THE CLINTON HEALTH PLAN - HISTORICAL-PERSPECTIVE

Did the Clinton administration ignore the lessons of history in. devising its ambitious plan to reform the health care system, thus dooming the plan to failure from the start? Or did the circumstances of the late twentieth century conspire to kill off a well-meant, if ill-executed, effort? No ''cookbook recipe for successful social reform'' exists in policy history, writes Hugh Heclo, yet certain patterns can ''nudge the probabilities for successful reform efforts in one way or another.'' In an attempt to shed light on what happened to the Clinton plan, he places the characteristics of successful past reform efforts into three general categories: (1) the nature of reform objectives; (2) the resources of the political environment; and (3) gestation periods for political learning. Heclo writes, ''[T]he interesting question [from a broader historical perspective] is not which particular nail in the horseshoe was faulty, thereby losing the horse, the rider, and the kingdom. The issue is why, in the first place, the kingdom was in a position to be vulnerable to any one or more of these factors.'' Heclo is Clarence J. Robinson Professor at George Mason University in Fairfax, Virginia, on sabbatical leave during the spring 1995 semester. He teaches courses in American national politics and social welfare policy. Heclo holds a doctorate in political science from Yale and a master of arts degree from Manchester University in England. He was on the faculty of the University of Essex (England), the Massachusetts Institute of Technology, and Harvard University, and was a research associate and then a senior fellow at The Brookings Institution. The invited comments of Margaret Weir and James Mongan, on both Theda Skocpol's and Heclo's papers, follow this essay.