Clinton's health reform

1. Clinton's Health Reform
Analyst: Ann Analyst
Policy Date:
Analysis Date:
Report Date: 8 April 2015
1A. Policy Content
Goal Mechanism Indicator
Achieve cost containment of rapidly
increasing health care costs.
Increase competition in health care while reducing administrative costs
and imposing budgetary constraints.
Levelling and eventual decrease in growth of
the percent of GNP spent on health.
Improve equity of access to high­quality
health services.
Implementation of "health alliances."
Percentage of population with better access
to high­quality health services.
Promote greater emphasis on preventive
and primary health care services.
Incentives for physicians to increase their practice of primary care
medicine.
Number of physicians who enter or switch to
primary care medicine.
Provide universal access to health care
and health security for all Americans.
Require employers to cover their workers, and provide government
subsidies to companies and individuals who cannot afford coverage
Decreased numbers of uninsured persons,
and possession of Health Security Card.
Provision of a guaranteed benefits
package.
Standard package of health benefits, with information about price of
health plans to enable informed choices.
Percentage of health plans that accept the
agreed upon set of minimum services.
Notes:
Provide universal access to health care and health security for all Americans: All the players seem to agree on this broad goal; but major disagreements arise
on how to assure access for all Americans. (More research needed)
Provision of a guaranteed benefits package: Much controversy exists about what a minimum benefits package should contain, and how the package should be
decided.
2A. Player Table
Player name Level Sector Position Power
American Medical Association National Commercial High Opposition High
Biotechnology Industry National Commercial High Opposition High
Clinton, Bill (President) National Political High Support High
Clinton, Hillary (First Lady) National Political High Support High
Consumers, insured National Social Non­Mobilized Medium
Consumers, uninsured National Social Non­Mobilized Low
Consumers, upper­class National Social Low Opposition Medium
Democrats in Congress National Political Medium Support High
DOL (Dept of Labor) National Governmental Non­Mobilized Medium
Dole, Bob (Senator) National Political High Opposition High
Governors (Natl Governors Assoc) National Political Non­Mobilized Medium
Health Insurance Industry National Commercial High Opposition High
HHS (Dept of Health & Human Serv) National Governmental Medium Support High
Magaziner, Ira C. National Political High Support High
OMB (Office of Management and Budget) National Governmental Medium Opposition High
Pharmaceutical Industry National Commercial High Opposition High
Press and Media National Media Non­Mobilized High
Republicans in Congress National Political High Opposition High
Single payer reformers National Non­Governmental Medium Opposition Low
Small business owners National Social High Opposition High
2B. Current Position Map

2. 2C. Current Feasibility ­ National
2C. Current Feasibility ­ Regional

3. 2C. Current Feasibility ­ Local
2D. Consequences
Type Player / Identity Size Timing Import.
Custom
Order
Beneficial
Clinton, Bill (President): Will demonstrate ability as a
politician and leader, and provide a major
accomplishment for his Presidency.
Huge
Upon passage of legislation by
both Houses of Congress
High
Beneficial
Consumers, uninsured: Access to minimum health
care package.
Large ­ depending on level of health care
coverage currently receiving.
Following passage of legislation
and additional time for full
implementation.
High
Financial
American Medical Association: Could increase the
numbers of patients, but could also expand
managed competition, driving down prices and fees.
Large
Initial consequences felt upon
enrollment into health alliance
plans and increasing with
implementation of plan.
High
Harmful
Biotechnology Industry: Potential financial losses to
biotech ventures, due to uncertainties of future
markets, with declines in investment and stock
prices.
Potentially large ­ depending on type of
medical research and whether products
are covered under the Guaranteed
National Benefit Package.
Potentially before passage of
legislation, if investors believe
that health reform legislation will
pass.
High
Harmful
Small business owners: Potential financial loss, if
required to pay more for employees health
insurance; potential bankruptcy or loss of jobs.
Potentially very large and widespread
throughout the United States.
Upon implementation of plan. Medium
Symbolic
Democrats in Congress: Symbolic benefits from
passage of major reform; could affect individual
political futures and overall balance between
Republican and Democratic parties.
Potentially very large.
Immediate short­term gain, with
increasing returns as legislation
is successfully passed and
implemented.
High
2E. Interests
Player / Interest Type Priority
Custom
Order
American Medical Association: Maintain current health system, in order to protect physicians' interests and professional autonomy
and limit government intervention.
Financial High
Clinton, Bill (President): Gain passage of universal health insurance legislation in first year of office. Political High
Clinton, Hillary (First Lady): Create consensus for a health reform policy in the "first 100 days," to demonstrate major political
achievement.
Political High
Consumers, upper­class: Maintain existing choice and quality of health care services, and avoid new taxes.
Self­
Interest
High
Democrats in Congress: Implement liberal social policies that would help in electoral campaigns. Political Medium
Dole, Bob (Senator): Prevent Pres. Clinton and the Democrats from achieving any sort of political victory by blocking the passage of
Health Care Reform, while creating stronger ties with allies for future political moves.
Political High
Magaziner, Ira C.: Manage the drafting of a major health reform plan, to create best possible technical plan and to assure political
success for President Clinton.
Political High
Small business owners: Maintain status quo of limited provision of health care insurance to employees, in order to protect financial
interests of small business owners.
Financial High
2F. Coalition Map

