Clinton health plan

Jim Westrich westrich at
Wed Nov 17 11:29:38 PST 1999

At 10:22 AM 11/17/99 , wrote:
>>Wasn't Clinton's health care reform well intentioned at least in a limited
>>sens? Admittedly it had many problems, but if one really wanted to get
>>universal care then some compromises seemed necessary. A single payer
>>system would have been impossible.
>That's the conventional wisdom, but I think a single-payer system could
>have been rammed through in a well directed legislative blitzkrieg more
>easily than the Rube Goldberg contraption that Hillary and Ira Magaziner
>cobbled together in doomed effort to make nice to the insurance
>industry. Clinton really had Congress on the defensive when he waved that
>prototype National Health Insurance card in their face. He clearly had an
>opening for a bold move and failed to follow up.

Clinton's health security plan had one good thing--universality of coverage. It may have been able as well to set up some "quality" improvements through some practice standards and the like (I am being generous here but the "quality" provisions may have been better than the industry-led "quality" assurances now in practice). There were no "quality" guarantees in the sense that medical institutions had to take all-comers. The various tiers built into the system did mean continuing the separate care systems along income, class, geographic, and race gradients.

Everything else about the plan was worse for citizens than the existing or current situation. Nearly every person in the country would have had to pay more out-of-pocket (this was the shameful acquiescence to the insurance industry mentioned above). There were subsidies for the poor but people at 150% PL would have had to pay 20% of their health care premiums out of pocket in addition to the built in co-pays and deductibles (also in a little known provision the plan had the authority to garnish wages for people who did not pay in some other way).

Employers would have ended up paying less than their share. Insurers would have ended up in sweet mercantilist deals. And the share of health cost borne by the sickest would have risen. That is what managed care is really about, making the sickest and poorest pay and undermine as much of social insurance as possible.

>Hillary's and Ira's hubris in this affair -- their proposal seemed
>designed mainly to prove how wonderfully *smart* they were -- is worse
>than a blunder; it's crime -- the worst offense this Administration has
>committed short of dropping high explosives on people. There are
>something like 44 million medically uninsured Americans, I believe, and
>there is no higher priority in this country than giving these people the
>assurance of adequate health care.

I agree that this was some sort of weird graduate seminar version of naive pluralism in action. I do think that many compromises could have been reached to do quite well. I actually think with Presidential leadership there was a chance for a more egalitarian universal health care system. For example there was a bill to extend Medicaid to all uninsured that had the support of the majority of the House at the height of the "we gotta do something" frenzy (70-80% of the people in polls in the early 90's consistently said that something "radical" had to be done with the health care system).



"You gotta have peace and love if you want freedom"

-Janis Alexander

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