Goldfield N
3M/HIS, Wallingford, CT 06492, USA.
Physician Exec. 1996 Jan;22(1):31-8.
Unlike the other articles in this series on efforts to reform the American health care system, this article is necessarily somewhat personal. I lived through it--not as a participant in the process but as a very interested bystander. To President Clinton's credit, his proposal was the first comprehensive proposal from a President since at least President Nixon and strictly speaking since President Truman. Yet, in the final analysis, the results were extremely depressing, not merely because of the obvious failure of the effort, but, even more important, because of the impact it has had on Americans' belief in the possibility for significant government role/responsibility in health care or, for that matter, in any significant domestic initiative. This article will trace portions of the failed Clinton health care initiative proposal--not the myriad other proposals that percolated through Congress. Realistically, only a proposal that had the support of the President had any chance of legislative success. This article will trace the development of the proposal and, while focusing on the universal coverage aspect, point to critical decisions that led to its legislative demise.
与本系列中其他关于美国医疗体系改革努力的文章不同，这篇文章必然带有一定的个人色彩。我亲身经历了这一过程——并非作为参与者，而是作为一个极为关注的旁观者。值得称赞的是，克林顿总统的提议是至少自尼克松总统以来，严格来说是自杜鲁门总统以来，首位总统提出的全面提议。然而，归根结底，结果令人极其沮丧，这不仅是因为改革努力明显失败，更重要的是，它对美国人关于政府在医疗保健领域（或者就此而言，在任何重大国内举措中）发挥重要作用/承担责任的可能性的信念产生了影响。本文将追溯克林顿医疗保健倡议提议失败的部分情况——而非国会中涌现的众多其他提议。实际上，只有得到总统支持的提议才有立法成功的机会。本文将追溯该提议的发展历程，并在聚焦全民医保方面的同时，指出导致其立法失败的关键决策。
