Health Care

Bill Clinton’s 1993 Attempt at Health Care Reform: Almost Sinking a Presidency

In 1993, President Bill Clinton spoke to Congress about the need for health care reform. He said,bill-clinton-healthcare

If Americans are to have the courage to change in a difficult time, we must first be secure in our most basic needs. Tonight, I want to talk to you about the most critical thing we can do to build that security. This health care system of ours is badly broken, and it is time to fix it.

Despite the dedication of literally millions of talented health care professionals, our health care is too uncertain and too expensive, too bureaucratic and too wasteful. It has too much fraud and too much greed. At long last, after decades of false starts, we must make this our most urgent priority, giving every American health security — health care that can never be taken away, health care that is always there. That is what we must do tonight.

Later he added,

So tonight, I want to talk to you about the principles that I believe must embody our efforts to reform American health care system, security, simplicity, savings, choice, quality and responsibility.

That night, Clinton laid out the need for a reformed health care system. He would call it the Health Security Act. The attempt to pass this piece of legislation would almost sink his presidency. The story of the act actually begins on the campaign trail and would end in a crushing defeat of Democrats in the 1994 mid-term elections. It almost sank Clinton’s presidency…almost.

Bill Clinton would not be the first President to talk about health care reform. Teddy Roosevelt, Franklin Roosevelt, and Harry Truman had spoken about the need long before Clinton. In the spring of 1992, Bill Clinton began addressing the need to change the health care system while on the campaign trail. It was not a priority in the minds of many voters that year. The economy would be the big issue of the day. For Clinton, however, he kept the idea on the back burner. As to what Clinton’s plan was, it was ever-changing throughout 1992 and into 1993. Whether it was “managed competition” or “pay-for-play,” no one was really sure as it changed often.


Hillary Clinton addresses Congress on Health Care Reform in 1993

Shortly after his inauguration, Clinton announced the formation of “The President’s Task Force on National Health Reform.” It would be headed by his wife, Hillary Clinton. Bill Clinton initially wanted the health care reform package to be part of the next budget and gave a 100 day deadline to get both the budget and the plan, as part of the budget, passed. The plan did not make it far.

The spring saw Bill Clinton begin to assemble meetings on the issue of health care reform. Leaks from members sabotaged any progress or effort. At the end of May, the President disbanded the task force. That summer saw the President take a new initiative to handling the issue. He set up a war room to handle attacks on the forthcoming fall plan and to help get the word out about the benefits of the plan. Opponents, both Democratic and Republican, attacked the “employer mandate” section which would require all employers to provide health insurance. Presidential Adviser David Gergen tried to convince the President to postpone his fall attempt at Health Care for another year. Clinton did not adhere to the advice. After his budget was passed that summer, the Clintons were all in on health care.

On September 23, 1993, President Clinton laid out his plan before Congress.

The plan, called the Health Security Act, was to have a hard row to hoe. Five days after the address, Mrs. Clinton began several days of testimony before Congress. The soon to be 1300 page plan was not going to just sail through Congress. In addition, the Clintons began to shut out the outside the world, in particular, their own party. They wanted things done their way which meant relying on populist support. The problem was their perception of populist support was wrong.

Even before the plan was laid out for all the country to see, attack ads began airing on television. In addition, counter ads also played off of what became known as the “Harry and Louise” ads.

On November 20, 1993, the bill made its first official appearance. The 1300 page document laid out what Clinton thought was going to be his legacy. It almost ended it. The Health Security Act was government-run health care. The government was going to oversee and control every aspect of the health care industry. After having spent the 1980s listening to Ronald Reagan say that government was the problem, America was not going to support the plan.
Over the next year, the support for the bill waned.The Clintons still could not persuade their own party to sign on to the bill. Closed door meetings between the Clintons and Democratic congressional leaders were tense, terse, and non-compromising. Neither side budged. In fact, Democratic leaders began to assemble their own bills in 1994. Senator George Mitchell and Congressman Dick Gephardt lead the charges to revamp health care as they saw fit. The Clintons tried to use the public to pass their bill by marching citizen after citizen before the cameras to tell of their individual woe in regards to health care. It was all for naught.

