was to maintain his party rank and file in a holding action, something he called ``coagulation'': ``You want to clot everybody you can away from Clinton,'' he told his troops. ``I don't care what you clot onto, just don't let it be Clinton.'' This was not passive resistance, as Gingrich's words seem to imply. His troops operated like a guerrilla army, lying in wait to spring what Gingrich himself described as an ``ambush'' that would destroy the Clinton forces.
Much more than political gamesmanship over defeating a rival's most cherished policy was at stake in Gingrich's battle plan. To Gingrich, defeating health care reform was essential to making himself the first Republican speaker of the House of Representatives in 40 years. He planned to ride to power on the crest of a new Republican wave. Republicans would win control of Congress and then reshape the American political, social and economic future. Killing the Clinton reform was a critical means to achieving that end. Had any part of the Clinton plan passed that Congress in any form, Gingrich and his closest conservative allies believed, their dreams for forging a militantly conservative future would ``have been cooked,'' as a key Gingrich strategist later explained. It would have been the final nail in the coffin of the American marketplace resulting in a social-welfare state like Britain and Canada, creating greater public dependency on government and a stronger allegiance of voters to majority Democrats, who provided them their benefits. Only by controlling Congress with a new conservative Republican majority could the final goals of their ``Republican Revolution'' be achieved: to break the public dependency on Democratic tax-funded government programs. In so doing, they would destroy the liberal constituency groups and permit the flowering of an anti-government, anti-tax, entrepreneurial nation. All these aims were threatened by the Clinton plan.
Nor was such determined political opposition the only obstacle to passage of reform. Perhaps most daunting of all was the very complexity of the health care industry. As House Majority Leader Richard Gephardt of Missouri would say, much later in the battle, ``There are a hundred cul-de-sacs where you can ride into the issue and drive around in it for days, with people just shooting at you and screaming at you about what they have to have - and never come out.''
But for the moment, the lobbyists representing this trillion-dollar American industry were, like the members of Congress, impressed with Clinton's selling job. Some of them had already begun working to undercut public support for his program. Others were just mobilizing. All of them knew they were in for a long, hard fight.
The ambivalence of public attitudes - to say nothing of the underlying doubts about Clinton and the Congress - underscored the political risks involved in this eagerly awaited public launching. All the players in The System were on trial. All would be judged by how well they rose to the occasion. But if risks were present, so were opportunities. They were potentially historic, and everyone in that chamber and countless Americans watching on television understood them, not least the president of the United States.
In February 1993 as the task force began work, Ira Magaziner sent the president a warning that 1,100 decisions would be required to shape the final plan. Starting in March, Magaziner began to walk the president through some of the simpler pieces of the puzzle, giving him a 45-minute briefing and decision-memo exercise on the American Indian health service, for example, or the many possible definitions of full-time, part-time, seasonal and contract employees - and how each category should be handled under the plan.
Magaziner and the first lady had developed a comfortable division of labor. As she told Dana Priest of The Washington Post at the time, ``We understand each other. He is an extraordinary analyst. I'm sometimes a better translator, and we have a great working relationship.''
By the end of March, a more formal process began. Cabinet members, National Economic Council Chairman Bob Rubin, Council of Economic Advisers head Laura D'Andrea Tyson, and the White House political and policy team joined in debating major decisions. Tyson and Rubin came to the table with many questions about the issues that needed to be decided: How comprehensive should the benefits be? Are short-term price controls needed? How long a phase-in to universal coverage? Above all, how do you pay for covering additional millions? The controversies were sharp, the disagreements vehement. ``And we started running into trouble,'' Magaziner said, in a masterpiece of understatement.
Even to many on the task force, the detail of the plan suggested a process that had run amok. Before they knew that it was going to produce a nearly 1,400-page bill, some White House officials had begun to speculate that Ira Magaziner and Hillary Clinton had lost sight of reality. They had been caught up in a sophisticated version of ``I dare you,'' egging each other on to answer every conceivable question. But the first lady and Magaziner had a ready rationale for their work. As she put it, ``Whatever the president came out with, I wanted to feel was totally defensible.'' So she spent ``countless hours studying, reading, talking, quizzing.''
Clinton himself had invested significant time in 1992 in framing his basic approach. No one would have condemned him for abandoning it, but he had persuaded himself that he knew what needed to be done. It was Bill Clinton's approach that determined the basic structure of the plan that emerged from eight months of extraordinarily hard work. And it was a complex design, including new structures - the alliances - for which no working models existed.
What can be questioned about the task forces process was not so much its workings as its location in the White House, not so much the time it took as the definition of the assignment.
