Paul Starr was in the balcony, sitting with Hillary Clinton, when Bill Clinton addressed Congress on his new health care bill. So when he says the story of that campaign has been distorted and mis-reported, listen to him. But in some ways, the most interesting part of his remembrances come not in his exoneration of Hillary Clinton -- who didn't, according to Paul, have much input into the basic shape of the reforms -- but in his retelling of Bill Clinton's approach:
During the 1992 campaign, Clinton had not given health-care reform top billing -- his primary issue was the economy, and he probably talked more about welfare reform than about health care. But higher deficit forecasts that fall led him to change his priorities soon after the election. Abandoning his promise of a middle-class tax cut and retrenching on other measures, Clinton opted for deficit reduction in the hope that it would lead to lower interest rates and higher economic growth. The deficit forecasts also highlighted how critical it was to control the cost of health care. If health costs kept gobbling up revenue, they would make long-term deficit reduction impossible and sharply circumscribe what the new administration could accomplish in other areas. Comprehensive health-care reform therefore held more than one attraction. If reform contained health costs, it would contribute to the success of Clinton's economic program.
Clinton's interest in health care was secondary to, and in many ways subsumed beneath, his economic agenda That explains why deficit reduction and NAFTA both went first. It explains, in part, why the plan he settled on made little political sense but a lot of economic sense. It explains why health care happened so late, and wasn't pushed first when Clinton had maximal media attention and political capital.
Indeed, that, I think, is one of the prime lesson's of 1994: Health care has to be the first priority for an incoming president. It has to be an extension of a presidential campaign that the candidate uses to build momentum for health reform, not an isolated initiative that comes two years in, and shortly before the midterms.