Americans now had a new voice to listen to in the spring and summer of 1994. The Republicans drove home a message that the Health Security Act meant more “big government.” More government programs was something the public did not want. In addition, the Whitewater and Paula Jones Scandals became fodder for Republican candidates as they campaigned not for themselves, but against Clinton. By late fall and just before the elections, the plan was dead. It would not even come before either house of Congress for a vote.

The mid-term elections in 1994 were a disaster for Republicans as Democrats lost control of the House of Representatives for the first time since the 1950s. All the blame lay at Clinton’s feet and the Health Security Act.

The attempt to reform health care failed for several reasons. The biggest and most pronounced reason was the inability of the President to work with his own party to ensure passage. Instead, at every opportunity to forge alliances in his own party, President and Mrs. Clinton stood fast for fear of compromising what they thought was the integrity of their plan. Instead, it was the downfall.

Bill Clinton reflects on why the 1993 attempt to reform Health Care failed:

Despite the horrific political disaster that the attempt at Health Care was, it did have its lessons which Clinton quickly put to use in the next session of Congress from 1995-1996. Throughout the crisis, he developed a thick skin. By the end, he knew he had lost, but he also learned how the game of politics in Washington was played. When the Republicans take control in January of 1995, they begin pushing through their “Contract with America” and all its platforms. Clinton stood strong and chose his battles wisely. When a budget battle threatened to shut down the Government, the public blamed the Republicans under the leadership of Newt Gingrich and Bob Dole. Clinton became presidential. It may not be how he wanted, but nonetheless, he now knew how to fight back. Teh Republicans tried their own version of health care reform in 1995 and it failed, too. By the fall of 1995, eleven of the thirteen platforms in the “Contract with America” had failed to pass. The President may have lost the battle for health care reform in 1993 and 1994, but he won back the Presidency 2 years later in 1996. In his 1996 State of the Union speech, he declared that the era of  “big government was over.”


Civil War Medicine: A Turning Point

The American Civil War was known for its brutality – its harsh weapons and tactics produced the highest causality rates in any American conflict. Over 600,000 Americans were killed in the conflict. At the Battle of Antietam, 23,000 were killed or wounded in a single day. In spite of these conditions, medicine in the Civil War has taken its share of hard knocks. In reality, for soldiers, life in a field hospital during the Civil War was grim. However, the Civil War actually marked a turning point in medicine – not only on the battlefield, but in the country as well.

What made medicine in the Civil War extremely deadly were three factors.
1. The Minie Ball
This 56 caliber bullet made any field surgeon’s job over before it could begin. The bullet shattered bones and tore through muscles leaving amputation as the only choice. In fact, 3/4 out of all surgeries in the Civil War were amputations. At the Battle of Gettysburg, doctors created separate piles for the hundreds of legs and arms outside the makeshift field hospital. Aside from the size of the minie ball, it was also known for accuracy. This combination created large numbers of casualties in the conflict.

What a minie ball did to a leg bone

2. The Tactics
While advances in weaponry took place in the 1800s, advances in tactics did not, and would not, until near the end of the war. The Generals used methods going back to the Revolution of marching in formation and alternating fire between rows of soldiers. The advances in the minie ball changed the distance a weapon could fire accurately making the column obsolete. In addition, artillery advanced to the point where it shred marching armies exposed on open ground. As a result, casualties flooded the field  hospitals.

