Existing accounts of the Clinton health reform efforts
of the early 1990s, which were intended in part to check unprecedented
health cost inflation, neglect to examine the possibility that
a steep drop in big business reform interests during the short
period between 1992 and 1994 might, to a considerable degree,
account for the stalling of comprehensive compulsory health insurance
legislation in Congress. This paper explores evidence for the
idea that big employers lost interest in national reform because
in those two crucial years they managed on their own, through
private actions, to bring their health cost inflation down without
government help. At the same time, economic recovery out of the
recession of the early 1990s rendered further cost control less
imperative. The paper puts the argument in historical perspective,
discussing how hard times during the Great Depression also made
big employers into "foul weather friends" of compulsory social
insurance. Unlike in the present case, however, foul weather did
not clear and the social insurance reform of the New Deal succeeded.
The article speculates, therefore, that had there not been a brightening
of economic circumstances, continuing and even growing big business
support may have neutralized small business opposition. Thus in
light of the Clinton administrationŐs willingness to compromise
on details of its plan, some kind of major reform might have passed.
Scott Greer, Graduate
student, Department of Political Science, Northwestern University Peter Swenson, Department
of Political Science, Northwestern University
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