January 2001

Grant Results

National Program

Investigator Awards in Health Policy Research

SUMMARY

W.W. Norton & Co. published the book Boomerang: Health Care Reform and the Turn against Government in 1996, with a paperback version in 1997.

The project was part of the Robert Wood Johnson Foundation's (RWJF) Investigator Awards in Health Policy Research program (for more information see Grant Results).

Written by Harvard professor Theda Skocpol, Ph.D., it examines the failure of President Bill Clinton's health care reform effort of 1993–94, connecting the event with historical trends, broad political movements, and the behavior of the executive and legislative institutions involved.

Key Results

  • As of February 2000, Boomerang had sold over 16,900 copies.
  • Boomerang received a favorable review from the Philadelphia Inquirer, which said it "probes beyond the single governmental initiative to provide a grim yet instructive diagnosis of what ails the American body politic."

Funding
The Robert Wood Johnson Foundation (RWJF) provided $181,534 in funding to Harvard University from July 1994 to July 1998 to support the work of Dr. Skocpol.

 See Grant Detail & Contact Information
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THE PROJECT

This grant from RWJF was intended to support historical research by Theda Skocpol, Ph.D., professor of government and sociology at Harvard University in Cambridge, Mass., on the politics of US health insurance reforms from the 1930s to the present.

It was intended to provide health experts with an intellectual framework for thinking about the changing institutional and political contexts within which reforms are debated and — if enacted — implemented and to analyze how policy changes or debates at one point in time affect subsequent political dynamics and possibilities for reform.

Skocpol undertook the study just after President Clinton's failed health care reform effort of 1993–94, when Clinton and his fellow Democrats fared poorly in the 1994 elections and conservative Republicans won many seats in Congress. Taking advantage of a timely opportunity, Skocpol decided to examine this very specific case: how the 1993–94 conflicts over health care reform contributed to the larger political turnaround.

Skocpol's work resulted in Boomerang: Health Care Reform and the Turn against Government, published by W. W. Norton & Co. in 1996. Using the failed health care reform effort of 1993–94 as a case study, Skocpol gives an overview and an explanation of what happened — or failed to happen — during those policy debates about the role of the federal government in health care.

Skocpol connects the events surrounding the health care reform debate with historical trends, broad political movements, and the behavior of the executive and legislative institutions involved. Her research drew from scholarly works on US politics, White House documents, and articles and reports on public opinion data, along with group manifestoes, government documents, position papers, and other writings.

Examining the history of the health care reform effort of 1993–94, Skocpol observes that the Clinton proposal surrounded its promised benefits for average Americans with tight, new regulations intended to push employers, doctors, hospitals, and insurance companies toward cost cutting. Established interests in the health care economy became very worried about their profits and their freedom to maneuver.

Privileged middle-class Americans who already had some kind of health coverage began to fear that Clinton's Health Security plan might make their health care more costly and cumbersome. Skocpol says President Clinton assiduously avoided the tax-and-spend modalities of traditional New Deal liberalism — only to fall victim instead to the political pitfalls of substituting regulations for spending.

According to Boomerang, by the early 1990s, ideologically committed conservatives had amassed many material and intellectual resources in US politics. They had plans to win elections and to begin to cut or eliminate federal domestic programs. These conservatives needed a cause to help them rally and unite the widespread local groups that were in opposition to the federal government as well as the Democratic Party, according to Boomerang.

In Skocpol's opinion, the Clinton health care reform bill as it was submitted to Congress and the public in the fall of 1993 inadvertently amounted to an ideal foil for concerted antigovernment countermobilization because it aimed to work through government regulations.

Support for the bill peaked at its introduction, with 59 percent of the populace in favor, but support never exceeded 50 percent after February 1994 and fell to 42 percent by June of that year. The basis was laid for an electoral upheaval in November 1994, bringing to power conservatives who wanted to dismantle rather than extend the federal government's role in the domestic economy and Social Security, according to Boomerang.

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CONCLUSIONS AND RECOMMENDATIONS

Boomerang describes what Skocpol sees as several major reasons for the popularity slide and ultimate failure of health reform and the subsequent turn of political events.

