WASHINGTON -- President Clinton's ambitious attempt to overhaul the nation's health care system, having faltered for months, finally collapsed yesterday for lack of support.
Almost a year to the day after the reform proposal -- one of the most far-reaching social programs offered in decades -- was unveiled with great fanfare before a joint session of Congress, Senate Majority Leader George J. Mitchell announced that he lacked the 60 votes needed to get even a modest version of the Clinton plan past a Republican filibuster.
"Under the rules of the Senate, a minority can obstruct the majority," said Mr. Mitchell, a Maine Democrat. He put the blame squarely on Republicans eager to deny Mr. Clinton a victory on the program he had made the centerpiece of his presidency. "That is what happened to comprehensive health insurance reform."
Sen. Bob Dole, the minority leader from Kansas, fired back: "Senator Mitchell blames the Republicans for everything except the plane that crashed into the White House, and that may yet come. . . . In fact, it was an overwhelming consensus of the American people to put the brakes on [health care reform.] It's my view that we saw democracy in action."
Mr. Clinton, who invested enormous time and prestige in the issue, chose to take the Republicans up on their promise to tackle the issue again next year. He leveled his most bitter complaints at the "special interests," which, he said, had spent more than $300 million to stop health care reform.
"We will fight for campaign finance and lobby reform, so these special interests do not continue to obstruct vital legislation, and we will return to the fight for health care reform," Mr. Clinton said in a statement issued from New York.
Beneath the bickering and recriminations, there was deep disappointment among some lawmakers, such as Sen. Edward M. Kennedy, a Massachusetts Democrat who had hoped to see the fulfillment this year of a goal he has held for nearly all his three decades in public life.
"We had a historic opportunity this year to make a real difference in the lives of all Americans," Mr. Kennedy said, referring to preventive care for children and pregnant women and prescription drugs for the elderly and home health care for people with disabilities.
Sen. Barbara A. Mikulski, a Maryland Democrat, added: "This is a sad day for the United States of America. . . . Misinformation and disinformation prevailed."
Lawmakers said the reform effort fell victim to several factors: its own complexity, intense industry opposition, partisan maneuvers, tactical missteps and a lack of consensus among the American public.
Legislators promised to return next year with renewed efforts. But unless the political climate changes, it's unlikely they will attempt anything as comprehensive as Mr. Clinton proposed. Even to succeed with more modest versions, the lawmakers must overcome many of the obstacles that tripped them up this year and perhaps new ones as well.
"As long as a majority of the people have the attitude, 'I'm OK; the rest of you are screwed,' I don't think anything is going to happen until there's another crisis," said Rep. Fred Grandy, an Iowa Republican.
A repeated observation of the debate was that the task of overhauling one-seventh of the economy is enormously difficult. The most recent comparable achievement by Congress was the enactment of Medicare in 1965, which, Mr. Mitchell noted yesterday, had been pending for a decade and didn't pass until President Lyndon B. Johnson won election in a landslide in 1964.
President Clinton, elected with only a 43 percent plurality, tried to rise to the enormous task of health care reform by putting his wife, Hillary Rodham Clinton, in charge of a task force that spent nearly a year crafting a 1,300-page proposal sent to Congress.
But the measure was so sweeping, affecting nearly every segment of society, that everyone could find something about it they didn't like.
Opponents -- led by the insurance industry, which had the most to lose from the proposed cost controls and regulatory reforms -- unleashed an extraordinarily fierce lobbying campaign. More than $100,000 was spent on tactics such as television advertisements designed to stir public alarm and reach members of Congress through phone calls and faxes from their districts.
"It was raw political power, and the best argument I've seen for campaign finance reform," said Sen. Paul Wellstone, a Minnesota Democrat, referring to influence wielded by opponents of health care reform by virtue of the vast sums they donate to political campaigns.
The Clinton bill included several flaws that made it vulnerable to attack. One was a provision to force everyone to join regional alliances that would bargain with insurance companies on their behalf. That gave opponents the chance to raise the specter of an inefficient, government-run health care system that would eliminate people's right to use doctors of their own choice.