Intro to Policy Process Midterm: Skocpol Case Study

President Clinton speech about Health Security proposal in 1992 (like social security)

Reflected the idea that problems shared by a majority of Americans could be solved by the government. Not “handouts,” but helped middle-class struggles. Skyrocketed support, optimistic of passage.

But, it died and Republicans won big in 1994 and made Clinton a lame duck. New Speaker waged war on social programs. TUrning point in US politics to the right

What went wrong?

• Secretive, unelected task force of controversial people arrogant and unwilling to compromise

• Public opinion unwilling to accept the sacrifices of universal care and confused

• Intersections of government, mass media, parties and corporations maneuvering around their goals

Was the plan crazy?

• Plan was made before the task force

• Actually a compromise between market and gov’t

• Would have reduced gov’t involvement in healthcare

• Debates were between people who weren’t afraid of losing insurance (elites)

• Was actually a compromise

Background of the need for healthcare reform

US pends a lot on healthcare, outlier. Large number of uninsured people, variation across states

Public opinion paradox

not a lot of trust in the government, skeptical of using it to solve problems. Wanted reform, but didn’t trust the gov’t to do it. This provides windows of opportunity for both sides

Policy Process

When Clinton was inaugurated, House and Senate were D. Ready to enact a bunch of legislation

Task force

Secretive, bureaucratic, controversial, Congress felt left out, interest groups felt like they had been promised success.

Act introduced in both chambers November 1993

By majority leaders

Committees

Five committees got involved because they all wanted a piece of theaction

2 policy processes

1. Centralized: task force where Hillary and Ira Magaziner were in charge of everything

2. Fragmented: Congress

Deals struck during the task force could not be maintained in Congress. 

What caused defeat according to Skocpol?

1. Personalities of key players

2. Public opinion divided/confused on the details. Supportive generally, conflicted on the details

Deficit concerns

Made promises on the campaign about cutting Reagan-Bush deficit, but also promised comprehensive healthcare reform

Task force?

• Congress irons out the details: staffers don’t have executive’s analytical resources, divisions in Congress, every member would want to be on the committee, if committee failed, it could prematurely politicize the issue

• Many interest groups (stakeholder system is fragmented), even multiple for physicians. Divisions of authority allow them to undercut each other

• Clinton thought he had a workable plan and Hillary’s caring touch

Policy planning in operation

511 person task force

• Quick turnaround for thinking outside of the box

• Groups worked through technicalities and presented them at tollgates

• Executive branch employees from Cabinet departments, policy experts, academics, physicians, staffers, governors, etc. 

• Stakeholder groups not included, but gave input. This made them think they were getting commitments. But, they were actually heard not heeded. 

• They thought it was perfect, leaks were losing votes. Meetings became confidential, media thought they stopped entirely

• CBO financial aspects also leaked

Going forward with bold reform 

Plan included universal coverage paid with employer mandates, regulation of privately competing health plans. 

Cooper Bill

not universal coverage, but subsidies for low-wage workers. Would not accept a mandate for all employers. Wanted to see if market costs would go down and coverage expanded before taking government action. Incremental reform for Conservative D and moderate R.

Advantages of task force

• Reduced policy conflict

• Centralized expertise

• Generated proposal power (it’ll be so good, Congress won’t want to change it!) High-quality and comprehensive

• Minimized conflict, insulated from lobbying and attacks from stakeholders

Downsides of task force

• Deals and compromises weren’t guaranteed, they had to go to Congress

• Congress was resentful for being excluded

• Secrecy = suspicion 

Pros and cons of giving broad principles to Congress

P: Congress sorts out details

C: not the most knowledgeable branch, divisions

Pros and cons of national commission

Pros: pressure is off Clinton Administration

Cons: R wouldn’t join, too many interests, high-profile = more politicization

Where and when did the Health Security Act die? 

Ideological campaigns against it sunk public approval, momentum was lost. Campaigned too late. 

Why did Clinton and allies not build up a coalition to build public support?

1. Lack of access to the President’s agenda

2. Congress makes it worse

3. Threatened stakeholders mobilize and activated social networks, blocking any reform. Mobilization against government

Access to the President’s agenda

Didn’t give any details in his campaign to Congress, the media, and the public + foreign eruptions/legislative battles took his attention away (Haiti, NAFTA) + Clinton lost credibility because he couldn’t control Congress.

Clinton reluctant to sell his bill, lack of advocates for specifics. Didn’t want the perception of “waffling” no public education/mobilization.

Congress Makes it Worse

Would have had to compromise, but D couldn’t agree on what they wanted to reform. Disarray and a lack of direction

D had control but were divided. Single payer vs. Clinton vs. Clinton Lite. Conflicting messages confused the public. Many committees claimed jurisdiction, could have streamlined it by making a temporary committee to sideline troublemakers, decision-makers, and CBO cost estimates. 

Why was the Democrat party in disarray?

1. Rise of interest group advocacy, incumbents had ties to different groups

2. Many healthcare experts and unreliable Senate Finance Chairman

3. Many healthcare committees wanted a piece of the action

4. Clinton’s election brought R together

5. Routine mechanisms used for extraordinary policies (5 committees = very visible)

6. Many coalitions when it needed all the help it could get

7. Aspiration for higher office lost votes in committees

8. Clinton couldn’t accept Cooper Bill

9. Even supporters had different ideas of how to achieve it

10. Many committees + conflicting interests = points of access for conflict

11. Media attention confused the public more 

Mobilization against government

Advocates were disorganized and didn’t give details. Anti-reform interest groups collected $ and did ideological campaigns against big gov’t

Threatened stakeholders mobilize

Formed coalitions to lobby, advertise, and increase agitation at the grassroots level. HIAA had nothing to lose and threw money in, ran attack ads in policy areas and grassroots agitation. The Clintons never explained and heightened public uneasiness

Activating social networks

Locally-oriented grassroots techniques, combo of ads, mailings, lobbying, and grassroots organization. Even groups that wanted reform wanted others to pay for it. Dug into extreme positions and avoided compromise, never mentioned specifics of what they liked, sowed anxiety and little determination to go foward. 

Stages of stakeholder mobilization

1. Express interest

2. Revolt

   1. Unease over regulation, public feared gov’t intervention in economic and social routines. New regulations and excessive complexity

   2. Opposition groups united: stakeholders and ideological groups, think tanks, talk radio, op-ed columnists, activists

   3. Rhetorical strategy: healthcare is not in crisis, Clinton’s plan is not a political compromise

   4. Comm strategies: ads, lobbying, activating sympathetic constituents

Opposition prevailed

Disorganized beneficiaries (underinsured, true middle class) 

Stakeholders united in opposition, feared paying the cost of reform, existed in every congressional district