Michael Bromberg, Health
care lobbyist for private hospitals. He was a major player in the Clinton health care reform drama and involved in the opposition which eventually defeated it.
Interviewed June 14, 1996
FL: Briefly, describe your involvement in health care over the last 20
I basically arrived in Washington in '64, when President Johnson was elected.
For about 26 years I ran a trade association of private hospitals, for-profit
hospital corporations, and about a year and a half ago, I went into law
practice. And I represent many different health clients, including hospitals,
but across the board. So, I've been here a long time and I've seen several
presidents try to get something called national health reform, or national
health insurance, certainly President Nixon tried hard, certainly President
Carter tried hard, and certainly President Clinton tried hard, and others
before, dating back to Harry Truman and Franklin Roosevelt, and it's a very
tough issue. [A]nd I think if we learn a lesson from it, it's that you can't
do it all at once because that scares people. That the average American looks
at national health insurance as something they want, but they don't want the
government that involved in it. In fact, that's what every poll shows.
Something like 80% of Americans would like everyone to have health insurance in
America, but they don't want the government too involved. And, that's what
kills it in the end. So the lesson probably is, that you have to find a way to
do it where the government isn't too involved, and you have to do it in steps.
You can't do it all at once.
Was Clinton's initiative on health care an historic opportunity...is that the
prevailing sentiment, that this was a historic opportunity?
I think when President Clinton came to office, he had a historic opportunity,
there's no doubt about it, to do something in this field. For several reasons.
Number one, there was a problem, that people were beginning to become concerned
about losing their health insurance, and would it be there when they needed it.
Secondly, he put his wife in charge of selling the program, and his wife was a
very bright, very articulate, very compassionate person, who really laid out
why needed something. That took a long time. This went from his Inaugural in
January, of '93, and it continued for months and months, and what started to
happen was you had these 500 people on a task force, operating in secret, that
was a problem, you had delays, and you really didn't see the plan until almost
October, November, December, of 1993.
Now, one thing everyone in politics knows, is that when a new President comes
to town, that first year, is the window of opportunity. If a President comes
here, elected and says, "my top priority is" x, y, or z, and he tries to get it
done in year one, his chances are a lot better. They let that year dissipate.
This task force took up months. There was no legislative proposal 'til the end
of the whole year. Even though he had made health care his top priority. That
took a lotta wind out of it. But it still wasn't too late, because there was
some consensus that something should be done. There were Republicans who were
willing to help do something, at least in a narrow window. [A]nd I think
Mrs. Clinton really did lay out the case. The problem was she gets an A+ for
effort, and an A+ for education, and an A+ for speeches, and so does the
President, but I think they get a terrible failing grade for drafting their
proposal, selling their proposal and understanding how Washington works.
The mentality that she brought to this, and she's a very bright woman, was, "I
want all or nothing. I didn't come to Washington to negotiate, to
compromise.:" And her core supporters-- labor unions, and Families USA and
others-- felt the same way. And, I think sending a thousand-page bill to
Capitol Hill was received with, with a thought that maybe this was a little
arrogant. That maybe she should've sent a 10-page outline, and let Congress
help draft it, instead of handing this, huge document, and saying, "Here it is,
pass it. And, by the way, I don't wanna compromise." And there were a lot of
other mistakes made as well. Number one, she really trashed, southern moderate
conservatives in her own party. Southern Democrats, and they were the swing
vote. You had liberal Democrats over here, you had conservative Republicans
over here, you knew how they were gonna vote. You had this big group in the
middle. And the leaders of it tended to be southern Democrats. Jim Cooper
was one, from Tennessee, a Congressman who was about to run for the Senate, a
Democratic party ticket. She trashed his bill. She said we can't have just
pre-existing condition reform, and job lock reform and portability for job, for
changing jobs. The bill we're probably gonna pass this year, and the President
will try to take credit for. He laid out the arguments to why that would be a
terrible idea. You had to have universal coverage. Every single American had
to be covered, and the government had to run the program or it was
unacceptable. So, there were just a host of mistakes, made one after the
Let's talk quite specifically about your relationship to Hillary throughout
this process. The key turning points in it and the series of
conversations that you had with her, and what it tells us, not only about the
plan, but about her and her approach.