  • The compromise between market-oriented and government-centered reform ideas inherent in the proposal was complex, and it provoked the same groups it intended to appease.
  • Democrats and supporters of the proposal were in disarray and were disinclined to explain the proposal's provisions. This contrasted poorly with the unity, resources, and grassroots effectiveness of the plan's conservative Republican opponents.
  • The health care reform debate took place in close proximity to the 1994 elections, and conservatives became involved in the opposition. This generated a more general mobilization-against-government movement, leading to the Republican victories and, Skocpol predicts, a long-term damper on comprehensive reform.
  • A deliberate campaign by the Clinton Administration to mobilize political support came too late — the victim of conflicting priorities such as negotiation of a major international trade treaty and a budget battle. These issues played out against a background of weak congressional leadership and what Skocpol sees as the Democratic Party's own damaging tendency toward interest group politics among upper-middle-class elites who were out of touch with average Americans.
  • The failure of the health care reform bill was interpreted by politicians as a mandate for limiting health reform to piecemeal regulation and incremental expansions — like the Kennedy/Kassebaum legislation. Skocpol points out such measures provide continuity for those with employer-based insurance, but offer neither premium caps nor subsidies to ensure affordability of insurance.
  • The next steps in health reform, Boomerang predicts, were likely to amount to contracted funding for Medicare and Medicaid, accompanied by overhyped adjustments in the rules for those who already enjoy insurance coverage. Skocpol says Congress might vote to fund health coverage for a few million more children — which Congress did, with passage of the State Children's Health Insurance Program in 1997. But, she notes, such a step might simply offset the ongoing loss of coverage as mothers and children get pushed off welfare or Medicaid by the states in the wake of federal block grants and as family dependents got dropped from employer health plans.
  • Even after the demise of Clinton's health care reform bill and the Republican electoral victories in 1994, the American people still wanted to expand health insurance coverage and they opposed cuts in Social Security and Medicare. This was subsequently demonstrated by polls to be correct.

Boomerang closes with some recommendations for how Democrats and those who favor universal health insurance could regain the credibility that Skocpol states became so severely eroded in the aftermath of the failure of the health care reform bill.

  • Health care quality and health insurance coverage remained good issues for Democrats. In Skocpol's opinion, unregulated competition and tax cuts for the wealthy at the expense of government programs cannot produce opportunity and security for the 60 percent of the population whose incomes fall at the at the lower end of the scale.
  • Democrats and public intellectuals who care about civic life and the needs of most working Americans need to:
    1. converse with Americans from all walks of life and forge new alliances
    2. speak about social justice, moral values, and the potentially positive role of government
    3. improve the effectiveness and efficiency of programs that promote equity.

    Until US politics has been transformed, Skocpol states neither Republicans nor Democrats in Washington will readily tackle the most difficult health care issues.

Communications

Boomerang was published by W. W. Norton & Co. in 1996, with a paperback version in 1997. As of February 2000, the book had sold over 16,900 copies. The national program office distributed copies of Boomerang to policymakers, the media, and targeted mailing lists. Information about the book was disseminated to the general public through the Author Series. Boomerang received a favorable review from the Philadelphia Inquirer, which said it "probes beyond the single governmental initiative to provide a grim yet instructive diagnosis of what ails the American body politic."

The author also published several other books, book chapters, and journal, newspaper, and magazine articles and made numerous presentations regarding her work. (See the Bibliography for details.)

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GRANT DETAILS & CONTACT INFORMATION

Project

Health Care Reforms in the United States: Institutions, Alliances, and Policy Feedbacks

Grantee

Harvard University (Cambridge,  MA)

  • Amount: $ 181,534
    Dates: July 1994 to July 1998
    ID#:  023490

Contact

Theda Skocpol , Ph.D.
(617) 495-3851
ts@wjh.harvard.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Books and Reports

Greenberg SB and Skocpol T (eds.). The New Majority: Toward a Popular Progressive Politics. New Haven, CT: Yale University Press, 1997.

Skocpol T. Boomerang: Clinton's Health Care Reform and the Turn against Government. New York: W.W. Norton, 1996 (paperback 1997). As of February 2000, over 16,900 copies of the two editions combined had been sold.