4. 3A. Opportunities & Obstacles
Player name Opportunity Obstacle
American
Medical
Association
Selection of expert working groups (for the design of health reform)
could include representatives of the AMA as part of the policy making
process.
Health care reform is likely to elicit opposition from many powerful and
well­organized interest groups.
Biotechnology
Industry
Health care reform is likely to elicit opposition from many powerful and
well­organized interest groups.
Clinton, Bill
(President)
New Democratic Administration, with potential for enacting major social
reforms.; General public concern about serious problems in health care
system.
Minority popular vote for President Clinton, and vulnerable majority in
Congress, could complicate efforts to psss health reform.
Consumers,
upper­class
Increasing fear among upper income consumers that they will lose
existing social benefits through health reform and other reforms proposed
by President Clinton and Democratic Congress.
Democrats in
Congress
Lack of consensus among Democrats in Congress, with multiple bills
under consideration.
Governors
(Natl
Governors
Assoc)
Rising financial difficulties in state health systems (due to high number
of uninsured persons) could make some moderate Republican
governors sympathetic to the Clinton health reform.
Health
Insurance
Industry
Health care reform is likely to elicit opposition from many powerful and
well­organized interest groups.
Pharmaceutical
Industry
Health care reform is likely to elicit opposition from many powerful and
well­organized interest groups.
Press and
Media
Selection of expert working groups (for the design of health reform)
could include representatives of the media as part of the policy making
process.
Talk­show hosts are criticizing federal funding for social programs as a
waste of taxpayers' money, and are generating pressure on elected
officals to cut social programs.
Small business
owners
Health care reform is likely to elicit opposition from many powerful and
well­organized interest groups.
Notes:
Press and Media: Initially the press was upset that they were not invited to working group meetings held at the White House at the beginning of the policy
process.

5. 3C. Strategy Table
Player Strategy and Actions Challenges Timeline
American Medical Association, Republicans
in Congress, Dole, Bob (Senator), Small
business owners
Win Support from Key Opponents: Include broader representation of conservatives, by
seeking out representatives of AMA, moderate Republicans, and small­business owners
who will support President's plan.
Governors (Natl Governors Assoc)
Mobilize Support from Governors: Promise governors that the policy will allow wide latitude
for state­level experimentation in design and implementation of innovative health polices.
Governors (Natl Governors Assoc), Press
and Media
Compromise on Coverage: Compromise on the definition of universal coverage, in order to
win support from some critics of the reform effort.
Press and Media
Strengthen Public Relations: Involve representatives of the press and media in the working
group process to draft the health reform policy.
Press and Media, Health Insurance Industry,
Republicans in Congress, Small business
owners
Invoke "Crisis" to Justify Reform: Organize a media campaign to create a sense of public
"crisis" regarding access to and costs of health care, in order to justify major reform and
override opposition.
Single payer reformers
Get Support from Single Payer Proponents: Persuade single­payer proponents that the
President's plan is the best plan they could hope to achieve.
Notes:
Single payer reformers: This is not going to be easy.
American Medical Association, Republicans in Congress, Dole, Bob (Senator), Small business owners: Who could negotiate support from these key
opponents?
4A. Strategy Impacts
Strategy Timeline Player name Current Position Future Position
Current
Power
Future
Power
Compromise on Coverage
Governors (Natl Governors
Assoc)
Non­Mobilized Low Support Medium High
Compromise on Coverage Press and Media Non­Mobilized Low Support High High
Get Support from Single Payer
Proponents
Single payer reformers
Medium
Opposition
Low Support Low Low
Invoke "Crisis" to Justify Reform Press and Media Non­Mobilized Low Support High High
Invoke "Crisis" to Justify Reform Health Insurance Industry High Opposition High Opposition High High
Invoke "Crisis" to Justify Reform Republicans in Congress High Opposition
Medium
Opposition
High Medium
Invoke "Crisis" to Justify Reform Small business owners High Opposition High Opposition High High
Mobilize Support from Governors
Governors (Natl Governors
Assoc)
Non­Mobilized Low Support Medium High
Strengthen Public Relations Press and Media Non­Mobilized Medium Support High Medium
Win Support from Key Opponents American Medical Association High Opposition Low Support High High
Win Support from Key Opponents Republicans in Congress High Opposition
Medium
Opposition
High High
Win Support from Key Opponents Dole, Bob (Senator) High Opposition
Medium
Opposition
High High
Win Support from Key Opponents Small business owners High Opposition
Medium
Opposition
High Medium
4B. Future Position Map ­ All Strategies

