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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 years.

BROMBERG:

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.

FL: Was Clinton's initiative on health care an historic opportunity...is that the prevailing sentiment, that this was a historic opportunity?

BROMBERG:

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 other.

FL: 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.

BROMBERG:

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.

FL: More specifically, tell me about the conversations you had with her......

BROMBERG:

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.

FL: Bill is an artful compromiser, so why isn't this an expression of Bill Clinton and his presidency?

BROMBERG:

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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