Governmentаl regulation of American health care system during the «Health security act: debates» (1993)

Today the United States of America is one of the few developed countries in the world that does not offer its citizens a universal medical coverage. In the beginning of 1990s this sphere was in crisis: the prices were skyrocketing while 38,5 million people still lacked health insurance. In December 1992 the newly elected president B. Clinton, tried to find the middle ground between the republicans, who resented governmental intrusion into the medical sphere, and the democrats who believed in federal mechanisms for dealing with health care crisis. His proposal was based on the popular concept of «managed competition», which attempted to give citizens more leverage on prices by creating insurance purchasing alliances that would negotiate better deals with the suppliers of medical services. It was also backed by the «global budget» - an overall limit on health care spending set by the government. The collapse of the socalled «iron-triangle» of federal bureaucracy, Congress and organized interests gave Clinton administration an opportunity for building a coalition in support of this reform. The White House managed to win the support of several long-time opponents of the health care overhaul, such as the American Medical Association and the US Chamber of Commerce. Meanwhile, Congress was divided on the issue. The republicans criticized the idea of «global budget» as ineffective and the whole upcoming reform as a governmental take-over of the US health care system. On the other hand, many democrats advocated for a large benefit package and stricter federal control. Congressional Budget Office was sceptical about the results of the «managed competition» in terms of price controls. Clinton reform project, Health Security Act, was presented to Congress in September 1993. The financial projections that attempted to stop spiralling costs and to reduce the budget deficit did not seem reliable to the congressmen and general public. The republicans saw the bill as a new tax, while a lot of democrats were reluctant to make the proposed cuts in Medicare. GOP and some interest groups (most vocal of which were small-business lobbies) were united in opposition to employer mandates - an attempt to make employers pay the biggest part of the insurance premium. In the light of the upcoming Congress midterm elections and deteriorating public support for the reform, the Republican Party made a decision to stop all bipartisan collaboration and to «kill» the health care overhaul. During the committees and subcommittees mark-ups several different versions of Clinton's bill emerged, none of which had chances for success in either Chamber.

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