Clearly, any serious proposal would have to confront the intricacies of an existing medical system with multiple parts and complex interactions - a system that was already 40 percent government financed but that had powerful private-sector participants in the insurance companies, the hospitals, the doctors and other providers and the parts of business that were paying much of the bill.
No one seeking to address such a system comprehensively could hope to come up with a simple solution. The Clinton administration cannot be faulted for the complexity of its plan. But the absence of a few simple, structural principles, readily grasped by the public, was a crippling defect - and one that could have been anticipated.
Within the administration, the selection of the first lady to head the task force had other consequences. As much as she wanted open debate, her presence - and her status - clearly made it harder for administration critics of the plan to make their case. One Cabinet official who had great experience in this area - and grave misgivings about the ambitiousness and complexity of the plan - said softly, ``You make your point once to the president's wife, and if it is not accepted, you don't press it.'' Rep. Jim McDermott, D-Wash., noting the deference paid the first lady by congressional colleagues who he knew believed her to be wrong, remembered thinking, ``It shows you the way politics really is, that no one's going to tell the president's wife: `Ma'am, you don't have any clothes on.' Nobody's going to say that.''
Most of the decisions by the Clintons and Magaziner were driven by policy considerations. But some critical decisions were politically driven and constituency oriented. Observers like Harvard's Bob Blendon said there was too much policy bias in the Clinton-Magaziner approach. ``They thought it was a policy problem with some political elements,'' he said. In fact, ``it was a political problem with some policy elements.'' From his viewpoint, the starting point for discussion should have been: What coalition will get us 218 votes in the House and 51 votes in the Senate, and what kind of plan will it take to hold that coalition?
With the advantage of hindsight, President Clinton told us in 1995, when Sen. Robert Byrd, D-W.Va., chairman of the powerful Senate Appropriations Committee, rejected on procedural grounds an attempt to include health care reform in a budget reconciliation bill in the spring of 1993, it should have been the signal for a fundamental shift of strategy on Clinton's part. ``This is entirely my mistake,'' he said, ``no one else's. I probably made a mistake in not then going for a multiyear strategy, and not trying to say we've got to try to do it in '94.''
In our experience as reporters, there have been few moments when a president has sat in the Oval Office and said, flat-out and without a trace of rationalization or self-pity, ``I made a blunder.'' But the next sentence was even more striking: ``I set the Congress up for failure,'' Clinton said. He set himself up for failure, too, he said, but Congress ``had to stand with it'' sooner - in 1994 - ``and I didn't, and I feel badly about that. We had an opportunity, and our leaders thought we might make it. But I think that our system probably cannot absorb this much reform with this much involved that quickly.''
``What we should have said,'' he thought, after the showdown with Byrd, ``is `This might take three years.'''
Did he really think, looking back on it, that he had the political freedom to ask the public for that much time? ``I don't think I did,'' he said, ``because I had made it such a big issue. But in retrospect, I think it would have been better to go before the American people and just say: `Listen. I know you're frustrated about this and we need to do it, but better to take another year and do it right.' I might have been able to sell that to the American people and it might have made a difference in the way the American people viewed the Democrats in the '94 election.''
The president's comments made it clear he had two regrets: the loss of his keystone program and the consequent Democratic loss of Congress. It was, as he knew better than anyone, a classic lose-lose proposition. And he blamed no one but himself.
President Clinton said he "probably made a mistake in not then going for a multiyear strategy."
``Whatever [health care plan] the president came out with, I wanted to feel was totally defensible,'' Hillary Clinton said.
SEPT. 22, 1993, 9:10 P.M. - The president made the discovery while he stood at the rostrum gazing at the scene below. He glanced at the TelePrompTer and was astonished. In the most important speech of his life, the moment that would launch a titanic battle affecting the lives of every citizen and a seventh of the U.S. economy, that could define his presidency, restore badly eroded public faith in the political system's ability to serve the people and redeem a promise more than 60 years in the making to provide universal health care, the president found the wrong speech displayed on the screen before him.
Not only that, he didn't even have his reading glasses to help with the written text in the binder resting on the rostrum. To compound his problem, that text was not the easily readable big-type script customarily provided on such major occasions: the president's own big-type version was a casualty of the chaotic round of strategy meetings and draftings and redraftings that had lasted virtually until the last seconds before he left the White House.
It was as if, the president thought, God were testing him. For a moment, he was seized with sharply conflicting emotions. Is God trying to tell me I shouldn't be doing this? Is this a message to change the subject?
But as he began, the president was riven no longer with doubts. His confidence surged. He knew what he wanted to say and told himself: If I can't convince these people that I know this cold, and that I care about it and they can trust what I say about it, I don't have a prayer anyway. So, as he recalled later, ``I just sort of whipped back and did it.''
