Health Care and the Hill: Why Is This Year Different From All Others?

Abstract

Before us is the question of whether or not the 103rd Congress will manage to do what no other U.S. Congress has ever accomplished: the enactment of a comprehensive reform of the way in which health care services are financed in the United States. Does a social science perspective give us a reason to believe that 1994 will be a legislative year that is different from all others? Conventional wisdom might well suggest a simple answer: “no.” Given what we know about the complexity of the issue, the enormous stakes in the system possessed by some of the most powerful private interests, the fragmentation of our governing institutions, the paralysis produced by deficit politics, and the general presumed enthusiasm in our system for caution and incrementalism, a large-scale transformation of health care financing by a legislature best known for parochialism, timidity, and gridlock would seem implausible at best. Can the institution that stimulated scholarly and popular assessments from Congress: The Electoral Connection (Mayhew 1974) to Hill Rat: Blowing the Lid off Congress (Jackley 1992) really overcome the well-known and thoroughly studied barriers to major policy change, especially in the wake of a health care reform proposal from President Bill Clinton that could legitimately prompt the estate of Rube Goldberg to sue for plagiarism (S 1757, HR 3600)?Rather than “no,” however, the answer really is that we simply do not know. President Clinton's proposed Health Security Act is typically introduced in the media as the most ambitious social policy initiative since the New Deal and social security.