-- Late September 1993: President Clinton urges health insurance coverage for all before a joint session of Congress. First lady Hillary Rodham Clinton follows up with dramatic testimony to five committees, earning broad acclaim.
-- Late September 1994: Senate Majority Leader George Mitchell, D-Maine, who gave up a Supreme Court nomination to usher health-care reform through Congress, reluctantly throws in the towel.
The story of the demise of health-care reform is one of policy, politics and public opinion, of fleeting time and faulty tactics, and of a president who lacked the mandate needed to do what his predecessors had failed to do for half a century.
"This has never been easy, and that's why it hasn't been done in 70 years of trying," says White House adviser Ira Magaziner, architect of much of the Clinton plan.
Says Brookings Institution scholar Thomas Mann: "Everyone overestimated the possibilities because of the initial response to the president, and because of the major investment he made in it."
Members of Congress "tried to get out ahead of the public and found that they couldn't."
In the days of finger-pointing between now and the fall elections, Democrats will argue that Republican intransigence and interest groups' multimillion-dollar advertising campaigns killed health reform.
That, in fact, was what Clinton said Monday. He cited a "Republican filibuster" in the Senate and "the interests who spent $300 million to stop health-care reform."
Republicans will claim it was Democrats' insistence on pushing a big-government plan laden with new bureaucracies, mandates and taxes.
"When their strategy fails, they should not be allowed to hide behind Republicans," says Republican National Committee Chairman Haley Barbour. "It was the Clintons, not Republicans, who killed health-care reform by failing to level with Americans about the facts."
But before both the policy and the politics came the reality that even if the public's heart was in it, its wallet was not. Seventeen out of 20 Americans have health insurance, and even those without it get emergency access to the best medicine money can buy.
"I've concluded that universal coverage is dead, and for good," says Princeton University economist Uwe Reinhardt. "The monied elite is not willing to give the poor . . . an entitlement to health care that the elite take for granted."
Or, in the more succinct words of Rep. Sherwood Boehlert, R-N.Y.: "There were two questions that had to be answered that weren't answered: How much is it going to cost, and who's going to pay for it."
Dozens of interviews conducted in the weeks leading up to Mitchell's anticlimactic announcement paint a picture of a domestic policy crusade that gradually lost its punch:
-- Even before the president made his pitch, the "crisis" - a word Clinton's opponents never embraced - was ebbing. Health-care inflation decreased, the economy improved and the public became less fearful about declining coverage and rising costs.
"They seriously miscalculated the attitude of the American people toward government," says National Federation of Independent Business lobbyist John Motley. "They really tried to get much too much."
-- Too much time was squandered in the months leading up to September 1993, as a White House task force labored behind closed doors over a 1,342-page bill destined to be carved up by Congress anyway.
"We should have had a lot of this debate last year instead of this year," says John Rother, chief lobbyist for the American Association of Retired Persons, blaming moderates and Republicans as well. "Next time around, we're going to have to pay as much attention to the marketing of health reform as was paid this time to developing the perfect policy."
-- The Democrats' prize product, heralded by Clinton on national TV and his wife in pitches to lawmakers, proved far too complex and controversial. Its mandatory purchasing cooperatives, requirements that employers pay for workers' insurance and caps on premiums all lacked support.
"It died because of the examination of the details," says Robert Moffit of the conservative Heritage Foundation.
He says, "What we've seen is a revolution in information technology that has undermined the capacity of Congress to enact legislation that contains a lot of things people find nefarious."
Adds Brookings Institution analyst Stephen Hess: "For most of us it looked like a Rube Goldberg cartoon. . . . They were smart enough to understand how complicated the problem was, but not smart enough to know how it had to be simplified."
-- Interest groups opposed to Clinton's plan or bent on knocking out key provisions went to work early. The insurance lobby spent tens of millions of dollars on ads; the small-business lobby organized grass-roots opposition across the country; doctors, hospitals and drug firms argued effectively against parts of the plan.
"Every time you turned around, you got slapped five times by (small business), Republicans, the docs," says Robert Chlopak of the Health Care Reform Project. "The sheer magnitude and money of the opposition is just awesome."
Says former GOP congressman Willis Gradison, president of the Health Insurance Association of America, which ran the "Harry and Louise" TV ads: "We encouraged people to look at the fine print, to look at the details. . . . Our ads struck a responsive chord."
-- At the same time, pro-reform groups representing organized labor, the elderly and consumer groups were much less active and spent far less money, allowing opponents to control the airwaves and the corridors of power.
"You had one set of voices screaming, `This is going to kill us.' You had the administration flailing around, waiting for the voices from the other side, and they were never heard," says Brandeis University professor Stuart Altman. "They were waiting for a better plan."
Grouses Sen. Tom Daschle, D-S.D.: "All of our interest groups chose not to fight."
-- Republicans coalesced after their initial disarray, opposing in virtual unanimity new taxes, mandates and bureaucracy. Clinton allies waited too long before agreeing to compromise on many issues - railing, for instance, against a "Clinton Lite" plan preferred by moderates of both parties. And by then it was too late.
"It's just a puzzle to me why the Democrats were so tenacious in holding on so long to a plan that was not going to pass," says Rep. J. Roy Rowland, D-Ga., a country doctor whose incremental plan was opposed by the White House and Democratic leaders.
Adds South Carolina Republican Gov. Carroll Campbell, past president of the National Governors' Association: "They were so bent on creating a federally run program that they lost it all."
Contributing: Judy Keen
Rise and fall of health-care reform
What Clinton promised Public support for health reform climbs to 59% after President Clinton and Hillary Rodham Clinton push for drastic expansion of coverage in September 1993. The president: -- Promises to veto any bill that doesn't give every American coverage that can never be taken away. -- Says 80% of cost should be paid by employers. -- Unveils a "health security card" to guarantee care, control access, medical records. -- Says savings from streamlining bureaucracy can help reduce deficit. -- Foresees no government-run health system; but critics see lots of government regulation.
Support for the plan
Favor Oppose
9/26/93 59% 33%
7/17/94 40% 55%
How momentum stalled At the White House -- The Clintons signal willingness to compromise on everything from costs to coverage, but no clear plan emerges. -- Health care falls from forefront as White House fields months of questions over Whitewater, the first lady's investments, and a sexual harrassment suit brought against the president by a former Arkansas
