A Detailed Timeline of the Healthcare Debate portrayed in "The System"
Events leading up to Clinton's Healthcare Address to Congress
From Clinton's Address to March 1994
From March through the November election of 1994
The 104th Congress
Spring 1991 - Minority Whip Newt Gingrich, in a private discussion about long-term Republican political strategy, predicts that the "next great offensive of the Left," as he puts it, will be "socializing health care." Gingrich declares the need for hardline Republicans to begin positioning themselves now to keep Democrats from winning in the future.
November 1991 - Arguing that every American should have the right to a doctor, Harris Wofford defeats Dick Thornburgh to become the first Democrat to win a U.S. Senate seat in Pennsylvania in thirty years. His victory attracts national attention and convinces Democrats they have found a powerful issue to use against George Bush in the upcoming presidential election.
January 19, 1992 - The Clinton caimpaign issues a health care white paper marking the opening round in what becomes an eight-month internal struggle to get Bill Clinton to define his approach to health care reform.
June 19, 1992 - During interviews at a convention of radio talk show hosts in Washington, D.C., Bill Clinton begins using the jargon of a new health care approach called "managed competition." It is an approach favored by Ira Magaziner and several other top Clinton advisers.
July 15, 1992 - Clinton accepts the Democratic presidential nomination. He vows to "take on the health care profiteers and make health care affordable for every family."
August 9, 1992 - Clinton is warned by campaign aides that his "position on health care is too unstructured" and too unclear to be easily defended.
End of August 1992 - Partly as a result of political pressures from incumbent George Bush, and partly as a result of internal debates among rival advisers, a major effort is launched to reposition Clinton's health policies, form a merger of Democratic views from left and right, and shed the "pay-or-play" label that has come under increased Republican attack.
August 30, 1992 - Democratic Senator Jay Rockefeller gets wind of Clinton's waning support for "pay-or-play" and fires off a memo arguing against any change of direction. He also tells Clinton that his statement that "Americans deserve or have a right to health care" might present problems for the candidate in the future. "Although many Americans may initially react positively to this statement," he writes, “over time it can make them uneasy. Before long they will be asking: How would we pay for all that care for all those people? Won't it require a huge new government bureaucracy?"
September 24, 1992 - In a speech before some two thousand employees of the Merck Pharmaceutical Co., Clinton unveils a revised version of his health reform policies. Without ever using the term "managed competition," he contrasts his approach with that of President Bush. The speech receives favorable coverage.
November 1992 - Clinton wins the election. Polls indicate that voters rank health care far behind the economy and slightly behind the budget deficit in importance. The majority of the public has only the fuzziest notion of what Clinton has in mind for health care reform.
January 25, 1993 - Clinton announces the formation of The President's Task Force on National Health Reform. The job of the task force, he says, is to "prepare health care reform legislation to be submitted to Congress within one hundred days of our taking office." He also announces that his wife, Hillary Rodham Clinton, will head the task force and that Ira Magaziner will be named its day-to-day operating head. A blanket of secrecy is imposed on task force operations. Magaziner objects but is overruled by George Stephanopoulos and others on the White House communications team.
The appointment of the First Lady sends a clear signal to all in the administration and players in both parties on Capitol Hill that Clinton places great importance on Health Care. It also serves instantly to limit how far cabinet secretaries and White House aides can go in pressing their views. One person watching from close range will later tell Johnson and Broder: "They went about this exactly in the right way, with one exception. The person who's in charge shouldn't sleep with the President, because if you sleep with the President, nobody is going to tell you the truth." Key economic advisers who have grave reservations about the direction of Clinton's reform plans from the very start are forced to ask themselves, "Do I want to take on the President's wife?"
In order to meet their hundred-day deadline and win swift congressional passage the Clintons intend to fit the health care proposal into the presidential budget and pass it all in one gigantic package. An advantage to this strategy is that under Senate rules the reconciliation bill can be debated for only twenty-four hours before it comes to an up-or-down vote.
February 17, 1993 - Bill Clinton delivers his first address to a joint session of Congress. While his focus is on the economy, the budget and taxes, he uses the speech to make the policy link between health care reform and deficit reduction. The initial positive response breeds false optimism within the White House. Stephanopoulos and other advisers with Capitol Hill experience argue for a one-two punch: First, win a great budget victory in April or May; then follow up immediately with the introduction of the health care plan.
February 22, 1993 - A White House aide alerts Hillary Clinton to danger signals emanating from Capitol Hill over rumors that the White House is considering a two-bill strategy. The consensus among Democratic congressional leaders is that there's nowhere near sufficient support for going to the well twice for difficult votes on health care and budget cuts.
