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The Lessons of “Lesson Drawing”: How the Obama Administration Attempted to Learn from Failure of the Clinton Health Plan

  • Kevin P. Donnelly (a1) and David A. Rochefort (a2)
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1. Tom Daschle with Nather David, Getting It Done: How Obama and Congress Finally Broke the Stalemate to Make Way for Health Care Reform (New York, 2010), 263.

2. See, for example, ibid.; Lawrence R. Jacobs and Theda Skocpol, “Hard Fought Legacy: Obama, Congressional Democrats, and the Struggle for Comprehensive Health Reform,” Prepared for the Working Group on Obama’s Agenda and the Dynamics of U.S. Politics, Russell Sage Foundation, October 2010; Jacobs Lawrence R. and Skocpol Theda, Health Care Reform and American Politics: What Everyone Needs to Know (New York, 2010); Morone James A., “Presidents and Health Reform: From Franklin D. Roosevelt to Barack Obama,” Health Affairs 29, no. 6 (2010): 10961100; Oberlander Jonathan, “Long Time Coming: Why Health Reform Finally Passed,” Health Affairs 29, no. 6 (2010): 1112–16; Staff of the Washington Post, Landmark: The Inside Story of America’s New Health-Care Law and What It Means for Us All (New York, 2010).

3. Oberlander, “Long Time Coming,” 1116.

4. Blumenthal David and Morone James A., The Heart of Power: Health and Politics in the Oval Office (Berkeley and Los Angeles, 2009), x.

5. Staley David J., History and Future: Using Historical Thinking to Imagine the Future (Lanham, Md., 2007).

6. Ibid., 22.

7. Ibid., 24.

8. Ibid., 28. Although Staley categorizes this nondeterministic model as a variation of the linear view, logically it is compatible with either a linear or cyclical model depending on the direction of choices made by historical actors.

9. Ibid., 37.

10. Ibid., 38.

11. Ibid., 44.

12. May Ernest R., “Lessons” of the Past: The Use and Misuse of History in American Foreign Policy (London, 1973).

13. Ibid., xiii.

14. Fiske Edward B., “Education; Lessons of History Applied to the Present,” New York Times, 10 March 1981.

15. Neustadt Richard E. and May Ernest R., Thinking in Time: The Uses of History for Decision-Makers (New York, 1986).

16. Ibid., chap. 13.

17. Ibid., 240.

18. Zelizer Julian E., “History and Political Science: Together Again?” Journal of Policy History 16, no. 2 (2004): 126–36, 129.

19. Hogwood Brian W. and Guy Peters B., Policy Dynamics (New York, 1983), 242.

20. Rose Richard, “What Is Lesson-Drawing?Journal of Public Policy 11, no. 1 (1991): 330; Rose , Lesson-Drawing in Public Policy: A Guide to Learning Across Time and Space (Chatham, N.J., 1993). See also Heclo Hugh, Modern Social Politics in Britain and Sweden (New Haven, 1974).

21. Rose, Lesson-Drawing in Public Policy, ix.

22. Rose, “What Is Lesson-Drawing?” 7.

23. Ibid., 9.

24. Rose, Lesson-Drawing in Public Policy, chap. 4.

25. Rose, “What Is Lesson-Drawing?” 15–17.

26. Howlett Michael and Rayner Jeremy, “Understanding the Historical Turn in the Policy Sciences: A Critique of Stochastic, Narrative, Path Dependency, and Process-Sequencing Models of Policy-Making over Time,” Policy Sciences 39 (March 2006): 118.