The remnants of the minie ball after going through soldiers

3. Conditions
The conditions in most field hospitals were notoriously filthy. Contrary to popular opinion, 75% of the soldiers receiving an amputation survived. However, water-borne diseases and intestinal disorders killed twice as many soldiers as bullets ever did. The large number of people in small areas created conditions that the viruses Staphylococcus aureus and Streptococcus pyogenes were able to spread quickly. The problem was not a lack of knowledge about sterilization and cleanliness, it was the ability to stay sterile and have clean water for drinking, laundry, bandages, and sterilizing hands and instruments. Water, or the lack of clean water, was the main culprit. There just was not much clean water to be found. Also, Antibiotics and antiseptics did not exist yet. The Union Army reported that 99.5% of all Union soldiers contracted some sort of bowel disorder at one point during their enlistment. Despite the formation of the Sanitary Commission in 1861, the conditions failed to meet recommendations.

As a result of these three factors, the state of medicine had to change if soldiers were going to survive.

The Civil War changed many  things about medicine.

1. Chloroform – Most movie accounts of th2e war show patients taking a swig of Whiskey or biting a belt or strap while doctors did their business. In fact, chloroform was standard issue for every doctor. The use of chloroform allowed for doctors to successfully amputate with the patient unconscious.

Standard Issue Bottle of Chloroform

2. Triage – Union Medical Director Jonathan Letterman created a system of diagnosis and care that still exists today. Letterman’s system called for triage near the battlefield followed by ambulance care to a field hospital, a regular hospital, and then post operative care (if they survived infection and disease). This type of diagnosis is still in effect in the military and in modern society.

In addition, Letterman took copious notes on his craft. Letterman details an amputation here:

The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon.

It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well.

It is easy to magnify an existing evil until it is beyond the bounds of truth. It is equally easy to pass by the good that has been done on the other side. Some medical officers lost their lives in their devotion to duty in the battle of Antietam, and others sickened from excessive labor which they conscientiously and skillfully performed. If any objection could be urged against the surgery of those fields, it would be the efforts on the part of surgeons to practice “conservative surgery” to too great an extent.

Letterman (seated on the far left) and his staff

3. Specialization – The large number of wounded from the civil war created a need in medicine. That need was for prosthetics and the new field of plastic surgery. After  the war, these two fields had huge advances in usability and availability. What once was for soldiers was now used in the general population.

4. Ambulances – Much like baseball spread after the Civil War when soldiers brought home the game, the use of ambulances did the same albeit with horses and wagons. Stretcher bearers and ambulances have not changed much since.

5. Embalming – While many soldiers were buried where they died, many others requested to be sent back home. To do so, new methods for embalming evolved to make sure the body could make the journey home.

6. Standardization of supplies and training – By 1863, every doctor in the Union had to take an exam, do an apprenticeship, and receive a standard set of supplies including a kit that included all the tools needed to amputate and perform a variety of tasks. In addition, each doctor received what amounted to barrels (kegs) for storing water for sanitary purposes.

7. Knowledge – By doing a large number of surgeries, doctors gained a lot of experience not only in dealing with war wounds, but also in their knowledge about the human body – mainly the vertebrae, spine, and head.

8. The Role of Women – While men were needed in battle, women filled the need for bodies in the hospitals. It is estimated that 3200 women served as nurses. They risked their lives leaving home to work in the cesspools of infection. They lived separately from the soldiers and only made $12 a month. While many women are nurses today, their service in the war began their integration into the work force over the next 100 years. But in medicine, women nurses soon became commonplace.

George Wunderlich, executive director of the National Museum of Civil War Medicine, called the conflict, “a watershed that really changed all medicine to the point where it could never completely go back to the way it was before.” Unfortunately, the demise of any soldier in the Civil War was a sad affair. But the large numbers of casualties necessitated the need for more advanced medicine and forms of care to help the soldiers survive their wounds. Most did survive the wounds but not the infection.

a field hospital

For further reading and historical sites, go to

For further research, the above site has a great reference page here:

Also see, Civil War Medicine by C. Keith Wilbur

Here is another interesting site:

Shades of 1994: The Republican Revolution

For almost 40 years, the Democrats controlled the House of Representatives and the Senate. Then along came Bill Clinton. Like Obama, Clinton polarized America. Clinton’s brash attempt at Health Care Reform turned many away from the Democratic Party. In the mid-term elections in 1994, the Republicans swept both houses of Congress for the first time since 1953. Largely based on their “Contract with America”, the new Republican Congress would try to change government and sweep out Clinton in the process. Not all went as planned, but in the following years, government did change.

