A leaf out of Bill's book

BOOK REVIEW; Boomerang: Clinton's Health Security Effort and the Turn against Government in US Politics Theda Skocpol Norton, pounds

There are very few books that Tony Blair and his closest advisers should read between now and the next election, but this is one of them.

Boomerang is a riveting, thriller-like account of Bill Clinton's failed attempt in the first years of his presidency to introduce "affordable, quality health care for all Americans". This was something for which there was huge support in a country where costs are out of control while growing numbers of Americans - 41 million at the last count - enjoy little or no cover.

Its interest here lies less in its focus on health - no one is proposing radical NHS reform - but in its chilling account of what went wrong and why.

For, as Theda Skocpol explains, in 1992 Americans elected a moderate Democrat, committed to fiscal prudence and reducing America's monumental deficit, a man who had kindled "enormous hope for people who want to address America's deepening social ills and inequities, in part through public initiatives". Tight though the race had been, it was clear, Professor Skocpol says, that "substantial majorities of Americans wanted the Clinton presidency to succeed."

For Clinton, read Blair in up to nine months' time - unless something very dramatic happens to the opinion polls between now and then.

Barely two years after his election, Clinton's health plan lay in ruins. It also provided the focus that allowed the resurgence of the anti- Government Republican right, producing a Republican Congress for the first time in 30 years and Newt Gingrich's "Contract with America", which, despite its failure, has engendered an anti-Government mood to the point where Skocpol, a Professor of Government at Harvard, judges that other key programmes such as Medicare, Medicaid and Social Security are at risk - witness Clinton's recent signing of a Bill containing draconian cuts in welfare payments.

What trapped Clinton, Skocpol calculates, were traits that are marked in New Labour's stance. Here was a party that had lost much of its traditional voter base - a situation present, but much less marked, for Labour. And its candidate was utterly determined to be fiscally responsible: he absolutely would not raise taxes; he tried to anticipate Republican criticism by taking Republican ground; he was careful not to appeal to the poor - the Democrats traditional base - but to the "hard-pressed" middle classes. And his rhetoric is acutely familiar in Blair's speeches.

What ditched Clinton, Skocpol judges, was his inability to raise taxes in return for the greater security - in this case over health care - that Americans craved. What resulted was a scheme involving a mass of regulation to release cash from the existing system by other means - a programme that the Republican right presented as "big government" but equally as cuts to existing middle-class beneficiaries, a problem not unrelated to the Blair/Brown promise to save before they spend.

Clinton's efforts were also hampered by distraction at crucial moments (by Somalia, free trade and crises in Moscow and Haiti) and by a hostile media that failed to explain a plan the American public never really understood, concentrating on the heat of the political battle rather than shedding light on what was involved - a criticism some may make of the media here.

The parallels cannot be pushed too far. The US is not the UK. Blair does not have anything as grand as Clinton's health plan on the stocks. But there are big ideas for changes to benefits, pensions, welfare to work and education and training in Labour's locker which in a "no more taxes" environment will involve changes that will be painful in other ways. Lose the argument for them and - despite Clinton's anticipated victory in November - the agenda here could switch as it has in the US to how to cut spending and programmes, not how to create or sustain the security for which voters in the US in 1992, and in the UK in 1996, say they crave.