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Clinton's pledge was the first of many promises he and his health team would have to adjust to reality. Over the next 18 months, Clinton's reform plan grew from a necessary campaign plank into a centerpiece of his presidency, and the President's attitude was marked by a whatever-it-takes practicality. For one thing, his aides reworked the timing of the scheme. Clinton now concedes he will need another year to enact his plan and three more to put it fully into place. After insisting that raising taxes wasn't necessary, Clinton's aides made an increase part of the strategy, then scaled the proposed taxes back to just a levy on cigarettes. Clinton fashioned the plan to curry the support of large insurance companies, hospitals, unions and a fearful middle class. Remarkably, however, his early vision of paying for reform mostly by controlling costs and reducing paperwork remains the proposal's central feature. This is the inside story of Clinton's revolutionary plan, a wonky, made-from-scratch idea that endured despite the efforts of nearly everyone, including its own creators, to second-guess it to death.
THE DEVIL IN THE NUMBERS
After weeks of writing and rewriting, Bill Clinton was ready in June 1992 to publish Putting People First, a slim volume on his entire foreign and domestic program. After a brutal primary season, Clinton was running third in the polls, behind both George Bush and Ross Perot, and the Democrat's aides hoped the book would help jump-start his campaign. But on June 22, as the plates of Clinton's book were literally going on the presses, Little Rock, Arkansas, headquarters called for a halt. One line in a single chart just didn't make sense. The problem was with the health-care numbers.
"They were not only uncertain," recalls a Cabinet officer, "they were big. The numbers bedeviled the process all the way through." Everyone knew that the numbers belonged to Ira Magaziner, the longtime Clinton friend whose consulting work for hospitals during the 1980s earned him a place as the candidate's most trusted health-care adviser. A tall, balding man with a weakness for jargon, Magaziner seemed to live in a world with its own brand of mathematics. He contended that Clinton could cover 37 million uninsured Americans by putting controls on costs and eliminating waste. Nearly every Democratic health-care expert, however, concluded that efficiencies alone would never be enough: Clinton would have to raise taxes as well.