Formerly a political science professor, she served as Clinton's Secretary of Health and Human Services throughout his presidency. Interview conducted October, 2000 by Chris Bury What are your most vivid memories of the transition? How harried it all was for us because many of us were still in our jobs, in our home stations, so to speak, and it was just hectic. I also remember an awful lot of people running around, trying to give us advice, who had no experience managing large complex institutions.... In the case of Democrats, their idea of taking control of a previous Republican-held government was to appoint layers and layers of political appointees. They didn't have a clue about the number of civil servants that you actually, in some ways, had to co-opt to get to move in the same direction the president wanted to move in, and no real feel for how you manage large, complex institutions. What substantive effects did [the bumpy transition] then have on the early part of the Clinton government? Well, it took everybody a while to build relationships of trust, whether it was the White House staff with the cabinet agencies. There's always been an assumption -- and I've been through a transition before, I was here at the beginning of the Carter administration -- that everybody in the agencies are Republican, even the civil servants, and that you can't trust them, and what you have to do is put your own people in. There is no such thing. I didn't know whether they were Republicans or Democrats. What I did know is there were more of them than there were of us, and that we had to have an attitude that we were going to do this together and build some trust from the beginning. We also had to build trust with the White House because they also came in with an attitude about how you take over the government. It took a while to get the policy development process in place. What you really remember at the beginning was that you have to throw a budget together. We made some terrible mistakes at the beginning in my own budget that took us at least a year to catch up on. We didn't put enough money in for NIH, because I was told when I went over to the White House that the president's science advisor, and that team, was going to take care of all the science investments. As it turned out, they didn't, and I hadn't put enough resources in. So it took us a while to catch up. When you went over to the White House in those early days what was it like?... ...They hadn't changed the culture of the campaign into the culture of a professional governance organization. So, I wasn't surprised at what I saw in those days. It still had the feel of an all-night campaign operation as opposed to governing. And it took a while to make that transition. But that was also true in the Carter administration, and I'm sure in Republican administrations too. It takes a while to get into a governance mode, to learn the rules and to set processes in place for policy development, for example, for budget development. George Stephanopoulos told us that looking back now, he feels that he and some of the other senior staff members, who were relatively young, didn't have the proper respect for the office. Did you feel that way? Was that your impression, that it was a little too loose? Yes. But, again, what I saw was a campaign culture in awe at being at the White House. Someone needed to say, "Wear suits. We've got to have a limit to the number of people who have access to the president. We have to have a systematic policy and budget development process." The fact that Leon [Panetta] and Alice Rivlin were over at Budget, and they were pros, made a difference on the budget side. It took the policy development side a while to get together, and there were some real professionals over there, obviously. Bob Rubin was there. Mack McLarty had run at least a private sector organization, so he knew that they needed some discipline. You don't want to destroy the energy that comes out of a campaign. You need to get going earlier in terms of getting your government organized, and it took a little while. But I liked the youthful enthusiasm that the Clinton campaign came in with. I think it allowed us to dream big. While we stumbled during that first year, in some ways it was worth it, because it meant that we didn't go after little things. The big thing that was decided that year was to emphasize deficit reduction, and there were a lot of internal discussions, even arguments and debates within the White House. Did you feel that the president was letting down the people who had supported him by abandoning some of the early promises to invest in people? No, because he really was investing in the programs in my department, so I didn't have that attitude. I did believe he was a different kind of Democrat, and he really was going to be a transitional figure. And his attitude about fiscal discipline, but also social progress was somewhat different than previous generations.... And I also knew that Leon and Alice Rivlin were, in fact, disciplined about the deficit. And [the] combination of them, and of course Robert Rubin, meant that we were really going to get a crew that wanted to bring down the deficit, that had very strong views about what we needed to do in terms of the budget. But the president made major investments in the programs that he promised, in Head Start, in child care. We started off with those investments and have never