27. Pierson Paul, Politics in Time: History, Institutions, and Social Analysis (Princeton, 2004).

28. Schlesinger Arthur Jr., War and the American Presidency (New York, 2004), 135. For a critical analysis of this book and Schlesinger’s perspective on the political uses of history, see the perceptive essay by Larry DeWitt, “The Utility of the Study of History: Reflections on a Recurring Folly.” Available at:

29. Davis Harold Eugene, History and Power: The Social Relevance of History (Lanham, Md., 1983), 74.

30. Graham Otis L. Jr., “The Uses and Misuses of History,” Public Historian 5 (Spring 1983): 519(8).

31. Bill Clinton, Health Care Reform Address Before a Joint Session of Congress, 22 September 1993. Available at:

32. Hacker Jacob S., The Road to Nowhere: The Genesis of President Clinton’s Plan for Health Security (Princeton, 1997), 145.

33. Ibid., 178.

34. Ibid., 179.

35. Johnson Haynes and Broder David S., The System: The American Way of Politics at the Breaking Point (Boston, 1996), 154.

36. Skocpol Theda, “The Rise and Resounding Demise of the Clinton Plan,” Health Affairs 14, no. 1 (1995): 67.

37. Paul Starr, “What Happened to Health Care Reform?” American Prospect, 1 December 1994. Available at:

38. Ibid.

39. Oberlander Jonathan, “Learning from Failure in Health Care Reform,” New England Journal of Medicine 357 (25 October 2007): 1677–79 (1678).

40. Ibid., 1679.

41. Antos Joseph, “Lessons from the Clinton Plan: Incremental Market Reform, Not Sweeping Government Control,” Health Affairs 27, no. 3 (2008): 705–10 (706).

42. Ibid.

43. Blumenthal and Morone, The Heart of Power.

44. Robert B. Reich, “Critical Care,” review of Blumenthal and Morone, The Heart of Power, New York Times, 6 September 2009.

45. Ezra Klein, “The Lessons of ’94,” American Prospect, 22 January 2008.

46. William Kristol, “Kristol: Kill It and Start Over,” Weekly Standard weblog, 20 July 2009. Available at:

47. William Kristol, Memorandum to Republican Leaders: Defeating President Clinton’s Health Care Proposal, 2 December 1993. Available at:

48. Jacob Hacker, “Jacob Hacker: Obama’s Almost Perfect Strategy,” New Republic weblog, 3 March 2009. Available at:

49. Paul Starr, “Sacrificing the Public Option,” American Prospect, 19 August 2009. Available at:

50. Stanley Greenberg, “Repeat the Question: Why Health Care Reform Could Fail Again,” New Republic online, 1 July 2009. Available at:

51. Ibid.

52. Stanley Greenberg Interview with National Public Radio, All Things Considered, 24 June 2009. Available at:

53. Noam N. Levey, “Daschle’s Got His Own Health Plan,” Los Angeles Times, 15 December 2008.

54. Daschle Tom, Critical: What We Can Do About the Health Care Crisis (New York, 2008), 112.

55. Ibid., 196.

56. Mark Warren, “Bill Clinton, Then and Now: The Esquire Interview,” Esquire, 8 September 2009. Available at:

57. J. Taylor Rushing, “Bill Clinton Tells Senate Democrats to Learn Lessons from ’94,”, 10 November 2009. Available at:

58. Barack Obama, Remarks by the President at the Opening of the White House Forum on Health Reform, 5 March 2009. Available at:

59. Dan Eggen and Ceci Connolly, “Health Industry Voices Support for Obama Health Plan,” Washington Post, 5 March 2009, A01.

60. Ricardo Alonso-Zaldivar, “Obama Tries to Start Conversation on Health Care,” Tucson Citizen, 5 March 2009.

61. Sheryl Gay Stolberg, “Obama Taps Clinton Ideas but Not Clinton Herself,” New York Times, 5 March 2009.

62. The Staff of the Washington Post, Landmark, 17.

63. Laura Meckler, “Obama, Health-Care Players Agree to Seek Overhaul,” Wall Street Journal, 6 March 2009.

64. Peter Baker and Carl Hulse, “Obama, House Republicans Debate Their Divisions,” New York Times weblog, 29 January 2010. Available at:

65. Barack Obama, Remarks by the President Before Meeting with Senate Democrats to Discuss Health Care, 2 June 2009. Available at:

66., Office of Management and Budget, “President Obama’s Fiscal 2010 Budget: Transforming and Modernizing America’s Health Care System.” Available at:

67. Robert Pear and Sheryl Gay Stolberg, “Obama Strategy on Health Care Legislation Appears to Pay Off,” New York Times, 2 November 2009.