Book Chapters

Skocpol T. "The Politics of American Social Policy, Past and Future." In Individual and Social Responsibility: Child Care, Education, Medical Care, and Long-Term Care in America, V. Fuchs (ed.). A National Bureau of Economic Research book. Chicago: University of Chicago Press, 1996.

Skocpol T. "Pundits, People, and Medicare Reform." In Medicare: Preparing for the Challenges of the 21st Century, RD Reischauer, S Butler and R Lave (eds.). Washington: National Academy of Social Insurance, 1998.

Skocpol T. "The Rise and Resounding Demise of the Clinton Health Security Plan." In The Problem That Won't Go Away: Reforming US Health Care Financing, HJ Aaron (ed.). Washington: The Brookings Institution, 1996.

Skocpol T. "Why the United States Has Repeatedly Failed to Enact Universal Health Insurance." In Social and Secure? Politics and Culture in the Welfare State: A Comparative Inquiry, H Bak, F van Holthoon, and H Krabbendam (eds.). European Contributions to American Studies 37. Amsterdam, Netherlands: VU University Press, 1996.

Articles

Hacker JS and Skocpol T. "The New Politics of U.S. Health Policy." Journal of Health Politics, Policy and Law, 22(2): 315–338, 1997. Abstract available online.

Skocpol T. "The Aftermath of Defeat." Journal of Health Politics, Policy and Law, 20(2): 485–489, 1995.

Skocpol T. "Democrats at the Crossroads," MotherJones, January–February: 54–59, 1997.

Skocpol T. "The Health-Care Bill That Might've Been," Newsday, May 26, 1996, A48–A49.

Skocpol T. "Health Reform by Inches," op-ed, The New York Times, June 12, 1996.

Skocpol T. "The Next Liberalism." Atlantic Monthly, (April): 118–120, 1997.

Skocpol T. "The Rise and Resounding Demise of the Clinton Plan." Health Affairs, 14(1): 66–85, 1995.

Presentations and Testimony

Theda Skocpol, "The Politics of Health Care," at the Harvard Alumni Association conference on Reforming America's Health Care System, October 1994.

Theda Skocpol, "The Rise and Resounding Demise of the Clinton Health Security Plan," at the conference on Health Reform: Past and Future, Brookings Institution, January 1995, Washington.

Theda Skocpol, "The Rise and Resounding Demise of the Clinton Health Security Plan," at the Center for Business and Government, Kennedy School, Harvard University, March 1995, Cambridge, MA.

Theda Skocpol, "The Failure of Clinton's Health Plan and the Future of American Politics," sponsored by the Department of Government and the College of Arts and Sciences, Cornell University, April 1995, Ithaca, NY.

Theda Skocpol, "The Rise and Demise of the Clinton Health Security Plan," at the Russell Sage Foundation, May 1995.

Theda Skocpol, "Why the United States Has Repeatedly Failed to Enact Universal Health Insurance," at Living in the Welfare State: Safe and Secure? Conference of the Netherlands American Studies Association, Roosevelt Study Center, June 1995, Middleburg, Netherlands.

Theda Skocpol, "The Defeat of the Clinton Health Plan and the Future of US Health Politics," at the Special Session on Health Reform in Historical and Cultural Perspective, annual meeting of the American Sociological Association, August 20, 1995, Washington.

Theda Skocpol, "What the Failure of Clinton's Health Plan Tells Us about US Politics Today," at the Executive Committee of the Center for International Affairs, Harvard University, Cambridge, MA, October 10, 1995.

Theda Skocpol, "Health Politics and the Waning of US Democracy at Century's End," at the Workshop on "Where Are We in American Political Development?" Kennedy School of Government, Harvard University, Cambridge, MA, October 14, 1995.

Theda Skocpol, "Entitlements: Too Much or Too Little?" at the Annual Meeting of the Association for Public Policy Analysis and Management, November 2, 1995, Washington.

Theda Skocpol, "The Time Is Never Ripe: The Repeated Defeat of Universal Health Insurance in the 20th Century United States," 26th Geary Lecture, at the Economic and Social Research Institute, November 13, 1995, Dublin, Ireland.

Theda Skocpol, "The Rise and Resounding Demise of the Clinton Health Security Plan," at the Olin Seminar on Constitutional Government, series on "Limiting Government." Harvard University Faculty Club, Harvard University, February 23, 1996, Cambridge, MA.

