The decision to push universal coverage as the central theme of healthcare reform doomed the Clinton administration's plan from the start, in the view of Democratic pollster and Clinton administration adviser Celinda Lake. Furthermore, the failure to pass healthcare reform in 1994 will make it nearly impossible to bring comprehensive reform to the front of the national agenda before the 1996 elections, she believes.
Speaking before the American Public Health Association recently, Ms. Lake delivered one of the harshest critiques of the Clinton administration's healthcare reform strategy by one of its own.
"There was a real failure of understanding where the public really was," she said. "The voters never wanted universal coverage, so we were leading with the thing that made voters the most uncomfortable."
Polling done by Ms. Lake during the past 18 months showed that most Americans were more interested in cost containment than they were in universal coverage. However, because of the opposition to global budgets or rate-setting from providers and insurers, the White House abandoned cost containment as an issue.
"In the end, we were arguing (for universal coverage), the thing the voters didn't want, didn't understand and didn't believe. Is it any wonder we got in major trouble?" Ms. Lake asked.
The failures of the past two years have made the public suspicious of any healthcare reform initiative, even modest proposals, Ms. Lake said.
When Congress returns to work in 1995 it will have "a long way to go just to get back to where we started (in 1992). We paid an enormous price for our failure," she said.
Because of the public's misgivings about healthcare reform, Ms. Lake said the only type of incremental plan that might have a chance of passage in 1995 would be one that expanded coverage to children.
"There isn't the political will to take on cost control at any level," making it impossible to finance a larger package of reforms, Ms. Lake predicted.