Foul Weather Friends: Big Business and Health Care Reform in the 1990s in Historical Perspective

Abstract

Existing accounts of the Clinton health reform efforts of the early 1990s neglect to examine how the change in big business reform interests during the short period between the late 1980s and 1994 might have altered the trajectory of compulsory health insurance legislation in Congress. This article explores evidence that big employers lost their early interest in reform because they believed their private remedies for bringing down health cost inflation were finally beginning to work. This had a discouraging effect on reform efforts. Historical analysis shows how hard times during the Great Depression also aligned big business interests with those of reformers seeking compulsory social insurance. Unlike the present case, however, the economic climate did not quickly improve, and the social insurance reform of the New Deal succeeded. The article speculates, therefore, that had employer health expenditures not flattened out, continuing and even growing big business support might have neutralized small business and other opposition that contributed heavily to the failure of reform. Thus in light of the Clinton administration's demonstrated willingness to compromise with business on details of its plan, some kind of major reform might have succeeded.

Misrepresented Interests: Business, Medicare, and the Making of the American Health Care State

“…They also threatened targeted punishments for individual companies like Ameritech, Caterpillar, and others. 81 Within a decade, the Republican Party would take the lead for the first time with a major expansion of health coverage, about which some Republicans were less enthusiastic than businesspeople. Drug makers, biotech companies, and insurers actively lobbied for a large bipartisan expansion of the State Children's Health Insurance Program (CHIP) of 1997.…”

Reflecting on ‘The 2010 U.S. health care reform: approaching and avoiding how other countries finance health care’

“…It is unclear. Firms can be fickle; the same corporations that encouraged Clinton to save their costs with a health plan abandoned him when managed care under their control seemed to deliver the savings they wanted (Swenson and Greer, 2002). Since then, payers have found it easier to just provide worse insurance when they need to: limited provider networks, restrictions on procedures, less insurance for dependents or part-time workers, etc.…”

How Sociology Lost Public Opinion

“…Other institutionalist accounts of the defeat of the Clinton health plan have paid attention to the role of public opinion and the struggle of various groups to influence it in accounting for the defeat of the plan (Hacker 1997; Jacobs and Shapiro 2000). By contrast, class-based accounts of the defeat of proposals for national health insurance have typically paid much less attention to the role of public opinion (e.g., Gordon 2004; Quadagno 2005; Swenson and Greer 2002).…”