Early on in the process, Dan Rostenkowski who was Chairman of the Ways and
Means Committee, and one of the two or three most powerful figures in this
debate, called me in, and said, I want you to help her. I want you to help
Hillary Clinton pass a bill. And he understood it wasn't going to be that
bill, it was gonna be a compromise. And I said, you know, I'm just not sure
she wants to compromise, and he said, oh, of course she's gonna compromise.
You know, the President's a good guy, he'll compromise. I said, I think she's
different, but I'll try. I think she's a true believer and a zealot, and an
ideologue but I'll try. And he said, I'll have her call you. And, a couple
months went by, and he called me one day and said, did you see her yet? And I
said, no, she never called. And, he got a little angry, and then finally she
called, we had a small, small meeting, maybe three or four people on a Saturday
morning. It lasted about an hour, hour and a half. And, I walked out of that
meeting, truly believing that there would never be a bill. Because of the way,
that she acted, I could tell, that she wasn't, she wasn't gonna compromise
enough. I mean compromise to her was changing a few words around the margin.
It wasn't coming half way. It wasn't saying we gotta throw out half this bill
and pass half of it. And that's what it would've taken. Because there were
things in the bill that were just unacceptable. I had about 18 meetings with
Ira Magaziner who was the key drafter of the bill, I had about two meetings
with her. [T]hey took copious notes, they listened, almost to the point of
absurdity, but every time I walked away it was, gee, they took a lotta notes
and they listened but I don't think it's gonna make any difference. I mean,
they were on a path, where they knew best, and, they weren't gonna change, and
I think the bill reflected that in the sense that the whole design of the bill
was government knows best.
Understand, we were talking about a proposal, that basically shifted a trillion
dollars, on people to Washington. It basically said that here's 1/7th of the
economy. It's almost as much as the whole federal budget. And it's now being
spent by people out there, all over the country. "We think government knows
better, we're gonna let government take that trillion dollars, and reallocate
it, redistribute it, tell the people in Cleveland, Ohio, or Toledo, you can't
spend more than this much. And we're gonna enforce it with price controls.
Even if you wanna buy more insurance, you can't. We're not gonna let you
because we know best. We're gonna design the package, we're gonna tell every
employer in the country they have to offer it." That was a tremendous shift of
power. In order for that bill to pass, the two things she would've had to drop
were, one, this global budget going to Washington with the power to, in effect,
control a trillion dollars, in reward for I don't know what, they've never done
anything else that well. And two, this provision that would've required every
employer to pay 80% of a premium when there woulda been a lot of lost jobs.
And that woulda left a big bill, let me tell you what it would've left. It
would've left, the kind of bill that's being debated now, to protect people
against job lock, portability to take their insurance from job to job. It also
would've included a voucher so that pregnant women and children all could be
covered. Children make up 25% of the 35 to 40 million people in this country
who are uninsured. We coulda helped those kids. We coulda helped people like
me with pre-existing conditions. That's probably half of 40 million. We
coulda helped them. Coulda had it. Three years ago. Instead of debating it
today, we coulda had it. But they trashed it. They said no. All or nothing.
If everybody isn't in it, it's a bad bill. Well today, they're probably trying
to take credit for doing just that. And that's what really disturbed me.
Because we coulda, we could've had something.
More specifically, tell me about the conversations you had with
My conversations with Hillary, were basically, private, but I think some of
them have been written about because, in one I know a reporter had his ear to
the door, believe it or not, in one of the meetings, it was not at the White
House. But basically there are two points. I told her that I was an
old staff person, and what I learned when I was a staffer in Washington was,
never take the boss out of a win-win position and put him in a lose-lose
position. And that the President was in a win-win position, because any bill
that passed, even if it was 50% of their bill, he would be the first President
in history, he would've done what Truman couldn't do, couldn't have done, and
what Carter didn't do, and et cetera.
