The Debate That Wasn't: The Public and the Clinton Plan

Prologue: Not since the repeal of the Medicare Catastrophic Coverage Act of 1988 has health care reform been first the “hero,” then the “goat” of the American policy scene in such a short period of time. As was the case after the repeal of Catastrophic in Congress, policy experts and opinion leaders have spent many hours debating what went wrong with the Clinton plan. Explanations range from blaming the plan itself, with its endless complexity and poorly understood provisions, to blaming the Clinton administration for its inability to articulate its vision to a confused, often frightened public. Not to be discounted is the role of special-interest groups and the millions of dollars spent on mass-media campaigns to discredit the plan. However, U.S. opinion polling expert Daniel Yankelovich believes that the problem is more deeply rooted, and therefore more troubling, than any of those reasons. The problem, as he states in this paper, is a “disconnect” between the American public and its leaders. That is, although elites have no problem conversing with one another, they carry out “a bizarre dialogue of the deaf with the people. As far as the American people are concerned, Yankelovich says, “the great health care debate of 1994 never took place.” Successful reforms in the future hinge on the nations ability to mend this “disconnect” and begin genuine public deliberation on a topic that is so crucial to the future health and economic well-being of the nation and its citizens. Yankelovich, who holds a graduate degree in psychology from Harvard, is chairman of DYG, Inc., a firm that tracks social trends and public attitudes. He is president and cofounder of The Public Agenda Foundation, a nonpartisan, nonprofit organization dedicated to improving the quality of public debate on important policy issues. The invited comments of Drew Altman and Karlyn Bowman, and comments of Mark Goldberg and Uwe Reinhardt, follow Yankelovich's paper.