stopped getting those kinds of investments. Were you disappointed at the time, that there was this huge emphasis on reducing the deficit? ...While a lot of the activity of the White House was about deficit reduction, it wasn't like anyone else was cut out of that discussion. It was very much going to have an impact on how much we could spend on the social side. Alice Rivlin, in particular, kept assuring me that if we could do this deficit reduction, we were going to have all kinds of money ready for the kinds of programs we thought needed to be done. Meanwhile, we had to get control of our departments, and actually get some discipline into the spending we already had. And a lot of that was quite sloppy. My department didn't have the level of computer that they needed in terms of management information systems, so there was a lot of work to do in the department while the White House was very focused on deficit reduction. In 1993, Mrs. Clinton is given the health care reform. What was your impression of the extent of her influence and power at that time? Well, specifically, on health care reform, she obviously was in charge of the process and obviously my department was deeply involved. Was she influential? Absolutely. She was also extremely helpful on a number of other issues -- priorities on Head Start, child care, and adoption. Some of the things we thought we needed to get done. She and I had worked for years at the Children's Defense Fund. So while she was focused on health care, she was also paying attention to some of the other issues.... How did you disagree with Mrs. Clinton about the health department reform? Well, I think that the idea of going forward and taking on the whole system was not such a bad idea. On process, I might have done it somewhat differently. I also knew something else -- that we were taking a huge risk by taking on the whole system. All of the literature -- I'm a political scientist -- says that if you're gonna take a giant step, there has to be consensus nationally that there is a problem, and consensus about the solution. We read the problem correctly. Americans were quite unhappy with the health care system. They were worried about it. We had large numbers of Americans without health insurance. We assumed that we could develop a solution that, in fact, had consensus, but the fact was there wasn't consensus on a solution. There wasn't a consensus on an approach, whether it was single payer. There was a consensus that we ought to have health care for everybody, but none on how you get there, whether you do it through a public/private system, whether you do it gradually or over time. And, in some ways, we misread that. From the beginning all of us were nervous about that because we had never seen a process like the one that we were going through. But Mrs. Clinton and I never disagreed about the goal or about the focus on health care in particular. What was her management style like? How would you describe that? I think that I would describe her a factotum of someone that convened as opposed to a hands-on, top-down manager. She actually had people that were doing that part. I think her job was more herding and bringing people together, and staying on top of the effort that was being done.... In retrospect, was it the right idea to put the first lady in charge of [health care]? I don't think it was the wrong idea. Look, we had someone in the White House, Bob Rubin, who basically managed a process in which we fundamentally changed the role of government in relationship to the economy, brought the deficit down. So it's not unusual for the White House to lead a cost-cutting process. Health care didn't involve just my department. It involved Treasury, it involved lots of other departments. Labor Department, for example. So, it's not unusual to have a policy development process led by the White House. What's highly unusual is to have a first lady [lead the process]. But it's also highly unusual to have a first lady with Mrs. Clinton's kind of qualifications. We will have more in the future, and running a policy development process that that individual leads, I think will be more likely in the future but not necessarily in the next round of, of first ladies. ...Was it a bad political judgment to have her? We wouldn't be having this discussion, if we were successful and I would argue that it was high risk, high gain, and the president took that risk. And would I have advised him to do that? He didn't ask me at the time. I wasn't surprised that he decided to do that. Should we have done it in a more traditional way? I certainly felt, from the beginning, because I knew something about the politics of achieving big things, that this was going to be hard to pull off because we didn't have national consensus on the solution, on the role of government here, and we were taking on lots of different constituencies. I believe what we did was build a negative coalition. Instead of building a positive coalition, we had so many people who had a problem with some part of our solution, that they got together and opposed it. It's a classic negative coalition. That's what you fear when you put something large and complex together, and that's why you have to have consensus on the solutions and not just consensus on the problem.... You talked about the difference between procedural and substantive parts of that program. On the question of the task force, Secretary