Theda Skocpol, "Clinton's Health Security Effort and the Turn against Government in American Politics," at New York University, sponsored by the Workshop on Politics, Power, and Protest, New York University, February 29, 1996, New York.

Theda Skocpol, "America's Entitlements Crisis," at the Cambridge Forum, First Parish, March 20, 1996, Cambridge, MA.

Theda Skocpol, "Explaining Social Policy in the United States and Beyond," at the Department of Sociology, University of Hong Kong, Hong Kong, March 29, 1996.

Theda Skocpol, "Social Security in the United States: Past and Future," at the Harvard-Yenching Institute, April 4, 1996, Cambridge, MA.

Theda Skocpol, "Should Americans Defend Universal Social Policies?" at the 1996 Nathan Levin Memorial Lecture, sponsored by the Robert J. Milano Graduate School of Management and Urban Policy at the New School for Social Research, April 23, 1996, New York.

Theda Skocpol, "Boomerang: Clinton's Health Security Effort and the Turn against Government in US Politics," talk at Politics and Prose bookstore, June 20, 1996, Washington.

Theda Skocpol, "Successful Social Policies in American Democracy," at the Kennedy School Conference on "Visions Governance," July 28–August 2, 1996, Bretton Woods, NH.

Theda Skocpol, "President Clinton, the Republicans, and the Politics of Health Care," public lecture at the College of the Atlantic, August 7, 1996, Bar Harbor, ME.

Theda Skocpol, "The Defeat of the Clinton Health Plan and the Future of US Health Politics," at the Annual Meeting of the American Sociological Association, August 1996, Washington.

Theda Skocpol, "Roundtable on Developing a Political Science of the Welfare State," at the Annual Meeting of the American Political Science Association, August 30, 1996, San Francisco.

Theda Skocpol, "Boomerang: The Politics of the Failures of US Health Reform," keynote Address at the 1996 National Clinical Leadership Conference, September 29, 1996, Woodcliff Lake, NJ.

Theda Skocpol, "Is Health Insurance for Children the Next Step? Cautionary Tales from History," at a conference on "First Steps for Children: Strategies for Universal Health Insurance for the Nation's Youth," Columbia University, October 3–4, 1996, New York.

Theda Skocpol, "Boomerang: Clinton's Health Security Effort and the Turn against Government in US Politics," dinner talk at the 1996 Annual Meeting for the Investigator Awards in Health Policy Research, Hyatt Regency Pier 66, October 15, 1996, Fort Lauderdale, FL.

Theda Skocpol, participant in discussions about democratic renewal with the trustees of the Florence and John Schumann Foundation, Sol y Sombra, October 19–20, 1996, Santa Fe, NM.

Theda Skocpol, "Health Care Reform in America: Historical and Comparative Perspectives," guest lecture in health care in John Akula's Kennedy School/Public Health School course "Health Care in the US: System, Policy, and Comparative Perspectives," Harvard University, October 23, 1996, Cambridge, MA.

Theda Skocpol, "The Missing Middle: Working Families in US Social Policy," at the Special Program for Urban and Regional Studies of Developing Areas, Massachusetts Institute of Technology, October 29, 1996, Cambridge, MA.

Theda Skocpol, "Bringing Ourselves Together: Unity and Conflict in the Politics of American Social Policy," at a meeting on "Social Fragmentation in America," sponsored by the American Jewish Committee, Princeton University, October 31–November 1, 1996, Princeton, NJ.

Theda Skocpol, "The Missing Middle: Working Families in US Democracy and Social Policy," plenary address at the Annual Conference of the National Council on Family Relations, Hyatt Regency Crown Center, November 8, 1996, Kansas City, MO.

Theda Skocpol, "A Partnership with Parents: A Family-Oriented Politics for Progressive Democrats," at the New Majority Conference, January 11, 1997, Airlie House, VA.

Theda Skocpol, "Pundits, People, and Medicare Reform," at the Ninth Annual Conference of the National Academy of Social Insurance on "Medicare: Preparing for the Challenge of the 21st Century," National Press Club, January 23–25, 1997, Washington. Attended by several hundred policy scholars and analysts from public and private agencies.

