Politics, Power & Policy Making: The Case of Health Care Reform in the 1990s

By Mark E. Rushefsky; Kant Patel | Go to book overview

president of all America and not just the Democratic Party ( Fineman and Turque 1996). Clinton acted on this advice for the remainder of his first term. In fact, his reelection campaign--his speeches, the party convention, his acceptance speech, his debates with Republican nominee Bob Dole-- were so well orchestrated that many media commentators referred to him as the most disciplined politician in the campaign!

Clinton's leadership during 1995-96 came to be defined more by what he stood against than by what he stood for. During 1993-94, a major initiative for reforming the U.S. health care system came from President Clinton in the form of the Health Security Act of 1993--a battle that he lost badly. During 1995-96, initiatives in the area of health care reform came from Congress. Instead of being an advocate of his policy initiatives, his role became one of responding to the policy initiatives of a Congress dominated by conservative Republicans. He took on the role of a fighter, standing up to Newt Gingrich and defending against the draconian policy measures initiated by Republicans with respect to Medicaid and Medicare. He became the protector of the elderly and the poor. He also took on the tobacco and gun lobbies, winning most of those battles. He even successfully prodded Congress into passing a health insurance reform law.

Whether President Clinton ultimately turns out to be a transformation leader or a transactional leader remains to be seen. Thus far, he gives every indication of being a transactional leader who has very little independent influence. Such a leader is mainly interested in staying afloat, drifting with the tides of history. A transformation leader, in contrast, operates in a world of bounded rationality and creatively shapes public perceptions of social conditions and designs responses to perceived problems and opportunities.


Conclusion

What this chapter demonstrates are the opportunities and limitations that presidents face in shaping and influencing the policy process. Presidents are generally in a strong position to set the nation's policy agenda. But a president's ability to determine the exact outcome of specific policies is problematic at best. President Clinton was successful in placing health care on the national policy agenda; he was less successful in determining outcome.

Presidents are constrained significantly in their role in the policy process by the constitutional and cultural setting within which they operate. There is no denying the fact that a presidential system of government characterized by separation of powers, checks and balances, and federalism, combined with the lack of a disciplined and ideologically cohesive political party

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Politics, Power & Policy Making: The Case of Health Care Reform in the 1990s
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • List of Tables and Figures ix
  • Preface xi
  • Acknowledgments xii
  • 1 - Setting the Stage 3
  • 2 - Health Care Reform Returns to the National Agenda: The Winds of Change 16
  • Conclusion 49
  • 3 - Presidential Leadership and Policy Making 51
  • Conclusion 86
  • 4 - Congress and Health Care 89
  • Conclusion 137
  • 5 - Interest Groups 140
  • Conclusion 169
  • 6 - The Role of the Mass Media in the Policy Process 173
  • Conclusion 209
  • 7 - Public Opinion and Health Care Policy 211
  • 8 - Politics, Power, and Policy Making 243
  • Chronology 255
  • References 273
  • Index 297
  • About the Authors 313
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