Administration strategists knew that many small businesses would reject any plan with the so-called employer mandate requiring companies to purchase insurance for their workers, but they hoped to gain significant support from big businesses that already provide coverage.
Instead, while some businesses, such as automobile and steel companies, have lobbied for Clinton's plan, most large companies have stayed on the sidelines, in part because top executives, most of whom are Republicans and conservative, decided they were uncomfortable pushing for a liberal Democratic initiative.
The U.S. Chamber of Commerce started out in favor of the employer mandate. But in February, its board retracted that support. Within days, two other business groups--the National Assn. of Manufacturers and the Business Roundtable--joined in the rejection of Clinton-style plans.
Similarly, the American Medical Assn. endorsed universal coverage and the employer mandate two years ago, but backed off last December. In July, the AMA shifted position again, joining the AFL-CIO and the American Assn. of Retired Persons to again call for universal coverage. This past week, the doctors flipped a third time, saying they would support an incremental reform bill proposed by conservatives in the House, rather than the universal coverage bills backed by the Democratic leadership.
Meanwhile, some groups that had much to gain from comprehensive health care reform remained eerily silent. Some hoped to gain greater bargaining leverage, others were unsure what to do.
The most notable was the AARP, whose 33 million members would have benefited from Clinton's proposals to expand coverage for long-term care and outpatient prescription drugs.
The AARP's leadership resisted repeated personal overtures from the President to support his plan. Instead, like other groups that were generally in favor of the Clinton approach, the AARP talked up long-term care and drug coverage without mentioning Clinton.
This became a pattern throughout the past 18 months. "People who opposed reform attacked the Clinton plan by name. But supporters just talked up the elements," said one lobbyist. Only this past week did the AARP leadership explicitly endorse the Democratic bills.
Those who opposed Clinton from the outset have been not at all reticent. The Health Insurance Assn. of America represents small- and mid-sized insurance firms, many of which faced bankruptcy under a Clinton-type reform plan. The HIAA launched the highly successful "Harry and Louise" ad campaign that raised doubts about the President's plan.
The opposition came even though HIAA shared many of Clinton's other goals, such as the employer mandate and universal coverage. Earlier this year, HIAA President Willis D. Gradison Jr. met with White House officials Harold M. Ickes and George Stephanopoulos and, during the course of a long conversation, suggested that an effective advertising campaign could be made to promote their common goals. In the end, those talks came to naught.
The combination of hesitant support from friends and unstinting opposition from foes has left many senior legislators and Administration officials exhausted and dispirited.
"Ultimately, a lot of us, a lot of groups, have to sublimate their concerns to some extent in order to get the group, the society, to be able to step forward and to change things for the better," said House Majority Leader Richard A. Gephardt (D-Mo.). "If everyone is just going to focus in on their narrow viewpoint on a particular issue, we're never going to get to the consensus that we've got to have in this society to move forward."
And after months of fighting, some in the Administration have begun, at times, talking in the language of post-mortems.
"You win some and you lose some, but at least you kind of pushed the ball and you keep moving the public debate," Hillary Clinton said in a recent interview. "So I think this is a political issue that is not going to go away, no matter what happens."
Times staff writers Karen Tumulty and Edwin Chen contributed to this story.