Early March 1993 - Sen. Robert C. Byrd, chairman of the powerful Senate Appropriations Committee, and a recognized guardian of Senate procedure, blocks the Clinton reconciliation bill strategy. He is convinced the strategy amounts to a "prostitution of the process" by pushing through "a very complex, very expensive, very little understood piece of legislation."
March 20, 1993 - Hugh Rodham, Hillary's father, suffers a stroke. The First Lady leaves immediately to be by his side at a hospital in Little Rock and spends most of her time there until he dies on April 7. Her absence presents a serious problem. Magaziner has come to depend on her to run interference for him with cabinet departments. At the same time President Clinton -- and most of his staff -- is preoccupied with the budget battle on Capitol Hill. Without Hillary's presence, few decisions can be made.
April 13, 1993 - Leaks to the press become a problem. Health and Human Services Secretary Donna Shalala tells USA Today's editorial board that a value-added tax is one of the ideas under consideration. Her slip sparks a wave of controversy.
April 30, 1993 - Hillary Clinton meets behind closed doors with Republican and Democratic senators. She implores them to tell her what she is doing wrong and tells them she is having trouble meeting with Republicans. It is common knowledge among many of those present that the staff of Senate Minority Leader Bob Dole has told Republicans they are not to meet with the First Lady.
May 3, 1993 - A chart that has been leaked to the New York Times detailing possible methods of implementing reform and highlighting their impact on national spending, appears in the paper. Not only has the chart been leaked, but its appearance has been altered to make it seem as if Clinton is calling for $150 billion in new taxes.
May 20, 1993 - The first of four scheduled internal health-policy debates takes place at the White House. Clinton asks everyone present to keep the meeting private but the very next weekend accounts of the session appear in the Washington Post and the New York Times. The next three debates are indefinitely postponed. This incident, and others, make the Clintons and Magaziner feel they are being subjected to intentional acts of disloyalty.
May 28, 1993 - Bill Gradison, the head of the Health Insurance Association of America (HIAA), writes a letter to the First Lady restating his support for universal coverage but complaining of three recent occasions in which Hillary has attacked the health insurance industry for "price-gouging, cost-shifting and unconscionable profiteering." Gradison is actually playing a double game. He wants to diminish public support for a Clinton plan that can adversely affect the industry but he also is eager to appear accommodating so that he will be able to make adjustments in the reform bill he believes will ultimately pass.
May 31, 1993 - The Clinton Health Care Task Force is officially disbanded.
Spring 1993 - The HIAA begins a three-and-a-half-million-dollar advertising campaign promoting its own approach to reform. HIAA pollsters also conduct foc groups to find certain phrases that resonate well with the public. Two of the mos likely are: "They choose, you lose" and "There's got to be a better way."
At the same time the National Federation of Independent Business (NFIB) starts mobilizing its forces to kill a key element of the Clinton plan -- the "employer mandate" that would require all businesses to provide health insurance for their employees. From its Washington headquarters the NFIB dispatches a constant stream of "Fax Alerts" and "Action Alerts" to tens of thousands of small-business owners who are also members. More than two million pieces of mail are sent. They also conduct seminars in states that will be critical when the time comes for Congress to vote. In Montana, they launch an unrelenting campaign against a Democratic Senator whose initial public comments have been favorable to the Clinton plan. They force the Senator to send a letter to Montana small-business owners pledging to vote against any bill that he feels hurts small business. When the employer mandate comes up the Senate Finance Committee, the Senator is one of five Democrats who join nine Republicans in killing it. The NFIB applies the same tactics in Louisiana, Washington, Georgia, Oregon, Pennsylvania, Florida, and elsewhere.
Early June 1993 - Worried that they have no effective political support team, the Clinton administration sets up a "War Room" -- a replica of the Little Rock nerve center of the Clinton presidential campaign -- to monitor media, orchestrate responses to attacks on the Clinton plan, and schedule administration and congressional visits to forums being held around the country.
June 15, 1993 - House Democrat Jim Cooper -- who introduced a bill in 1992 based on the principle of managed competition -- meets with Hillary Clinton to explore their differences over health care. He has serious problems with employer mandates and universal coverage that are part of Clinton's plan and expresses his concern that the administration is being pushed to the left by liberals in the House. Cooper says he will not be able to support the Clinton plan unless changes are made.
June 25, 1993 - Clinton's budget measure squeaks through the Senate with Vice President Gore casting the tie-breaking vote. Clinton is holding on to his agenda by his fingertips, and health care reform is shunted off until another day. Attempts by Magaziner to schedule meetings with key members of the administration's economic team are consistently rebuffed.