68. Sheryl Gay Stolberg and David M. Herszenhorn, “Obama’s Health Bill Plan Largely Follows Senate Version,” New York Times, 22 February 2010.

69. America’s Health Insurance Plans, press release, “Health Plans Propose Guaranteed Coverage for Pre-Existing Conditions and Individual Coverage Mandate,” 19 November 2008. Available at:

70. Barack Obama, Remarks by the President in Town Hall on Health Care, Belgrade, Montana, 14 August 2009. Available at:

71. Mark Milian, “White House Using Social Media to Debunk ‘Myths’ About Healthcare Reform,” Los Angeles Times weblog, 10 August 2009. Available at:

72. Drew Armstrong, “Axelrod Fuels Democratic Message Machine for Health Care Overhaul,” CQ Today, print edition, 13 May 2009.

73. Ibid.

74. Meckler, “Obama, Health-Care Players Agree to Seek Overhaul,” 2009.

75. Barack Obama, Remarks at the Annual Conference of the American Medical Association, Chicago, 15 June 2009. Available at:

76. Barack Obama, Remarks to a Joint Session of Congress on Health Care, Washington, D.C., 9 September 2009. Available at:

77. James Poniewozik, “Obama Shifts Health Presser for NBC & the Hoff.” Available at:

78. Ezra Klein, “The Ghosts of Clintoncare,” Washington Post, 26 July 2009.

79. Robert Pear and David M. Herszenhorn, “Obama Hails Vote on Health Care as Answering the ‘Call of History.’” New York Times, 21 March 2010.

80. Sheryl Gay Stolberg and Robert Pear, “Obama Signs Health Care Overhaul Bill, With a Flourish,” New York Times, 23 March 2010.

81. Brian Montopoli, “Tallying the Health Care Bill’s Giveaways,” CBS News, 21 December 2009. Available at:

82. Michael O’Brien, “CBO Pegs Nelson’s Nebraska Medicaid Deal Cost at $100 Million,” The, 20 December 2009. Available at:

83. Montopoli, “Tallying the Health Care Bill Giveaways.”

84. Alessandra Stanley, “Parties Jousting with Dire Warnings,” New York Times, 26 February 2010.

85. Morone, “Presidents and Health Reform,” 1097.

86. “Filibuster and Debate Curbs,” New York Times, 26 January 2011.

87. Brian Montopoli, “Reid Suggests Health Care Reform May Not Come This Year,” CBS News, 3 November 2009. Available at:

88. Daschle with Nather, Getting It Done, 135.

89. Ibid., 136.

90. Mark Jurkowitz, “Health Care News Heats Up,” Pew Research Center Publications, 11 August 2009. Available at:

91. The Staff of the Washington Post, Landmark, 54.

92. “A Historic Moment for Health Care?” New York Times, 21 March 2010. Available at:

93. Morone, “Presidents and Health Reform.”

94. Ibid., 1098.

95. Robert Pear and David M. Herszenhorn, “Republican’s Vote Lifts a Health Bill, but Hurdles Remain.” New York Times, 14 October 2009.

96. Carl Hulse and Robert Pear, “Sweeping Health Care Plan Passes House,” New York Times, 8 November 2009.

97. Jeff Zeleny, “Obama Plans Bipartisan Summit on Health Care,” New York Times, 8 February 2010.

98. Sheryl Gay Stolberg and Robert Pear, “President Urges Focus on Common Ground,” New York Times, 26 February 2010.

99. Johnson and Broder, The System, 40.

100. David Frum, “Waterloo,” Frum Forum, 21 March 2010. Available at:

101. Robert Pear and David M. Herszenhorn, “G.O.P. Counters with a Health Plan of Its Own,” New York Times, 3 November 2009.