The story of the Republican Revolution begins with none other than Barry Goldwater. Most think it starts with Reagan, but back in the 1960s, Goldwater began the conservative movement within the Republican Party. A candidate for president in 1964, Goldwater’s sharp contrast to Lyndon Johnson did not go down well with Americans outside of Arizona and the deep south. Personally, Goldwater was more of a libertarian than would become known as a conservative.

A sharp move to conservatism began in the Republican party with the Halloween Massacre of Gerald Ford in 1975. In one fell swoop, Ford, his chief of staff Donald Rumsfeld, and Rumsfeld’s aide, Dick Cheney, swept out the moderate wing of the party, and the remnants of Nixon cronies and replaced them with more conservative thinkers.

In the 1980s, Ronald Reagan came to embody the conservative movement. Reagan had a fantastic ability to speak about American values and how government was the problem. In reality Reagan’s inability to control legislation resulted in the largest deficits (at that time) in the nation’s history. However, the conservative movement continued to gain steam in the Republican Party. The conservatives, led by a group called the Religious Right, transformed politics as 150 years of the Democratic Party control in the south faded away in a matter of 10 years. Thus the base of the party of was born.

What created the rise of Republican anger that swept into Congress in 1994 was the reaction to Clinton’s attempt at health care reform and the growing federal deficit. Clinton, largely elected on George H.W. Bush’s failed campaign promise not to raise taxes, had been a disaster as President his first two years. Unbeknownst to many American, the Republican Revolution would change Clinton for the better as an executive.

The Republican’s swept into Congress largely on the outrage of Americans, much like the 2010 mid-term elections. But the 1994 Republicans also brought with them their Contract with America. It stated

On the first day of the 104th Congress, the new Republican majority will immediately pass the following major reforms, aimed at restoring the faith and trust of the American people in their government:

  • FIRST, require all laws that apply to the rest of the country also apply equally to the Congress;
  • SECOND, select a major, independent auditing firm to conduct a comprehensive audit of Congress for waste, fraud or abuse;
  • THIRD, cut the number of House committees, and cut committee staff by one-third;
  • FOURTH, limit the terms of all committee chairs;
  • FIFTH, ban the casting of proxy votes in committee;
  • SIXTH, require committee meetings to be open to the public;
  • SEVENTH, require a three-fifths majority vote to pass a tax increase;
  • EIGHTH, guarantee an honest accounting of our Federal Budget by implementing zero base-line budgeting.