Theda Skocpol, presentation at the New Synthesis group, February 6, 1997, Washington.

Theda Skocpol, "Social Security in the United States, Past and Future," talk at the Visiting Scholars group at the Harvard-Yenching Institute, April 4, 1997, Cambridge, MA.

Theda Skocpol, comment on the Kennedy-Kassebaum bill at the Children's Health Forum, sponsored by Project H.E.A.L.T.H., Institute of Politics, Kennedy School, Harvard University, April 7, 1997, Cambridge, MA.

Theda Skocpol, presentation about Boomerang, Department of Social Sciences, US Military Academy at West Point, April 10, 1997, West Point, NY.

Theda Skocpol, luncheon talk at the Health Consumers' Summit on the Future of Medicare and Universal Coverage, Dupont Plaza Hotel, April 27, 1997, Washington.

Theda Skocpol, presentation at a panel on "The Great Entitlement Debate: Who Wins, Who Loses," Alzheimer's Association Ninth Annual Policy Forum, Hyatt Regency Capitol Hill, April 27, 1997, Washington.

Theda Skocpol, "Health Care Reform in the 1990s," at the Harvard Club of Westchester, October 16, 1997, Westchester, NY.

Theda Skocpol, "The Missing Middle: Working Families and the Future of American Social Policy," Distinguished Political Science Lecture at the University of Vermont, November 5, 1997, Burlington, VT.

Theda Skocpol, presentation on panel about "The Golden Years: The Boomers and the Future of Social Security and Medicare," at a breakfast workshop convened by the Twentieth Century Fund, November 20, 1997, New York.

Theda Skocpol, series of untitled presentations, including some materials on health care politics, at the Texas Industrial Areas Foundation, January 29–30, 1998 Austin, TX.

Theda Skocpol, "The Politics of Health and Welfare Reforms in the 1990s," at the Welfare State Seminar, Department of Economics, Harvard University, February 25, 1998, Cambridge, MA.

Theda Skocpol, "Democracy Unravelled: America in the Late Twentieth Century," second of two Robert Wesson Lectures on Democratic Theory, at Stanford University, March 12, 1998, Palo Alto, CA.

Theda Skocpol, "A Partnership with American Families," at the retreat of the Board of the Twentieth Century Fund, Carmel Valley Ranch, April 3, 1998, Carmel, CA.

Audio-Visuals and Computer Software

"Social Responsibility in the United States: The Current Tapestry." Transcript of a conversation between Theda Skocpol and David Kuo, disseminated in US Society and Values, an electronic journal of the US Information Agency, January 1997.

Book Reviews

Robert Schmuhl, "How Health Care Initiative Sputtered," Philadelphia Inquirer, May 5, 1996, Section K, p. 2.

Radio Coverage

"The Connection with Christopher Lydon," interviewed on WBUR radio, May 6, 1996, Boston.

"Capitol Newsbeat," Bonneville radio network, May 13, 1996.

"Boston Sunday Review," interviewed on WBCN radio, May 20, 1996, Boston.

"Focus 580" with David Inge, interviewed on WILL radio, May 21, 1996, Champaign-Urbana, IL.

"New York and Company" with Leonard Lopate, interviewed on WNYC radio, May 22, 1996, New York.

"Talk America Radio Network," interviewed on the Hugh Rodham show, June 4, 1996.

WOSU radio, June 4, 1996, Columbus, OH.

"Cover to Cover" with Henry Tischler, interviewed on WGBH radio, June 10, 1996, Boston.

"The Radio Book Review," interviewed by Michael Svoboda, WPSU radio, June 25, 1996, State College, PA.

Television Coverage

C-SPAN. Tape for broadcast on "Politics of America's Economic Distress, 1996." Theda Skocpol, speaker on American Prospect Panel. Cambridge Forum, January 31, 1996, Cambridge, MA.

Interviewed on WHDH-TV, channel 7, on June 13, 1996, Boston.

NEWSCHANNEL 8 cable TV, June 21, 1996, Virginia and Washington.

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Report prepared by: David Kales
Report prepared by: Janet Heroux
Reviewed by: Molly McKaughan
Reviewed by: Marian Bass
Program Officer: David Colby

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