6. 4C. Future Feasibility ­ All Strategies ­ National
4C. Future Feasibility ­ All Strategies ­ Regional
4C. Future Feasibility ­ All Strategies ­ Local

7. 4D. Strategy Implementation
Strategy Expected Impact
Success(%)
1­Jul­1993
Success(%)
1­Oct­1993
Success(%)
1­Jan­1994
Is
Assigned
Compromise on the definition of universal coverage, in order to win
support from some critics of the reform effort.
Governors (Natl Governors Assoc):
Position weakened to Low Support
and weakened to Low
15 75 0 Yes
Compromise on the definition of universal coverage, in order to win
support from some critics of the reform effort.
Press and Media: Position weakened
to Low Support
25 50 0 No
Include broader representation of conservatives, by seeking out
representatives of AMA, moderate Republicans, and small­
business owners who will support President's plan.
American Medical Association:
Position weakened to Low Support
0 0 0 Yes
Include broader representation of conservatives, by seeking out
representatives of AMA, moderate Republicans, and small­
business owners who will support President's plan.
Dole, Bob (Senator): Position
weakened to Medium Opposition
15 60 100 Yes
Include broader representation of conservatives, by seeking out
representatives of AMA, moderate Republicans, and small­
business owners who will support President's plan.
Republicans in Congress: Position
weakened to Medium Opposition
25 50 95 No
Include broader representation of conservatives, by seeking out
representatives of AMA, moderate Republicans, and small­
business owners who will support President's plan.
Small business owners: Position
weakened to Medium Opposition and
strengthened to Medium
0 0 0 No
Involve representatives of the press and media in the working
group process to draft the health reform policy.
Press and Media: Position weakened
to Medium Support and strengthened
to Medium
0 0 0 No
Organize a media campaign to create a sense of public "crisis"
regarding access to and costs of health care, in order to justify
major reform and override opposition.
Health Insurance Industry: (No
position or change)
20 0 0 Yes
Organize a media campaign to create a sense of public "crisis"
regarding access to and costs of health care, in order to justify
major reform and override opposition.
Press and Media: Position weakened
to Low Support
0 0 0 No
Organize a media campaign to create a sense of public "crisis"
regarding access to and costs of health care, in order to justify
major reform and override opposition.
Republicans in Congress: Position
weakened to Medium Opposition and
strengthened to Medium
0 0 0 No
Organize a media campaign to create a sense of public "crisis"
regarding access to and costs of health care, in order to justify
major reform and override opposition.
Small business owners: (No position
or change)
0 0 0 Yes
Persuade single­payer proponents that the President's plan is the
best plan they could hope to achieve.
Single payer reformers: Position
weakened to Low Support
0 0 0 No
Promise governors that the policy will allow wide latitude for state­
level experimentation in design and implementation of innovative
health polices.
Governors (Natl Governors Assoc):
Position weakened to Low Support
and weakened to Low
0 0 0 No