Thereafter, within the first 100 days of the 104th Congress, we shall bring to the House Floor the following bills, each to be given full and open debate, each to be given a clear and fair vote and each to be immediately available this day for public inspection and scrutiny.
1. THE FISCAL RESPONSIBILITY ACT: A balanced budget/tax limitation amendment and a legislative line-item veto to restore fiscal responsibility to an out- of-control Congress, requiring them to live under the same budget constraints as families and businesses. (Bill Text) (Description)
2. THE TAKING BACK OUR STREETS ACT: An anti-crime package including stronger truth-in- sentencing, “good faith” exclusionary rule exemptions, effective death penalty provisions, and cuts in social spending from this summer’s “crime” bill to fund prison construction and additional law enforcement to keep people secure in their neighborhoods and kids safe in their schools. (Bill Text) (Description)
3. THE PERSONAL RESPONSIBILITY ACT: Discourage illegitimacy and teen pregnancy by prohibiting welfare to minor mothers and denying increased AFDC for additional children while on welfare, cut spending for welfare programs, and enact a tough two-years-and-out provision with work requirements to promote individual responsibility. (Bill Text) (Description)
4. THE FAMILY REINFORCEMENT ACT: Child support enforcement, tax incentives for adoption, strengthening rights of parents in their children’s education, stronger child pornography laws, and an elderly dependent care tax credit to reinforce the central role of families in American society. (Bill Text) (Description)
5. THE AMERICAN DREAM RESTORATION ACT: A S500 per child tax credit, begin repeal of the marriage tax penalty, and creation of American Dream Savings Accounts to provide middle class tax relief. (Bill Text) (Description)
6. THE NATIONAL SECURITY RESTORATION ACT: No U.S. troops under U.N. command and restoration of the essential parts of our national security funding to strengthen our national defense and maintain our credibility around the world. (Bill Text) (Description)
7. THE SENIOR CITIZENS FAIRNESS ACT: Raise the Social Security earnings limit which currently forces seniors out of the work force, repeal the 1993 tax hikes on Social Security benefits and provide tax incentives for private long-term care insurance to let Older Americans keep more of what they have earned over the years. (Bill Text) (Description)
8. THE JOB CREATION AND WAGE ENHANCEMENT ACT: Small business incentives, capital gains cut and indexation, neutral cost recovery, risk assessment/cost-benefit analysis, strengthening the Regulatory Flexibility Act and unfunded mandate reform to create jobs and raise worker wages. (Bill Text) (Description)
9. THE COMMON SENSE LEGAL REFORM ACT: “Loser pays” laws, reasonable limits on punitive damages and reform of product liability laws to stem the endless tide of litigation. (Bill Text) (Description)
10. THE CITIZEN LEGISLATURE ACT: A first-ever vote on term limits to replace career politicians with citizen legislators. (Description)

Further, we will instruct the House Budget Committee to report to the floor and we will work to enact additional budget savings, beyond the budget cuts specifically included in the legislation described above, to ensure that the Federal budget deficit will be less than it would have been without the enactment of these bills.
Respecting the judgment of our fellow citizens as we seek their mandate for reform, we hereby pledge our names to this Contract with America.


Some of the measures would pass, some would be altered, others radically changed, but many measures would not change. However, several changes occurred as a result. Conservatism was now “in”. From the south to great plains, a new America was cast. And for the past 16 years, it has not changed. What began with Goldwater, shifted with Reagan, was fully born with Gingrich and the Republican Revolution in 1994. The 10-point legislative plan aimed to reduce federal taxes, balance the budget, and dismantle social welfare programs established during six decades of mostly Democratic rule in Congress. Gingrich was feisty, sometimes controversial, but he knew he had somewhat of a mandate from the American people.

What the Republicans did not foresee were two changes on the horizon. The biggest change of all in America as a result of the Republican Revolution was Clinton’s governing style. As we used to say in south central Polo, “He grew a pair.” He stood up to Gingrich. And on one occasion, Clinton shut down the government rather than give in to the Republicans. Americans sided with Clinton.

The second change was with a computing and technology revolution, the economy boomed in 1995 and 1996. In the Presidential election, Republicans did not select the a candidate to challenge Clinton appropriately. As a result Clinton defeated Bob Dole and Ross Perot (for a second time). The Republican Congress continued to keep an eye on fiscal matters, and with Clinton, they both balanced the budget and created surpluses many thought would last a decade and the US would be out of debt by 2010. Yeah,…..that didn’t happen. By 2002, the Republican controlled Congress under George W. Bush had strayed far away from the roots of the Revolution. The Republicans were out of Congress after the mid-term elections in 2006. Over the last four Bush years, and Obama’s first two years, the largest deficits in our nation’s history occurred raising the deficit to a staggering 12 trillion dollars including 3 straight years of trillion dollar deficits with no end in sight.

It was no surprise to anyone that this past week, America responded by changing the course of the Congress. The Republicans took back the House but not the Senate. As to what will happen, neither party has control of anything. Gridlock may be the answer. Who knows? We may be having this same conversation in two years about how either Obama “grew a pair”, the Republicans wasted an opportunity, the economy grew or fizzled, or even the birth of a new political party. We will just have to wait and see. One thing is clear, Americans have had enough and want results.

