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CONGRESSIONAL FELLOWSHIP REPORT
"Having choices we don't like is no choice at all, " Louise laments. 'They choose," Harry agreed. 'We lose," replied Louise.
-Ad sponsored by Health Insurance Association of America, July 1994
"Looks like we may finally get health care reform," Harry says. "It's about time," Louise responds, "We need good coverage people can afford, coverage they can get . . ." Harry, finishing her sentence, says, ". . . even if they have a pre-existing condition."
-New ad sponsored by Pharmaceutical Research and Manufacturers of America (PhRMA) and Families USAJuIy 2009
The advent of a new, engaging president; a poor economy; and soaring health care costs made the time ripe for major health reform- both in 1993 and now in 2009. In 1994, Americans came to associate health care reform with a couple named Harry and Louise who, sitting at the kitchen table, fretted over the hopeless maze of bureaucratic procedures and seeming lack of choice in the Clinton health care plan. But as the current "Harry and Louise" television ads demonstrate, the environment has changed. From our vantage points as APSA Congressional Fellows- one working for an influential moderate Democratic senator on a key committee and one working for a rank-and-file moderate Democratic House member- we describe our view of the attempts to successfully pass health reform in the 111th Congress where similar attempts during the 103rd Congress failed. Comparing the health reform process under President Clinton to what we have observed firsthand in 2009, we argue that the strategies and tactics used to achieve reform in 2009 are more likely to succeed, but are still subject to powerful pressure from outside interests and internal centrist members. By appealing to moderate Republicans, especially on the Senate Finance Committee, and by negotiating the support of interest groups who could derail reform entirely, pro-reform politicians are mounting a formidable campaign for a new health care system- yet this strategy may be insufficient to pass comprehensive reform. Learning from Earlier Mistakes
Much has been written analyzing the death of health care reform under President Clinton (Hacker 1997; Johnson and Broder 1996; Skocpol 1996). These studies demonstrate how the Clinton plan ultimately was sunk by a confluence of key actors in health reform, including...