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烟草行业及其他公司对1994年克林顿医疗保健计划失败的影响。

Impact of tobacco industry and other corporations in the defeat of the 1994 Clinton health care plan.

作者信息

Givel Michael

机构信息

Department of Political Science, The University of Oklahoma, 455 West Lindsey, Room 215, Norman, OK, 73019, USA.

出版信息

BMC Public Health. 2017 Jun 21;17(1):591. doi: 10.1186/s12889-017-4501-7.

Abstract

BACKGROUND

The primary reason cited by many scholars for the defeat of the Clinton Administration's 1994 health care reform bill has long been identified as Health Insurance Association of America and National Federation of Independent Businesses opposition to the bill. Given this predominant consensus combined with sizeable proposed funding for the bill by a large tobacco product tax, this manuscript examined what the tobacco industry's role was in whole or part in defeating the Clinton health care bill.

METHODS

This research occurred through crosschecking internal tobacco industry documents and Clinton White House documents.

RESULTS

Prior to the passage of the bill, the tobacco industry accepted a compromise of 45 cents per pack increase phased in over five years. Due to this compromise, the industry or third party allies had no role in the ultimate defeat in the bill.

CONCLUSIONS

The primary reason for the bill's ultimate defeat was general business (but not tobacco industry and third party ally) opposition, the bill running out of time, and conflicting bills. Secondary reasons for the bill's defeat included issues with: employer mandates, high taxes on insurance plans, impacts on medical research and education, Congressional attention to other issues, election year politics, and possible future excise tax possibilities.

摘要

背景

长期以来,许多学者认为克林顿政府1994年医疗改革法案失败的主要原因是美国健康保险协会和全国独立企业联合会反对该法案。鉴于这种主流共识,再加上该法案通过大幅提高烟草产品税获得可观的拟议资金,本文探讨了烟草业在克林顿医疗法案失败中是否或多或少起到了作用。

方法

本研究通过交叉核对烟草行业内部文件和克林顿白宫文件进行。

结果

在该法案通过之前,烟草业接受了一项为期五年逐步实施的每包提价45美分的妥协方案。由于这一妥协,该行业或第三方盟友在该法案最终失败中没有起到任何作用。

结论

该法案最终失败的主要原因是企业界(而非烟草业和第三方盟友)的反对、法案时间耗尽以及相互冲突的法案。该法案失败的次要原因包括以下问题:雇主强制参保、保险计划高额税收、对医学研究和教育的影响、国会对其他问题的关注、选举年政治以及未来可能的消费税可能性。

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