bill clinton and healthcare -- 6/8/2026

08 Jun 2026

bill clinton and healthcare -- 6/8/2026

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Today's selection -- from American Contradiction by Paul Starr. Though the country seemed primed for true healthcare reform as Bill Clinton took office, it suffered an ‘unqualified political defeat.’

“The early 1990s were one of those rare historical moments when the world seemed to be moving in a great rush toward democracy, peace, and economic growth all at once. The collapse of Soviet communism and end of the Cold War, the formation of the European Union and diminishing importance of national boundaries, the expansion of global trade and travel, the advent of the internet–all these developments appeared to signal a new era of progressive change. Perhaps naively, I shared in the enthusiasm. In spring 1990, Robert Kuttner, Robert Reich, and I launched a new political magazine that we called The American Prospect. The cover of the first issue showed an egg breaking open to reveal a new world inside, a world reborn. But the promise of that new world would not be fulfilled over the next three decades. Politics in the 1990s took a particularly ugly turn in the United States.

“For nearly a half century after 1932, with only brief interludes, Democrats had enjoyed overwhelming control of both the Senate and House. It was a surprise in 1980 when Republicans won a Senate majority, which they held for six years. But from the 1980s on, control of Congress became much more hotly contested. As the political scientist Frances Lee argues in a study of the U.S. Congress, parties act differently depending on their prospects for control. If they see no chance of winning a majority, members of the minority are likely to try to achieve what they can through cooperation in writing legislation. But when control is up for grabs, both parties invest more in party-building and image-making and become more aggressive in drawing distinctions. The incentives for the minority change from legislating to messaging. Instead of taking part in writing laws that could redound to the majority's advantage, the minority party is likely to become more confrontational, assailing the majority as feeble and corrupt and accentuating issues where public opinion appears to be on its side.

“This was the strategy that Republicans in the House adopted during the late 1980s and early 1990s, when Newt Gingrich led the party's drive for power even before he became its formal leader and Speaker of the House in the wake of the 1994 election. Ferociously partisan, he brought down a Democratic Speaker in 1989 and broke from the old norms of civility, restraint, and partnership in government that previously shaped the workings of Congress. He had a grandiose vision of himself as a transformative leader. ‘People like me,’ he said in 1994, ‘are what stand between us and Auschwitz. I see evil all around me every day.’ In a guide to other Republicans about language as a ‘mechanism of control,’ Gingrich set out a glossary of terms for describing their opponents, including ‘sick,’ ‘pathetic,’ ‘lie,’ ‘betray,' ‘traitors,’ ‘corruption,’ ‘obsolete,’ ‘they/them,’ ‘cheat,’ ‘steal,’ and, of course, ‘liberal.’ He advised, ‘The number one fact about the news media is they love fights,'' and so to draw attention and ‘educate’ the public, combat was the best policy. While irony may have been having a moment among the young, vitriol was having a moment in politics. Like Buchanan at the 1992 convention and Limbaugh on the radio, Gingrich infused the culture war into partisan politics, accusing Democrats of every random outrage and of being ‘anti-child’ and ‘antiflag’ (words he also recommended). If this style had been Gingrich's alone, it would have had limited significance. But other Republicans learned to ‘speak like Newt,’ and even some of the party's moderates in the House supported Gingrich for leadership, believing he could carry them to power. The same pattern later led most of the dwindling number of moderate Republicans in Congress to support Donald Trump, ultimately reducing the center right in the United States to political impotence.

Official portrait, 1993

“After losing three presidential elections in a row, Democrats in the early 1990s also faced an imperative for renewal. But the winner of the party's presidential nomination in 1992, Bill Clinton, adopted a strategy that combined progressive and neoliberal elements to achieve that renewal. No Democrat nominated that year could have succeeded by going as far to the left as Gingrich went to the right. Democrats did not have the luxury of writing off the South because they lacked sufficient support elsewhere to win a national election. (In defeating Bush, Clinton would take every state on either side of the Mississippi River, except Mississippi itself; in 1996 he would be the last Democrat, as of 2024, to win five of those states: Arkansas, Missouri, Louisiana, Kentucky, and Tennessee.) A Democrat could also not afford to write off either the so-called Reagan Democrats–Northern working- and middle-class whites who had defected to the Republicans–or the party's liberal base, or its support in minority communities. The Democrats needed support from all those heterogeneous groups to build a winning coalition.

“Faced with that imperative, Clinton called for a mix of policies framed in terms that implicitly acknowledged the reservations of culturally conservative voters even while backing liberal priorities. For example, he called for universal health insurance, more support for education and training, and fairness in taxation as mere justice for ‘people who work hard and play by the rules.’ He defended reproductive rights but said he would seek to make abortion ‘safe, legal, and rare.’ In his first year, he had two major priorities, a plan for economic recovery and a plan for health-care reform, neither of which was especially left wing. But, in this new era of partisan warfare, he had no cooperation from Republicans in passing either one.

“The economic program, presented in Clinton's first budget in 1993, gave a surprising priority to a presumably conservative goal–deficit reduction. Together, Reagan and Bush had generated in twelve years more than three times as much debt as the federal government had accumulated in its previous 192 years. Clinton reversed direction despite promises he had made during the campaign for an economic stimulus. Proposing long-term reductions in the deficit, he called for a combination of tax increases and spending cuts in the belief that interest rates would fall and the economy would get a stimulus by that means. This was the case that Clinton's Wall Street advisers, backed by Federal Reserve Chairman Alan Greenspan, were making, and during the 1990s their strategy seemed to work. As the economists Alan Blinder and Janet Yellen show, the 1993 budget proved to be a ‘fiscal turning point’: Interest rates did fall afterward, and the economy grew faster than it otherwise would have, an average 4 percent annual growth rate. Not only did Clinton's presidency cut the deficit; in his final three years, the government ran a surplus. After a dozen years of mammoth deficits, Clinton and the Democrats served as the party of fiscal repair and responsibility, while unemployment fell to its lowest point in more than two decades. The budget that set the government on that path, however, did not receive a single Republican vote in either the House or Senate and, because of its tax increases, probably contributed to the Democrats' loss of Congress in 1994.

“Clinton and his advisers on health care–I was one of them–originally expected that his proposal for reform would lead to a negotiation with congressional Republicans as well as Democrats. This hope did not seem far-fetched: Business groups at the time supported reform, Republican senators had sponsored a bill that included universal coverage, and Clinton's plan retained private insurers under a system of regulated competition, a model consistent in its rough outlines with what many conservatives were advocating. The plan, however, also called for a government cap on the rate of growth of total health spending, a provision aimed at long-term health-care cost containment that conservatives did not support. Unlike Clinton's federal budget plan, the health legislation could not pass without Republican votes because Democrats alone had fewer than the sixty needed to overcome a Senate filibuster. But congressional Republicans abandoned their own bills and turned against any deal. In a memo to party leaders three months after Clinton sent his plan to Congress, Republican strategist Bill Kristal (Irving Kristal's son) warned that the Clinton proposal was ‘a serious political threat to the Republican Party.’ It would ‘help Democratic prospects in 1996’ and in the long term ‘revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests.’ Republicans had to ‘adopt an aggressive and uncompromising counterstrategy’ to ‘delegitimize’ the Clinton proposal and bring about its ‘unqualified political defeat.’ They should reject any compromise proposal ‘sight unseen.’ When they killed the Clinton plan, one Republican senator remarked that they just had to make sure they left no fingerprints.”