The first-year initiatives most clearly bearing Clinton’s stamp, the BTU tax and new policy regarding homosexuals in the military, were either squelched or substantially altered, primarily by two Senate Democrats, Oklahoma’s Boren and Georgia’s Nunn. Many of Clinton’s first-year preoccupations illustrated the inertia of issues and the momentum of events. With the Family Leave bill he signed what Bush had twice vetoed. NAFTA was a Reagan idea and a Bush product passed by Republican votes. The Brady bill was a hardy perennial, a gesture whose time had come.
Clinton’s economic policy so far is fairly conservative. That is not primarily a reflection of his preferences, which were revealed as traditionally even banally, liberal in his proposed “stimulus” package. His economic policy is largely dictated by pre-existing conditions–what Reagan did in reducing government revenues, and what the political class, in routine governance as well as in myriad scandals, has done to reduce the public’s trust of government. The result is that Clinton is forced to depend on growth driven almost entirely by private sector dynamism produced by low interest rates.
Clinton’s Year Two will be, in a sense, Year One because as health care claims the spotlight, the nation will at last see Clintonism clearly. Clinton’s plan is baroque and is the brainchild of one of Clinton’s many Sancho Panzas–Ira Magaziner. He recently said that “working in the federal government is everything I thought it would be and worse,” adding: “You work at 25 percent efficiency a lot of the time.” Yet he proposes the most gargantuan permanent expansion of government (Nixon’s wage and price controls were temporary) since the New Deal–actually, more gargantuan than any New Deal enterprise other than the short-lived National Recovery Act, which was declared unconstitutional.
“Magaziner’s guiding idea,” writes Jacob Weisberg in a long New Republic profile. “is that rational planning can solve any problem, social, economic or spiritual. His universe is one in which the uncertainty principle and the law of unintended consequences do not exist; his career is testimony to the belief that for every problem there exists a total solution.” He has extravagant confidence in the ability of economists to anticipate and politicians to overcome the resistance of reality to management–“managed trade” and “managed competition” are core components of the catechism of Clintonism. Magaziner has a gimlet eye for the vices of people in the private sector, such as those doctors who self-interestedly prescribe too many procedures. But Weisberg says:
“He doesn’t worry about abuse by those who will wield enormous power under his system through the new structure of a health care alliance. ‘The people this plan trusts the most, those who are absolutely filled with good will, who do nothing but the best for society, are governors and state legislators,’ says Lawrence O’Donnell, chief of staff of Senator Daniel Patrick Moynihan’s Finance Committee, ’the people who gave you congressional districts’.”
Weisberg refers to those who “will” wield power. Make that “would.” The subjunctive mood is apposite until Congress acts. And when it does it probably will produce minimalist reform–more Bauhaus than Baroque. The Clinton plan is a power grab without precedent in American history and goes aggressively against the grain of this era of dyspeptic feelings about government. The plan, says The Washington Post, which is sympathetic, amounts to “federalizing the health care system by another name.” Joseph Califano was President Carter’s Secret of Health, Education and Welfare, so he understands bureaucracy. He was at Lyndon Johnson’s side during the apogee of the Great Society, so he understands overreaching. He says Clinton’s plan rests on the “belief that an army of policy wonks can predict what would happen under a program that would change one-seventh of the economy, which 30 years of experience tells us we can’t do.”
Clinton’s plan uses the 38 million uninsured Americans–that is a “snapshot” number: most who are among the 38 million at any time either will be insured a year later, or are healthy young people who choose to be uninsured–to justify clamping federal controls on 260 million Americans. James Pinkerton, a policy planner in the Bush White House, says, “That’s like a mechanic telling you that he can’t fix the fan belt, so you have to buy the new experimental prototype car he happens to be selling.” And last week a Boston Globe headline heralded devastating news for proponents of the power grab: SCHOLAR WHO INSPIRED HEALTH PLAN NOW CALLS IT UNWORKABLE.
Alain Enthovan, a Stanford professor of management, is one of the principal developers of the idea of managed care for the health industry. He says Clinton’s Plan “puts the federal budget at enormous risk and will result in huge tax increases,” taxes of perhaps 12 percent on salaries to cover the plan. He terms “extremely unrealistic” the plan’s goals for holding down cost increases, even to 1.5 percent by 1996, “goals that have not been seen in the free world in the history of health care.” His prescription: “Price controls don’t and won’t work and therefore the first thing Congress should do is delete pages one through 1,342 of Clinton’s 1,342-page bill.”
It might do essentially that. No reason not to. American government was never meant to be a drama scripted by presidents, and in this age of continuing conservatism, Congress’s “additional dialogue” may matter more than any script suggested by this president.
