The Clintons’ Health Care Plan: Look Again Before We Leap

It is becoming obvious that the enormous edifice of ambitious reform represented by Bill and Hillary Rodham Clinton’s health care proposal needs to be tinkered with more than just around the edges.

That conclusion fills us with no great joy. U.S. health care may or may not be in “crisis”--a much overused word--but it certainly is in a great deal of difficulty. Far too many Americans can’t afford care, and those who can are paying too much for less and less.

During his election campaign President Clinton promised action and the American people applauded; and during the first year of his presidency he, his top advisers and, most notably, the First Lady worked hard to propose a set of coherent reforms. Not surprisingly, the people support that effort. Across widely divergent groups there now is broad consensus that health care coverage needs to be made as universally available as possible and that the feverish rise in costs needs to be cooled.

WHAT IS THE REAL NEED?: When millions have no health insurance and thus cannot get proper routine and preventive care, all of us, whether through the specific risk of communicable disease or the general lowering of the public health, are affected. Tens of millions are shut off from everything other than emergency care. Worse yet--and this is the Great American Health Care Paradox--the nation continues to pay out, year after year, an ever-greater percentage of its national wealth to health care.

THE PRESIDENT’S RESPONSE: The President and the First Lady--activist Democrats with a moderate, healthy tendency to want government involved--have presented an extraordinarily detailed and ambitious blueprint for national health care reform. Perhaps not since Franklin D. Roosevelt’s New Deal--certainly at least not since Lyndon B. Johnson’s Great Society--has there been such a comprehensive effort at redoing social policy.

One shortsighted contention--largely from overly partisan Republicans--is that the national health care problem has been overstated and therefore the proposed remedy is overwrought.

The problem definitely has not been overstated. But, and it’s a big but , the proposed remedy--”The President’s Health Care Security Plan”--may be the wrong medicine. In the final analysis the Clintons may well be proven better diagnosticians than surgeons.

THE OVER-ENGINEERING: What is proposed is incredibly complex. It is a daunting pastiche of idealism, federal interventionism and public policy modeling that is awesome and even a little frightening. It raises concern over the kind of controls the Clintons would have government exercise.

The fear within the medical community is that individual medical decisions might be made in the abstract by bureaucrats. That fear needs to be fully addressed.

Our sense is that the proposal’s reach needs to be more modest, the phasing in of reforms more gradual, the articulation of and public education on the choices and trade-offs more completely aired.

While the American system is no doubt the costliest in the world, it is by no means the worst: On the contrary, many aspects of the existing system work very well. And those are surely worth noting--not to mention saving.

California, for instance, has a nationally admired health insurance system for public employees, run by CalPERS, that controls costs and keeps quality high. If the Clintons’ plan were to pass intact, the CalPERS health plan would be history, superseded by regional health alliances. These alliances--purchasing and administrative Goliaths--would cross state boundaries and presumably roll over everything in their way. Doesn’t that make you just a tad uneasy?

A NECESSARY CORRECTION: The plan needs to be reconsidered, but not in the semi-secrecy that characterized its formative stage last year. Reconsideration needs to be on glass-house display, wholly public in the various congressional committees. And the process needs to answer such basic questions as:

--If the plan is an effort to establish a new federal entitlement program, is that what America wants, given the fact that it is the many government entitlement programs that fuel government deficits?

--Is it possible that a more creative use of powerful federal tax laws, to encourage universality of coverage and reduction of health care inflation, might in the end prove to be a more effective engine of reform than building new bureaucracies?

--How will the plan affect employment and business activity if, as envisioned, employers are required to contribute the lion’s share of the insurance costs?

--Would it not make more sense to start the reform with a minimum of coverage--a bare-bones plan--and then ever so gradually and very carefully phase in new layers of benefits? Universality of coverage, absolutely; cost-consciousness, yes; but a basic menu first.

--Would it not make sense to have a system that retained not only good state health care programs (like Hawaii’s, and like California’s if state Insurance Commissioner John Garamendi’s plan were adopted) but also good public employee programs like CalPERS?

--Would it not make sense for the federal government to set health care reform standards for the states to meet, rather than to impose over the states regional entities and therefore a federal plan?

Health reform is essential, but the nation needs to look further before it leaps. Americans need to hear out the criticisms and alternatives. After all, it’s their health that’s at stake.