The Rationale Behind the Clinton Health Care Reform Plan

Prologue: The Clinton administration's health care reform plan can be described as many different things to the array of individual and institutional interests to which it would apply. Certainly it is a political document, based on a calculus that Congress is most likely to approve a plan of universal insurance coverage if the measure does not impose a broad-based tax to finance it. But it is also the health equivalent of reinventing government, proposing as it does the creation of new institutions, new relationships, and new responsibilities for private and public sectors alike. In our lead paper one of the principal architects of this complicated proposal introduced by President Bill Clinton outlines what the author characterizes as “a study in paths taken and not taken” in pursuit of the plan. Walter Zelman is one of a tiny cadre at the White House still working on health policy issues after the dismantlement of the Clintons’ mammoth task force on health care reform. Zelman holds a doctorate in political science from the University of California, Los Angeles, and was instrumental in structuring the concept of a health insurance purchasing alliance. He was executive director of California Common Cause from 1978 to 1990. In 1990 he ran unsuccessfully against John Garamendi for the post of California insurance commissioner. After Zelman lost, Garamendi hired him as his deputy for health issues. Zelman chaired a task force that developed Garamendi s health care reform proposal, which set out in legislation for the first time the concept of a purchasing cooperative. The California Legislature never approved the measure but did enact legislation that created a state-based voluntary alliance (see page 350 in this issue) and strict, comprehensive, small-group health insurance underwriting reforms.