“Our Reach Is Wide by Any Corporate Standard”: How the Tobacco Industry Helped Defeat the Clinton Health Plan and Why It Matters Now

摘要

Contemporary health care reformers, like those who promoted the failed Clinton era plan, face opposition from multiple corporate interests. However, scant literature has examined how relationships between corporations and other stakeholders, such as think tanks and advocacy groups, shape health care reform debate. We show how the 2 biggest US tobacco companies, Philip Morris and RJ Reynolds, and their trade association coordinated in mobilizing ideologically diverse constituencies to help defeat the Clinton plan. Unwittingly perhaps, some reform supporters advanced the tobacco industry's public relations blitz, contributing to perceptions of public opposition to the plan. As the current reform debate unfolds, this case highlights the importance of funding transparency for interpreting the activities of think tanks, advocacy groups, and “grassroots” movements. Health care reform is an Obama administration priority. 1 The Clinton Health Care Security Act, the last federal attempt at comprehensive reform, failed to pass in 1994. That plan, introduced in September 1993, 2 represented a compromise between constituencies favoring government-guaranteed universal coverage and those favoring free-market competition. It proposed universal coverage through “managed competition”: competing government-regulated private plans. 2 To be funded through employer mandates, business and health care provider charges, and a 75-cent per pack tobacco excise tax, 2 the plan initially received strong public support. However, ensuing compromises satisfied few, and criticisms that had begun months earlier continued: diverse constituencies intensified public relations and lobbying efforts. 2 , 3 Ultimately, Congress abandoned the legislation; efforts to enact alternatives failed. 2 Media coverage of Obama's efforts suggests that, as for the Clinton plan, corporate influence and contention over financing pose challenges. 2 , 4 – 10 Previous research on the Clinton plan's demise faulted its complexity, divisions among reform supporters, and the administration's failure to effectively communicate the plan's features, enabling opposition to mobilize. 3 , 11 – 17 Although lobbying and advertising by multiple corporate interests also played important roles, 13 , 18 – 20 scant literature has examined how relationships between corporations and other stakeholders, such as think tanks, advocacy groups, and “grassroots” movements, affected reform debates. We explore how the 2 biggest US tobacco companies, Philip Morris and RJ Reynolds, and their now-defunct trade association, the Tobacco Institute, worked together to mobilize right-leaning think tanks and smokers’ rights, labor, and left-leaning public policy groups to help defeat the Clinton plan. Through a coordinated, nationwide initiative, the industry helped persuade policy makers that considerable public opposition existed to both a funding mechanism—a tobacco excise tax increase—and the plan as a whole. This case offers lessons for the current health care debate, highlighting the importance of funding transparency for interpreting activities of think tanks, advocacy groups, and “grassroots” movements and the need for advocacy organizations to consider how accepting corporate donations may compromise their agendas.