Second opinion: The United States public and the demise of health care reform, 1993--1994

Date of Completion

January 2003


Political Science, General|Political Science, Public Administration




This dissertation examines the role of public opinion in President Clinton's 1993–94 proposal for comprehensive national health insurance. The dissertation challenges the dominant interpretation of the 1993–4 health care debate: that the public wanted universal health care, Clinton attempted to deliver it to them, but failed because of a flawed political process. Different analysts see different flaws, but most agree that the health care debate was indicative of an “unhealthy” political process, where special interests dominated a debate marred by misinformation and big money. Some go so far as to conclude that universal health care is “terminally ill,” forever doomed by an institutional structure that fragments power, allowing well-organized, well-financed special interest groups to easily dominate the political playing field. ^ Using public opinion and archival data, the central findings include: (1) The public did not ever strongly support the Clinton Plan. A majority initially supported the Clinton plan, but felt the plan would affect them adversely; (2) Public support of the Clinton Plan would have dissipated, even without the unprecedented campaign waged against it by business interests; (3) Elected officials listened to the public. Public opinion affected the health care debate in important ways. Clinton eschewed the so-called “single payer” approach to health care, fearing adverse public reaction. Second, anticipating hostile public opinion, Democrats in the House of Representatives froze their chamber's consideration of the health care reform until the Senate spoke on controversial aspects of the plan. And public opinion directly affected senators' decisions to support or oppose health reform. In particular, Senate Republicans sought to kill health reform when the polls turned against the Clinton Plan. ^ The debate over health reform, while imperfect in many ways, was still indicative of healthy political process. The Clinton Plan forced a debate about the role of government in American society. Here, as in many cases, the public showed both support for the ends of the government involvement but discomfort in granting the government broad new powers. The public understood the broad choices the Clinton Plan presented and rejected it. Moreover, that the public significantly influenced public policy. ^