Seven minutes elapsed before frantic aides placed the correct speech in the TelePrompTer. But the speech was a smash, the presidential delivery superb, powerful, compelling. Never had the president been better. Response to his words was overwhelmingly favorable.
What no one knew - or could imagine - was that this was the high point of the battle for the Clintons and their plans. The bobbles that plagued the president and his unhappy TelePrompTer operator were but a small symptom of the problems that would continue to bedevil the project. And no rescue squad would be standing by to solve these crises in seven minutes flat.
Already, the health plan was dangerously behind schedule. Clinton had promised in the 1992 campaign to have his proposal ready within the first 100 days, but even as he spoke, five months after he had hoped to begin, there was no bill for Congress to see. The task force led by Hillary Clinton and directed by Ira Magaziner had labored in secrecy for months - sometimes employing as many as 600 people to analyze what should be done. But the president's own decision-making had been delayed until the last minute, just like the speech revisions. Another two months would elapse before the Clinton bill - all 1,342 pages of it - would be sent to Capitol Hill.
There, many traps awaited. Despite the cheers that filled the House chamber on the night of the speech, the Democrats were deeply divided over what constituted real reform. Some wanted government-run health care, financed by an addition to the payroll tax. Others would rely on market competition. And on the Republican side, some key leaders came with a steely determination to deny Clinton the political and policy victory he was seeking.
None was more determined than Newt Gingrich of Georgia, the second-in-command of House Republicans. Gingrich already had devised a private strategy to kill the Clinton plan. His idea was to maintain his party rank and file in a holding action, something he called ``coagulation'': ``You want to clot everybody you can away from Clinton,'' he told his troops. ``I don't care what you clot onto, just don't let it be Clinton.'' This was not passive resistance, as Gingrich's words seem to imply. His troops operated like a guerrilla army, lying in wait to spring what Gingrich himself described as an ``ambush'' that would destroy the Clinton forces.
Much more than political gamesmanship over defeating a rival's most cherished policy was at stake in Gingrich's battle plan. To Gingrich, defeating health-care reform was essential to making himself the first Republican speaker of the House of Representatives in 40 years. He planned to ride to power on the crest of a new Republican wave. Republicans would win control of Congress and then reshape the American political, social and economic future. Killing the Clinton reform was a critical means to achieving that end. Had any part of the Clinton plan passed that Congress in any form, Gingrich and his closest conservative allies believed, their dreams for forging a militantly conservative future would ``have been cooked,'' as a key Gingrich strategist later explained. It would have been the final nail in the coffin of the American marketplace resulting in a social-welfare state like Britain and Canada, creating greater public dependency on government and a stronger allegiance of voters to majority Democrats, who provided them their benefits. Only by controlling Congress with a new conservative Republican majority could the final goals of their ``Republican Revolution'' be achieved: to break the public dependency on Democratic tax-funded government programs. In so doing, they would destroy the liberal constituency groups and permit the flowering of an anti-government, anti-tax, entrepreneurial nation. All these aims were threatened by the Clinton plan.
Nor was such determined political opposition the only obstacle to passage of reform. Perhaps most daunting of all was the very complexity of the health- care industry. As House Majority Leader Richard Gephardt of Missouri would say, much later in the battle, ``There are a hundred cul-de-sacs where you can ride into the issue and drive around in it for days, with people just shooting at you and screaming at you about what they have to have - and never come out.''
But for the moment, the lobbyists representing this trillion-dollar American industry were, like the members of Congress, impressed with Clinton's selling job. Some of them had already begun working to undercut public support for his program. Others were just mobilizing. All of them knew they were in for a long, hard fight.
The ambivalence of public attitudes - to say nothing of the underlying doubts about Clinton and the Congress - underscored the political risks involved in this eagerly awaited public launching. All the players in The System were on trial. All would be judged by how well they rose to the occasion. But if risks were present, so were opportunities. They were potentially historic, and everyone in that chamber and countless Americans watching on television understood them, not least the president of the United States. |n n| In February 1993 as the task force began work, Ira Magaziner sent the president a warning that 1,100 decisions would be required to shape the final plan. Starting in March, Magaziner began to walk the president through some of the simpler pieces of the puzzle, giving him a 45-minute briefing and decision-memo exercise on the American Indian health service, for example, or the many possible definitions of full-time, part-time, seasonal and contract employees - and how each category should be handled under the plan.
Magaziner and the first lady had developed a comfortable division of labor. As she told Dana Priest of The Washington Post at the time, ``We understand each other. He is an extraordinary analyst. I'm sometimes a better translator, and we have a great working relationship.''
