What Happened to Americans' Support for the Clinton Health Plan?

Prologue: Nearly a year has passed since Congress declared the demise of health care reform, at least for the current legislative session. However, the problems that drove the 1993-1994 health reform effort remain and, indeed, are growing worse in many cases. In this study Robert Blendon and colleagues examine public opinion polls during the 1993-1994 period to attempt to understand why Americans' strong initial support for health care reform—and specifically the Clinton administration s managed competition-based proposal—reversed itself during the debate. Within a twelve-month period, they found, public support for the Clinton plan fell from 71 percent to 43 percent. The authors offer a number of explanations for this drop-off of public support, especially among key groups that traditionally have supported Democratic proposals. They are sharply critical of the Clinton administration s failure to retain public support and translate political momentum into action. Blendon has had a long, distinguished career in tracking and interpreting opinion polling about health care, both in the United States and in other countries. He is Roger I. Lee Professor of Health Policy and Management and chairs the Department of Health Policy and Management, Harvard School of Public Health. He directs the Harvard Program on Public Opinion and Health Care and the Program on the Future of Health Care. Mollyann Brodie is senior researcher and director of special projects at The Henry J. Kaiser Family Foundation in Menlo Park, California. She holds a doctorate in health policy from Harvard. John Benson is deputy director of the Kaiser/Harvard Program on the Public and Health/Social Policy at the Harvard School of Public Health. He received a master s degree in history of science from the University of Wisconsin. Abstract: Within a twelve-month period public support for the Clinton plan fell from 71 percent to 43 percent. The administration lost substantial support among two politically important groups—the elderly and Democrats. This outcome was brought on by a series of key strategic and substantive misjudgments by the administration in the choices that it made in the development of its plan. These particular decisions inadvertently reinforced the public's deeply held cynicism that although health care reform was needed, the government in Washington would not do it right and would ultimately leave the middle class worse off than it was before.