And she looked at me and she said, "Bill and I didn't come to Washington to do
business as usual and compromise." And when I heard that, I knew there wasn't
gonna be a bill, that she just, either, she probably understood. Either she
didn't understand that Washington was a town of compromise, where both sides
had to get credit, for a final product to be enacted. Or else she knew it, and
was determined that, to either try to railroad it through, and that all or
nothing was a, was a risk she was willing to take. I still to this day don't
understand, which it was. But, my conversations, that was basically the gist
of 'em. And there were other conversations in which I, they were sort of right
before the bill was written, before the bill was introduced, I had gotten a
hold of a draft of it. Actually from a Democratic congressman, and she was
surprised that I had it, and I said, there are price controls in this bill.
And she denied it. And she turned to Ira and said, is that true, and he said
no. So I ripped a page out of the bill, and put it on her desk, and I said,
you're a lawyer, I'm a lawyer. Read this page and tell me, if you represented
anyone in the health care field, could you possibly let this page go unnoticed?
And that was the end of that conversation. She didn't deny it, or try to
correct it. And the bill came out and it did have, a cap on how much America
could spend on health care, which I thought was unconstitutional, by the way.
I don't think Washington has any right telling people they can't spend more
than X dollars on health care. Just like they couldn't do it on cars or
televisions. And two, it was enforced by price controls. Clear as a bell. So,
there was a communication problem, there was no doubt about that. She didn't
like to hear what I was saying, that was clear. [I]t also became clear to me
that in our first meeting at the White House, the purpose of that meeting, her
agenda, was to get me to come to the ceremony in the Rose Garden when the bill
was introduced. This was like in October and the bill was introduced a few
months later. And I said to her, I can't possibly do that. I said, that would
be a sign that I support it when I know I'm not, I'm gonna oppose at least half
of it. I said, but I'll tell you what. I'll come to the Rose Garden ceremony
when you sign it, and I hope you get there. But it won't be this bill. It'll
be some piece of this bill. And that infuriated her. I mean, I could just
see she was angry. She didn't understand what I was saying. That I wanted to
help. She didn't believe it. Believe me, I wanted a health bill more than
anybody in this city. 'Cause I knew, no one else knew at the time, but I knew
that I was gonna quit my job in a year. And I didn't wanna be locked without
insurance, and for other reasons, I thought there needed to be a bill. And I
tried to convince her of it and she just didn't believe it. I think other
people in the White House believed it. But she didn't.
Going back to when the Clintons first came to Washington. There was a sense of
excitement. I mean, I think that 90% of the people in Washington said, the
President's made health care reform his top priority. She's a really bright,
articulate salesperson who's framed the issue well. It's gonna pass. It,
being something. We're gonna get a health bill. For the first time in 50
years of trying. Other presidents tried, and you know, if you look at the
major bills in health care that have passed, the real landmark bill was
Medicare and Medicaid. And it passed for two reasons. One, it past
posthumously, as a tribute to John F. Kennedy. He couldn't of passed it. It
was dead when he was President. But the minute Johnson came in, he was able to
get through right away as a tribute. And two, we had a two-to-one majority.
It was a railroad, one-party job. In this case, you had a very close Congress.
And the President had to really sell it and work with them and both sides had
to come out with credit. And that's where it fell apart. There was a
historic opportunity, everyone's excited, everyone said there's gonna be a
bill, it's a question of what it looks like. People were running around
drafting compromises and alternatives. The southern moderate Democrats drafted
their bill, the liberal Republicans drafted their bill. There was a centrist
group that was bi-partisan form. Even Phil Gramm, who said over his dead body
would this ever pass, even he had an alternative bill. Bob Dole put his name
on a bill. Bob Packwood put his name on a bill, they were key players at the
time. So everyone, started off with the assumption, there's gonna be a bill,
and it's up to us to draft the different versions and, and find the center. In
fact, that expression was used a lot by politicians, where's the center?
Where's the compromise gonna be?