By the end of March, a more formal process began. Cabinet members, National Economic Council Chairman Bob Rubin, Council of Economic Advisers head Laura D'Andrea Tyson, and the White House political and policy team joined in debating major decisions. Tyson and Rubin came to the table with many questions about the issues that needed to be decided: How comprehensive should the benefits be? Are short-term price controls needed? How long a phase-in to universal coverage? Above all, how do you pay for covering additional millions? The controversies were sharp, the disagreements vehement. ``And we started running into trouble,'' Magaziner said, in a masterpiece of understatement.
Even to many on the task force, the detail of the plan suggested a process that had run amok. Before they knew that it was going to produce a nearly 1,400-page bill, some White House officials had begun to speculate that Ira Magaziner and Hillary Clinton had lost sight of reality. They had been caught up in a sophisticated version of ``I dare you,'' egging each other on to answer every conceivable question. But the first lady and Magaziner had a ready rationale for their work. As she put it, ``Whatever the president came out with, I wanted to feel was totally defensible.'' So she spent ``countless hours studying, reading, talking, quizzing.''
Clinton himself had invested significant time in 1992 in framing his basic approach. No one would have condemned him for abandoning it, but he had persuaded himself that he knew what needed to be done. It was Bill Clinton's approach that determined the basic structure of the plan that emerged from eight months of extraordinarily hard work. And it was a complex design, including new structures - the alliances - for which no working models existed.
What can be questioned about the task forces process was not so much its workings as its location in the White House, not so much the time it took as the definition of the assignment.
Clearly, any serious proposal would have to confront the intricacies of an existing medical system with multiple parts and complex interactions - a system that was already 40 percent government financed but that had powerful private-sector participants in the insurance companies, the hospitals, the doctors and other providers and the parts of business that were paying much of the bill.
No one seeking to address such a system comprehensively could hope to come up with a simple solution. The Clinton administration cannot be faulted for the complexity of its plan. But the absence of a few simple, structural principles, readily grasped by the public, was a crippling defect - and one that could have been anticipated.
Within the administration, the selection of the first lady to head the task force had other consequences. As much as she wanted open debate, her presence - and her status - clearly made it harder for administration critics of the plan to make their case. One Cabinet official who had great experience in this area - and grave misgivings about the ambitiousness and complexity of the plan - said softly, ``You make your point once to the president's wife, and if it is not accepted, you don't press it.'' Rep. Jim McDermott, D-Wash., noting the deference paid the first lady by congressional colleagues who he knew believed her to be wrong, remembered thinking, ``It shows you the way politics really is, that no one's going to tell the president's wife: `Ma'am, you don't have any clothes on.' Nobody's going to say that.''
Most of the decisions by the Clintons and Magaziner were driven by policy considerations. But some critical decisions were politically driven and constituency oriented. Observers like Harvard's Bob Blendon said there was too much policy bias in the Clinton-Magaziner approach. ``They thought it was a policy problem with some political elements,'' he said. In fact, ``it was a political problem with some policy elements.'' From his viewpoint, the starting point for discussion should have been: What coalition will get us 218 votes in the House and 51 votes in the Senate, and what kind of plan will it take to hold that coalition?
With the advantage of hindsight, President Clinton told us in 1995, when Sen. Robert Byrd, D-W.Va., chairman of the powerful Senate Appropriations Committee, rejected on procedural grounds an attempt to include health-care reform in a budget reconciliation bill in the spring of 1993, it should have been the signal for a fundamental shift of strategy on Clinton's part. ``This is entirely my mistake,'' he said, ``no one else's. I probably made a mistake in not then going for a multiyear strategy, and not trying to say we've got to try to do it in '94.''
In our experience as reporters, there have been few moments when a president has sat in the Oval Office and said, flat-out and without a trace of rationalization or self-pity, ``I made a blunder.'' But the next sentence was even more striking: ``I set the Congress up for failure,'' Clinton said. He set himself up for failure, too, he said, but Congress ``had to stand with it'' sooner - in 1994 - ``and I didn't, and I feel badly about that. We had an opportunity, and our leaders thought we might make it. But I think that our system probably cannot absorb this much reform with this much involved that quickly.''
``What we should have said,'' he thought, after the showdown with Byrd, ``is `This might take three years.'''
Did he really think, looking back on it, that he had the political freedom to ask the public for that much time? ``I don't think I did,'' he said, ``because I had made it such a big issue. But in retrospect, I think it would have been better to go before the American people and just say: `Listen. I know you're frustrated about this and we need to do it, but better to take another year and do it right.' I might have been able to sell that to the American people and it might have made a difference in the way the American people viewed the Democrats in the '94 election.''
The president's comments made it clear he had two regrets: the loss of his keystone program and the consequent Democratic loss of Congress. It was, as he knew better than anyone, a classic lose-lose proposition. And he blamed no one but himself.
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