102. John Dorschner, “Healthcare Reform Bill Included Big GOP Idea: Individual Mandate,” Miami Herald, 24 March 2010.

103. Meet the Press, “Roundtable,” 28 March 2010. Available at:

104. Ezra Klein, “Obama’s Moderate Health-Care Law,” Washington Post, 12 November 2010. Available at:

105. Huffington Post, “The Historic (and Sometimes Insane) Health Care Debate in 10 Minutes,” video, 22 March 2010, Available at:

106. David M. Herszenhorn, “A Grand Achievement, or a Lost Opportunity?” New York Times, 24 March 2010.

107. Jacobs and Skocpol, Health Care Reform and American Politics, 75.

108. Peter H. Stone, “Health Insurers Funded Chamber Attack Ads,” National Journal, 12 January 2010. Available at:

109. Sarah Kliff, “The Polling Contradiction,” Newsweek, 19 February 2010. Available at:

110. Bob Cesca, “Keep Your Goddamn Government Hands Off My Medicare!” Huffington Post, 5 August 2009. Available at:; Paul Krugman, “Health Care Realities,” New York Times, 30 July 2009.

111. Sheryl Gay Stolberg and David M. Herszenhorn, “Obama Weighs Paring Goals for Health Bill, New York Times, 20 January 2010.

112. David M. Herszenhorn and David D. Kirkpatrick, “Lieberman Gets Ex-Party to Shift on Health Plan, New York Times, 15 December 2009.

113. Robert Pear and David M. Herszenhorn, “Health Care Gives Way,” New York Times, 28 January 2010.

114. Gail Russell Chaddock, “To Advance Healthcare Reform, Obama Comes Down on Insurers,” Christian Science Monitor, 8 March 2010.

115. Sheryl Gay Stolberg, Jeff Zeleny, and Carl Hulse, “Health Vote Caps a Journey Back from the Brink,” New York Times, 20 March 2010.

116. Ibid.

117. Garance Franke-Ruta, “Now, NRAL Displeased with Obama-Stupak Deal,” Washington Post, 21 March 2010.

118. Michael D. Shear and Peter Slevin, “Kucinich in Obama’s Crosshairs,” Washington Post, 15 March 2010.

119. Carl Hulse, “A Fail-Safe Works for Legislation, but Not as Expected,” New York Times, 28 March 2010.

120. Sheryl Gay Stolberg, “Lessons for the Democrats, Some Perhaps Cautionary, After a Signal Triumph,” New York Times, 22 March 2010.

121. William Branigin, “Obama Reflects on ‘Shellacking’ in Midterm Elections,” Washington Post, 3 November 2010.

122. Skocpol, “The Rise and Resounding Demise of the Clinton Plan,” 67.

123. Robert J. Blendon and John M. Benson, “Health Care in the 2010 Congressional Election,” New England Journal of Medicine, Perspective, 27 October 2010. Available at:

124. Ibid.

125. Kaiser Family Foundation, “Public Opinion Poll on Health Care Issues,” November 2010. Available at:

126. Barack Obama, Remarks at a Press Conference in the East Room of the White House, Washington, D.C., 3 November 2010. Available at:

127. Mark S. Smith, “Obama: Agenda ‘All at Risk’ in any Republican Romp,” Washington Post, 2 November 2010.

128. David Lawder and Vicki Allen, “Boehner Vows to Repeal Obama Healthcare Reforms,” Reuters, 3 November 2010. Available at:

129. Robert Pear, “G.O.P. to Fight Health Care Law with Purse Strings,” New York Times, 6 November 2010.

130. Ibid.

131. Peter Cohn, “Ryan: Health-care Repeal Unlikely Until 2013,” National Journal, 7 November 2010. Available at:

The authors are grateful to Christopher Bosso and Michael Dukakis of Northeastern University, as well as two anonymous reviewers of the Journal of Policy History, for their comments on this article.

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Journal of Policy History
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