And then all of a sudden, it became clear that Mrs. Clinton didn't want a
compromise. It was all or nothing. She was gonna roll the dice. And, was
pretty unrealistic about Washington in terms of what kind of a bill it could
stomach. And I know that people blame the special interests, the drug
companies where opposed to the bill, the insurance companies were opposed to
the bill. Some of the hospitals were opposed to the bill. Even though it
woulda helped a lotta hospitals, by the way, who have a lot of bad debts and
charity care and under this bill everybody would've been covered, so selfishly
it would've been good for them. But they were afraid of this big government
monstrosity. Estimates of a hundred thousand new bureaucrats, to enforce the
provisions of this thousand-page bill, 17 new agencies, 17 new taxes. Taxes on
premiums, I mean, this bill was dead from the start in it's form, but it was
alive, and could've passed if there'd been a compromise. And people like me
really wanted a compromise. We really wanted a bill, we knew it had to
happen, it was time. And they turned their back on us. They didn't wanna talk
compromise. They wanted the PR benefit, the public relations benefit of
blasting the drug companies, and the insurance companies as villains. They
were afraid to do that with hospitals because there's one in every community.
So they let us off the PR battle, but they still wouldn't talk to us about
compromise. They talked to us about, will you help us? You know, will you
support it? Never, we'll support a modified version of it, they'd walk away.
So I have to put most of the blame, I'm sorry, on Mrs. Clinton. I really do.
Because she did such a great job of educating people and preparing this
possibility. That people thought it was gonna happen and then she just
flunked, the test of understanding Washington, understanding reality. Not so
much the special interests, you can fight them, but the people would never go
for a bill with this much government in it. Never. It was naive to think that
the American people, who were so suspicious of government, that 20% voted for
Ross Perot, were suddenly gonna buy a trillion dollar package, sending 1/7th of
the economy to Washington to manage? And tell people what kind of insurance
they should have, and what they can't have? It was impossible.
I think health care reform is coming. The question is, is it coming in
pieces, one step at a time, or is it gonna come in one fell swoop. Every
effort to do it in one gigantic change has failed. Primarily because people
got scared, of too much government power. There really are polls out there
that were done before the last election that showed that 80% of the people want
national health insurance. But they want it without the government involved,
which of course, is almost impossible. And when the government gets too
involved it gets labeled nationalized health insurance, and that really scares
people, and it should scare them. Because it, it really could lead to
rationing care, because if the government controls a pot of money, you know
it's going to be under-funded. And if they tell people they can't spend their
own money, the only thing that can happen is less care, and reduced services.
It's not that different from rent controls or anything else you try to regulate
in that way. The quality would suffer, they're right, and they see it. So
this, this, in one sense, wasn't different, in the sense that if you wanted to
do it all at once, it just wasn't gonna pass, it's too tough, no President
could do it. But I'll tell you if Lyndon Johnson had been President, knowing
the Congress as he did, and knowing politics and Washington reality and
interest groups like he did, he woulda gotten 50% of this bill through. And it
would be lauded...But the Clintons just didn't understand how Washington
worked, or, and I'm not sure which, they thought they could change it. And,
you can change it somewhat around the edges, but you can't walk in here with a
plan, this gigantic, and just hand it to the Congress, and expect them to pass
it. It's just not gonna happen. But, they coulda had half of it.
Bill is an artful compromiser, so why isn't this an expression of Bill Clinton
and his presidency?
There were articles written during this debate about two White Houses. Bill's
White House, and Hillary's White House. And what it was illustrative of was
the fact that Bill Clinton was known, or thought to be by most members of
Congress I talked to, as an amiable guy, good guy, one of the crowd, a guy who
could compromise with them. They could reach a deal in a room with him. He
was a compromiser. He wanted to get things done. And in fact, on other
issues, he's even been accused of flip-flopping. So there is no hard ideology
there. But the view of her was, that, she was much to the left, and had
friends to the left, and would never compromise. That she was an ideologue,
and a true believer and that she wasn't at all like him. The question that
everybody asked for, for the two years this fight was going on is, who was in
charge? Which White House was in charge? In the end, would he say, "Hillary,
you've done a great job, but I'm gonna compromise now"? Or would he let her
make that decision. And I think he let her make that decision. Bill Clinton
would not have trashed southern Democrats and their compromise. I think in the
end, if he saw that was the most he could get, his gut instinct probably
woulda been, like most people's, to grab it. I mean, these are Democrats after
all, and it woulda been a pretty good compromise, and it would've helped
millions of people. She wouldn't let that happen. So, maybe there were two
White Houses, and maybe there still are.
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