Herman Cain’s first brush with political fame was a standoff he had with President Bill Clinton during the fight over the 1994 health-reform proposals. Conservatives thought Cain had gotten the best of the president. He became an instant star. Watching the exchange now, I’m mostly impressed by how sedate it is, and how effortlessly Clinton can rattle off facts about the food-services industry. And knowing what has happened since, the trivia of the video comes to look more like tragedy. Ryan Cooper sums up the last 20 years for health care and small businesses:

Because of rising costs, starting in the late nineties, small employer coverage was steadily eroded, down from 65 percent offering coverage in 1999 to 59 percent in 2009, compared to 99 percent of large businesses. More small firms contribute nothing to their employee plans than large firms (for singles, 35 percent versus 7 percent; for families, 14 percent versus 2 percent), and their employees face increasingly higher deductibles.

And here are premiums just since 1999:

(Kaiser Family Foundation)

Looking back, the failure of the Clinton reform process was a real tragedy. If we had passed Clinton’s plan, or one of the compromise alternatives, the debate over how to cover all Americans would have been settled, and we would have been working on the mechanics of health-care reform — which mainly amount to cost control — for the last 20 years.

As it is, we’ll never get that time — or that money — back. Even if the Affordable Care Act is implemented and proves far more successful than its most enthusiastic backers hope, it will only slow the rate of cost growth from here on out. It won’t undo the premium increases that came while we twiddled our thumbs for two decades.