Reich tells us that he thinks the fundamental error was the decision to hold those meetings in private, that it alienated too many important constituencies. ...If you want to do something big, your process has to be transparent. Open. But more importantly, you have to read the politics from the beginning correctly. You have to know what the ending is. And my argument is that we read the problem but we didn't read whether there was public consensus about what the approach should be. It's very difficult to pull off what we were trying to pull off unless you have both pieces.... ...When Mrs. Clinton became a political target did that damage the health care reform process? I don't think it did at all. I really believe that if you go back and look at our earlier judgment, we judged the problem correctly. There was no consensus on the solution by the American people. They weren't so sure they wanted more government involved in their health care. You think it was that and not Mrs. Clinton as the political figure? ...Most people will say it was the process. It should have been done in a more traditional way, that we should have taken some principles and run to the Hill. And some of us actually wanted to do that. We actually wanted to write it with Congress, because we thought we'd get more consensus and a broader-based solution. But we also would have gotten a smaller conclusion, I think, than we ultimately recommended.... As a friend of Mrs. Clinton as the Whitewater scandal started to gain steam later that year, early the next year, how did that affect her personally? I think her father's illness and death affected her personally during the health care debate more than even that. I think that all of these things just added extra burdens to a very talented and very thoughtful and very compassionate woman.... You say the two things coincided, but Whitewater of course would go on and become a major thorn. Looking at how that affected her personally, did she feel under siege? Did she feel that all this was somehow unfair? What was she saying to you? She was saying nothing privately to me. What she was doing was trying to focus on being supportive to get some things done for kids, in particular, and working on some issues that she was particularly concerned about. I did not talk to her about Whitewater. I didn't know anything about Whitewater. What about the collapse of health care? What [were] Mrs. Clinton's feelings? Well, I think she was very disappointed. I mean, there's no question about that. But in some ways we didn't look back. We just kept moving. We can look back now. But we had a lot to get done and that included starting to bite off some large pieces of what we were trying to do in health care reform. And those included covering children, making sure the disabled had good health coverage, using our own administrative flexibility through waivers to expand health insurance, working with state governments. We actually covered more than 2 million people by working with states and getting them to expand existing programs. There was still a big political cost. I mean, one of the things that most people think led to the Republican election in 1994 was the failure of health care. That's always given a huge amount of weight. What did that election do to the president? How did that change him? He was pretty stunned, but he can take a punch. This president can take a punch. His attitude was he was going to brush himself off and we were going to get going, with even more energy than we had had before. Did you see him on election day? I did see him on election day. What do you remember? I think a perception was that he had taken a punch, that he was pretty shaken. It was not what we expected. We expected it to be a tough election but not that tough. But within 24 hours he was ready to bounce back.... What [was] your reaction to the president bringing Dick Morris back? I think the president can bring anyone he wants back to advise him. I had known Dick Morris years ago in New York. I happen not to be a particular fan but it's up to the president.... But I also know this about the president -- that he takes his own counsel. He takes advice from lots of people, and he himself is a first-class politician. So if he was looking for political ideas and strategies and decided to talk to Dick Morris, that was his business. My business was working with him on a set of issues that he cared deeply about, in health and welfare, children's issues, science, and international health issues. Did you see Dick Morris having real influence on policy though? No. No. Dick Morris says in his book that he had tremendous influence on things like the tobacco policy, for example. He takes full credit for it, something we had been working on quite secretly, actually, without the White House knowing, for more than a year before we actually made the presentation to the White House. ... I think he had less influence on policy than he did [on] how to position things, than he actually takes credit for.... When Gingrich was sort of at the apex of his power in 1995, he was kind of a prime minister of this town. The president gave a famous remark at a news conference where he said, "I am still relevant here." How did that strike you? ...Well, one thing about this president is he says lots of things, but he also does more. When this Clinton presidency is judged, it will be judged by what he did, not just what he said.