Early Summer 1993 - Bill Clinton tells the DNC to gear up a grassroots effort to support the reform plan. The DNC first tries to set up a tax-exempt "educational" foundation, separate from but allied to the DNC. When word of the plan leaks, critics say it will allow power brokers with their own agenda to curry favor with Clinton by secretly financing his pet project. The DNC backs off and offers to run the program itself -- and disclose the names of all donors -- but they lack a budget for any serious grassroots effort. Clinton's political consultants, including Mandy Grunwald, Paul Begala, and James Carville, argue that the grassroots effort should be junked in favor of a media campaign.
Mid-July 1993 - David Gergen urges that the health care plan be delayed until 1994, but Hillary Clinton and Magaziner are convinced this would amount to a death sentence for health care reform. Among White House political strategists, the belief is that the legislation has to be introduced in September to have any chance of winning passage before the 1994 midterm congressional elections.
August 6, 1993 - Clinton's budget is approved with Vice President Gore casting the tie-breaking fifty-first vote. Clinton's presidency is saved, but by the slimmest possible margin of victory. It is a clear and dramatic warning about the growing difficulty of passing anything in a bitterly divided Congress.
August 7, 1993 - Magaziner begins rounding up the Cabinet and economic team to discuss health care. Now that the budget battle is over he hopes high-level decisions can be reached before the Clintons begin their vacation. Acrimony reigns in meetings of senior advisers over the next few days, and discussions on how best to improve coverage while containing costs are tense.
August 11, 1993 - Unhappy that his advisers are in disagreement, Clinton decides not to make any decisions until after his vacation. Magaziner is devastated. When Congress returns after Labor Day he will still have no plan to give them.
August 16, 1993 - Despite the fact that major questions remain unsettled, Bill Clinton gives an outline of his health care reform plan to the National Governors' Association. Before hearing from Clinton, John Motley -- vice president and top Washington lobbyist of the National Federation of Independent Business -- addresses the group. Motley attacks the "untried, untested" approach Clinton is preparing and charges that thousands of small businesses will go bankrupt, threatening a national recession. Taken aback by the bold, bare-knuckles assault even before the administration plan has been formally introduced, Clinton -- listening nearby in a small "holding room" -- huddles with the First Lady and other advisers and hurriedly rewrites his speech to respond to Motley's attack.
Late August 1993 - In a memo about Bill Clinton's upcoming health care speech, Ira Magaziner advocates a moderate, centrist approach stressing political flexibility, openness to new ideas, and a true bipartisan spirit. Magaziner also suggests emphasizing that this is not merely a "Clinton plan," but the work of many Republicans and Democrats over the years. Ironically, while Clinton planners privately stress a conciliatory, middle-ground approach for reform, the public and many on Capitol Hill are beginning to form an impression -- painted in part by opponents and in part by the Clinton team's own actions -- that the administration's plan is a liberal, secretly concocted, Big-Government scheme that will dictate how people get their health insurance and medical treatment.
Early September 1993 - Magaziner and his staff complete a rough draft of the plan embodying Clinton's final decisions on alliances, proposed price ceilings on insurance premiums, and the extent of Medicare cuts. He and Hillary go to Capitol Hill to brief members of Congress and their staffs. Pete Stark, of the Ways and Means Health Subcommittee, throws a tantrum and demands a copy of the draft plan. Soon after Stark receives it, the supposedly secret plan is leaked to the press and to anti-Clinton lobbying groups.
The HIAA begins running its powerful "Harry and Louise" television ads featuring the focus group phrase "They choose, we lose." It quickly becomes an American advertising classic. By moving early, aggressively, and publicly, HIAA has become a major player in the debate.
September 2, 1993 - Clinton's political and policy advisers agree on an explicit congressional strategy. Rather than start from the center, writing a bill that will appeal to conservative Democrats and moderate Republicans (while telling the liberals this is the best deal they can get), Clinton decides to follow a strategy of starting from the left and moving as far to the center as is needed to reach a majority. The advisers do not know that Newt Gingrich is determined there be no Republican support for any Clinton-designed reform and that the whole effort be derailed.
September 11, 1993 - The New York Times and the Washington Post run stories describing and analyzing Clinton's secret draft plan.
Mid September 1993 - Relentless pressure continues as Clinton's staff struggles to prepare his upcoming speech to launch health care reform. Political strategy meetings on how best to employ appearances by the President and the First Lady after the speech also produce conflict. Decisions are made, revised, and remade again about what TV shows cabinet members and Democratic members of Congress will appear on. The result, according to one of those involved, is "piss poor planning and disastrous conflicts."
September 19, 1993 - Pat Moynihan, speaking on Meet the Press, dismisses the economic calculations in the Clinton plan -- which has not even been formally launched -- as "fantasy numbers." He also joins with Republican critics and strikes at the very heart of reform by saying there is "no health care crisis."