The Great Society

As the nation awaits the vote by the House of Representatives today on Health Care Reform, Lyndon Johnson may be somewhere smiling. If passed and signed into law, health care legislation may arguably be the most important piece of legislation passed since 1965. That year saw the passage of some of the most sweeping legislation this country had seen since the New Deal. The New Deal saw the federal government take an active role in the economy; the Great Society saw the federal government take an active role in the welfare of its people.

The Rationale…

…I am concerned about the whole man. I am concerned about what the people, using their government as an instrument and a tool, can do toward building the whole man, which will mean a better society and a better world.
…We have the opportunity to move not only toward the rich society and the powerful society, but upward to the Great Society.
…the Great Society is not a safe harbor, a resting place, a final objective, a finished work. It is a challenge constantly renewed, beckoning us toward a destiny where the meaning of our lives matches the marvelous products of our labor

Lyndon Johnson simply wanted to make the United States a better place. He thought that the United States with all of its riches could and should take care of its own. A New Dealer at heart, Johnson wanted the government to do what the people could not.

For his whole life, Lyndon Johnson knew nothing but poverty. A former school teacher, Johnson’s life experiences drew him to helping the poor fro rural electrification to education. As a congressman in the 1930s, the New Deal permeated every form of government in the United States. For 20 plus years, Johnson served the people of Texas as a congressman and then Senator. He knew Congress inside and out and was a politician’s politician – he knew how to make a deal and what buttons to push.

After Kennedy’s Assassination, Johnson was elected President in his own right and took it upon himself to pass the second largest amount legislation in the 20th century behind the New Deal and declared a War on Poverty.

What All Was in The Great Society…
Johnson gets a lot of flak for how he handled Vietnam and rightfully so. However, he does not get enough credit for his own domestic agenda. The Great Society swept across the cultural landscape in hopes of creating a better society where all children had opportunity. Regardless of race of economics, Johnson wanted every child to live the American dream.
No president passed more Civil Rights legislation than Johnson. Johnson’s legislation marked the end of segregation and the beginning of a new era for all of America’s citizens. The Great Society also included many other programs such as VISTA – Volunteers in Service to America. This was Johnson’s Peace Corps at home. Head Start, Food Stamps, and Upward Bound were all aimed to help feed and give opportunity where there was not before. Johnson passed more environmental legislation than any other president. Before George W. Bush called himself the education President, Johnson passed sweeping reforms with the Elementary and Secondary Education Act of 1965 (which is still in effect today), Bilingual Education, and Higher Education reform. He also started PBS and the National Endowment for the Humanities along with many cultural centers across the nation.

The Social Security Act of 1965
Government run health care has been taking place since 1965. Public health care was not a new idea. It is an idea over 100 years in the making. From the Progressive Era to Harry Truman, health care was something some saw as a right, while others saw as a need, and some saw as no need. What Medicare and Medicaid have done is to take care of our nation’s elderly (age 65 and over) for over 45 years.

The LegacyThree Points of View
1. The Great Society created a welfare state which the US didn’t recoil from until welfare was reshaped  in the mid 1990s. It has cost trillions of dollars to maintain over forty-five years. It created a society dependent on the government to take care of its people. If you are a senior citizen, there remains no incentive to get your own health insurance.
2. The Great Society righted the wrongs of injustice, segregation, and inequality. It has fulfilled the mission of the ethos of the Declaration of Independence that “all men are created equal.”
3. The Great Society is a mixed bag. Some programs have been highly successful and worthy programs while others have been failures. Programs on civil rights, the environment, education, and culture have raised our country to new levels while food stamps and welfare programs gave many no incentive to get off of them. In fact, many saw the incentive was to stay on them. Welfare reform in the 1990s changed that for the better. However, it was the Great Society which gave the current President everything he needed to lift himself up.

The question now remains: what will this new Health Care law do over time? Will it be remembered fondly in 40 years? Or will it be remembered at all?