Above assumes Clinton's aim was so-called universal coverage rather than promoting big capital interests in insurance industry. Clinton's 'managed competition' proposal would have mandated large purchasing pools in which only a few large companies would have been able to offer 'health care' packages because of amounts of capital involved. AETNA, Prudential, Blue Cross & Blue Shield, a couple of others would have gained control of 50% of the 'health care market' still held by smaller insurance firms. Clinton would have completed corporate for-profit 'socialized' medicine in US.
Clinton's plan was defeated in Congress, in large part, because legislative branch is more 'contest terrain' than is executive. Smaller companies mobilized policyholders to contact representatives to express satisfaction with their coverage and to voice opposition to 'big government.' Of course, opposition 'concerns' about bureaucracy and reduced choice for health care 'consumers' were disinegenuous, increased administration and reduced benefits are being imposed through private sector 'managed care' without government intervention.
Distributive bias of US policymaking whereby congressional members must be convinced that dispensation of funds will be of direct economic benefit to key groups in their constituencies mitigates against redistributive features (in this case, 15 of population without health care coverage and 60% of poor ineligible for Medicaid). Controversy over Clinton proposal followed similar pattern as physicians, hospitals, drug companies, etc. responded according to how proposed changes would affect their historic roles as providers of protection or dispensers of health benefits.
Clinton could have pursued universal coverage (which is neither public health insurance nor socialized medicine) in manner that Hawaii has since 1974 if that was goal. Existing private insurance system administers state-mandated, employer-sponsored health insurance for everyone. Program, financed by employers and workers, includes public fund to pay premiums for unemployed and poor ineligible for Medicaid and supplemental fund to assist small businesses in paying premiums. Providing both comprehensive coverage and emphasizing preventative care, Hawaii's plan has not led to soaring costs (in fact, Hawaii premiums are below average and 50% of most expensive states) nor has it destroyed small businesses.
While single-payer was unlikely given 'debate' disadvantages faced by its advocates, surely that was the starting point if compromises (following either Madison's 'balanced government' model or pluralist theory 'broker' rule) were to be made. Then again, had a concerted effort been made to inform folks that simplified reimbursement procedures include patient's freedom to choose doctors and hospitals *and* reduce costs, who knows... Michael Hoover
'health care' and that they opposed another layer of 'big government'...an example of the more 'contested' arena of the legislative branch...the point is not the politics involved here because most of it came from the right, the left and single-payer advocates being at a clear disadvantage in the 'debate'...but as chief exec, Klingon was promoting the 'vanguard' interests of monopoly capital...