Among all the thousands of meetings on health care reform, one Sunday night session in June still creeps into conversations. Hillary Rodham Clinton gathered about 15 people -- key staff, cabinet members and the president himself -- to discuss tactics in dealing with Congress. At one point Treasury Secretary Lloyd Bentsen quietly dropped a grenade: "You may want to think about if you get something less than universal coverage." Finally, someone had said it loud enough to spark a much-needed discussion. But Bill Clinton cut it short: "I don't think I can come off universal. I'm accused of wavering. We have to stick to it, we have to be strong on this." Mrs. Clinton agreed and suggested he deliver the message during an appearance on the "Today" show. He did.
Some participants walked out thinking the reform effort was dead. It was, says one, "deflating. It was the most important meeting we had on health care, and health care was over, then and there." If Clinton was unwilling to bend, nothing would happen. But the president, in his usual way, also left his aides confused: He refused to promise a veto. "We're leaving the public with the impression that we're hard on this, yet there is something ticking away inside him that's not there," thought one attendee. "Maybe he is beginning to lose control of himself."
Too big. The charitable view is that Clinton could not decide how hard to press for universal coverage because he had no good choices. He had been handed a plan that many now concede was too complex and required too much government. Maybe he could never have controlled a Congress with its own ideas and parochial political considerations, driven by demon special interests. And maybe some Republicans would never have supported any bill with Clinton's name on it.
But the death of Clinton's health care reform plan is a defeat of much broader proportions. It is a sad lesson about a White House that had a grand vision but produced a plan with a narrow constituency. It is both a strategic failure to understand what the public wanted and a tactical failure to understand what Congress could do or how to get it done. And when the plan started sinking from its own audacity and complexity, its authors had little help in keeping it afloat.
Inside the White House, health reform became the victim of an unhealthy combination of arrogance and naivete. When advisers -- such as then counselor David Gergen and then budget chief Leon Panetta -- raised doubts, the reply was that the White House intended to be bold. Launching health care reform was to be the political equivalent of sending the first shuttle into space. Instead, the plan sits like an abandoned car, the air seeping out of its tires.
The day Hillary Clinton was named to lead the crusade, Dan Rostenkowski, then chairman of the House Ways and Means Committee, gave her some advice. "Listen to everybody," he said. "The people that are your most visible adversaries in the beginning are the people you will be negotiating with in the end. Don't make enemies." Looking at Ira Magaziner, the Clintons' health guru, he added, "Get people around you that have a little dirt under their fingernails."
Magaziner remained -- and did the opposite of what the chairman had advised. His secretive, 500-member "Tollgate" process to write the plan made politicians wince and convinced the rest of the world that he was hatching a Rube Goldberg scheme. Many now call the deliberations a complete waste of four months. "We don't speak the same language," Louisiana Democratic Sen. John Breaux complained at the time. "He is a technician; we are politicians. It doesn't work."
The real problem was inside the Clinton White House. The White House solicited advice throughout the administration but ignored much of it. Last summer, with the plan nearing completion before its September send-off, then chief of staff Mack McLarty tried to nudge the Clintons into opening things up a bit. So did Gergen. But what might have been a final debate about ideas became an 11th-hour stab at finding out what was in the plan -- and fixing it.
By August, the cabinet was in a frenzy. "We were in terrible trouble," says one White House official. "And we knew it." Health and Human Services Secretary Donna Shalala was worried: She had already cornered Mrs. Clinton at a July social event, gently warning of possible disaster. Others did the same. Like orphans, the cabinet bonded: They told one another about meetings they had not been invited to, about proposals they might need to know about. Some held rump meetings; a black market in Magaziner-held documents even sprouted.
Divide and conquer. Magaziner's idea was to put together a version of reform for the Clintons to consider. But he wanted each department to contribute its piece -- and allow no one to see the whole product. The plan drove Bentsen crazy, and he bluntly told Hillary Clinton: "We have a staff staying up 24 hours a day through the weekend. We have got to have access to all the information." Mrs. Clinton agreed. Later, she got a memo from Council of Economic Advisers Chairman Laura Tyson urging a more modest benefits package; National Economic Council chief Bob Rubin agreed. Bentsen delivered a 38-page, single-spaced memo arguing that Congress would never go for huge Medicare cuts, among other things. Rubin now says that "by the time it got finished, people had enormous input and we wound up with a structure everybody agreed with." Others disagree.
The principals' strategy was to build not from the center out, but from the left to the center, so "impassioned allies" would get the debate off to a good start. But there were no impassioned allies: Although Magaziner had expected otherwise, big groups such as the U.S. Chamber of Commerce fought the bill. Even the elderly lobby was lukewarm. Panetta, in a meeting with Magaziner, dumped the plan on a table: "No one is going to be for this." Shalala told Magaziner he had built a "negative coalition." Gergen argued that the Republicans would never accept a plan with employer mandates or with big health care alliances. The Clintons were about to call for a revolution that neither the public nor the Congress wanted. Nebraska Democratic Sen. Bob Kerrey calls the plan an "academically correct" piece of legislation -- all structure, no constituency.
Inevitably, the special interests will get much of the blame. The White House will argue it could not battle the bloated budgets of powerful lobbyists such as small business and the insurance industry. The president's bully pulpit, says Rubin, cannot compete with a daily barrage of TV ads that "grossly misrepresent" his plan. That is true. But a dismal communications effort, along with the impact and distractions of Whitewater, Bosnia, North Korea and Haiti, all produced an opening large enough for the opposition to crash through with a Mack truck.
The lobbyists and congressional veterans also knew something the White House did not: Health care reform was a piece of legislation, not a crusade. Writing laws hardly ever produces outright winners or losers. When the Business Roundtable failed to endorse the plan, the White House made big business a demon instead of trying to deal.
At the start, Hillary Clinton wanted a war room for health care. "They don't understand this is not a war," said one top Democratic Senate aide. "No one in Congress ever surrenders." The congressional committees battled over who would get the first lady first. Next on the schedule was the Treasury secretary, but he refused to testify because he did not have all the numbers. So Shalala trekked to the Hill and was pummeled by Senate Finance Chairman Daniel Patrick Moynihan. It was, she said, the worst day of her professional career.
For months, Congress fiddled. Groups of Senate Democrats and Republicans retreated to the mountains to commune on community ratings and other concepts. West Virginia's Jay Rockefeller --who some say liked Clinton's p
