As simply and directly as I could, I explained the problem—that our system cost too much and covered too few—and outlined the basic principles of our plan: security, simplicity, savings, choice, quality, and responsibility. Everyone would have coverage, through private insurers, that would not be lost when there was an illness or a job change; there would be far less paperwork because of a uniform minimumbenefit package; we would reap large savings through lower administrative costs, which were then significantly higher than those of other wealthy nations, and a crackdown on fraud and abuse. According to Dr. Koop, that could save tens of billions of dollars.
Under our plan, Americans would be able to choose their own health plan and keep their own doctors, choices that were vanishing for more and more Americans whose insurance was carried by health maintenance organizations (HMOs), which tried to hold down costs by restricting patient choices and conducting extensive reviews before approving expensive treatments. Quality would be assured by the issuance of report cards on health-care plans to consumers, and the provision of more information to doctors. Responsibility would be enforced across the board against health insurance companies that wrongfully denied care, providers who padded their bills, drug companies that overcharged, lawyers who brought bogus suits, and citizens whose irresponsible choices weakened their health and exploded costs to everyone else.
I proposed that all employers provide health insurance, as 75 percent of them were already doing, with a discount for small-business owners who otherwise couldn’t afford the insurance. The subsidy would be paid for by an increase in cigarette taxes. Self-employed people would be able to deduct all the costs of their health-care premiums from their taxable incomes.
If the system I proposed had been adopted, it would have reduced inflation in health-care costs, spread the burden of paying for health care more fairly, and provided health security to millions of Americans who didn’t have it. And it would have put an end to the kinds of horrible injustices I had personally encountered, like the case of a woman who had to give up a $50,000-a-year job that supported her six children because her youngest child was so ill she couldn’t keep her health insurance, and the only way for the mother to get health care for the child was to go on welfare and sign up for Medicaid; or the case of a young couple with a sick child whose only health insurance came through one parent’s employer, a small nonprofit corporation with twenty employees. The child’s care was so costly that the employer was given the choice by its insurer of firing the employee with the sick child or raising the premiums of all the other employees by $200. I thought America could do better than that. Hillary, Ira Magaziner, Judy Feder, and all those who helped them had crafted a plan that we could implement while reducing the deficit. And contrary to how it was later portrayed, health experts generally praised it at the time as moderate and workable. It certainly wasn’t a government takeover of the health-care system, as its critics charged, but that story came later. On the night of the twentysecond, I was just glad that the TelePrompTer was working. Toward the end of September, Russia dashed back into the headlines, as hard-line parliamentarians tried to depose Yeltsin. In response, he dissolved parliament and called new elections for December 12. We used the crisis to increase support for our Russian aid package, which passed the House, 321–108, on September 29 and the Senate, 87–11, on September 30.
By Sunday, October 3, the conflict between Yeltsin and his reactionary opponents in the Duma erupted into a battle on the streets of Moscow. Armed groups carrying hammer-and-sickle flags and portraits of Stalin fired rocket-propelled grenades into the building that housed a number of Russian television stations. Other reform leaders in former Communist countries, including Václav Havel, issued statements in support of Yeltsin, and I did, too, telling reporters that it was clear that Yeltsin’s opponents had started the violence, that Yeltsin had “bent over backwards” to avoid using excessive force, and that the United States would support him and his effort to hold free and fair elections for parliament. The next day Russian military forces shelled the parliament building and threatened to storm it, forcing the surrender of the rebellion’s leaders. Aboard Air Force One, on my way to California, I called Yeltsin with a message of support.
The battle in Moscow’s streets was the top news story across the world that night, but the news in America led with a different story, which marked one of the darkest days of my presidency and made famous the phrase “Black Hawk Down.”
In December 1992, President Bush, with my support, had sent U.S. troops to Somalia to help the UN after more than 350,000 Somalis had died in a bloody civil war, which brought famine and disease in its wake. At the time, Bush’s national security advisor, General Brent Scowcroft, had told Sandy Berger they would be home before my inauguration. That didn’t happen because Somalia had no functioning government, and without our troop presence, armed thugs would have stolen the supplies the UN had been providing and starvation would have set in again. Over the next several months, the United Nations sent in about 20,000 troops and we reduced the American force to just over 4,000, down from 25,000. After seven months, crops were growing, starvation had ended, refugees were returning, schools and hospitals were reopening, a police force had been created, and many Somalis were engaged in a process of reconciliation moving toward democracy.
Then, in June, the clan of Somali warlord Mohammed Aidid killed twenty-four Pakistani peacekeepers. Aidid, whose armed thugs controlled a good part of the capital city of Mogadishu and didn’t like the reconciliation process, wanted to control Somalia. He thought he had to run the UN out to do so. After the Pakistanis were killed, Secretary-General Boutros-Ghali and his representative for Somalia, retired American Admiral Jonathan Howe, became determined to get Aidid, believing the UN mission could not succeed unless he was brought to justice. Because Aidid was well protected by heavily armed forces, the United Nations was unable to apprehend him and asked the United States to help. Admiral Howe, who had been a deputy to Brent Scowcroft in the Bush White House, was convinced, especially after the Pakistani peacekeepers were killed, that arresting Aidid and putting him on trial was the only way to end the clan-based conflicts that kept Somalia mired in violence, failure, and chaos. Just a few days before he retired as chairman of the Joint Chiefs of Staff, Colin Powell came to me with a recommendation that I approve a parallel American effort to capture Aidid, though he thought we had only a 50 percent chance of getting him, with a 25 percent chance of getting him alive. Still, he argued, we couldn’t behave as if we didn’t care that Aidid had murdered UN forces who were serving with us. Repeated UN failures to capture Aidid had only raised his status and tarnished the humanitarian nature of the UN mission, I agreed.
The American commander of the Rangers was Major General William Garrison. The army’s Tenth Mountain Division, headquartered in Fort Drum, New York, also had troops in Somalia under the overall commander of U.S. forces there, General Thomas Montgomery. They both reported to Marine General Joseph Hoar, the commander of the U.S. Central Command at MacDill Air Force Base in Tampa, Florida. I knew Hoar and had great confidence in his judgment and ability. On October 3, acting on a tip that two of Aidid’s top aides were in Mogadishu’s “Black Sea” neighborhood, which he controlled, Major General Garrison ordered the Army Rangers to mount an assault on the building where the men were thought to be. They flew into Mogadishu in Black Hawk helicopters in broad daylight. It was a much riskier operation during the day than it would have been on a dark night, when helicopters and troops are less visible and their night-vision devices give them the ability to operate as well as they can in daylight. Garrison decided to take the risk because his troops had carried out three previous daylight operations successfully.