Clinton offers health proposal

For Hillary Rodham Clinton, the healthcare system has been a political danger zone since she unsuccessfully tackled the issue as first lady in the early 1990s.

Health insurers and conservatives vilified Clinton for her efforts then, and Congress reacted coolly to her presentation of a universal healthcare plan as a fait accompli after months of secret meetings. The “Harry and Louise” commercials, aired by the insurance industry, mocked her effort, and the plan’s perceived complexity made it a laughingstock in some quarters.

On Thursday, as a Democratic candidate for president, New York Sen. Clinton returned to the topic, acknowledging mistakes and promising to do better.

“Now, I’ve tangled with this issue before, and I’ve got the scars to show for it,” Clinton told an auditorium packed with medical students and doctors at George Washington University. “But I learned some valuable lessons from that experience. One is that we can’t achieve reform without the participation and commitment of healthcare providers, employers, employees and other citizens who pay for, depend upon and actually deliver healthcare services.”

Clinton offered a proposal Thursday focused on reining in healthcare costs. Two other proposals are expected -- one seeking to improve the quality of healthcare and the other to insure all Americans. She has already introduced legislation in Congress to expand healthcare coverage to all children.

The proposals represent her effort to counter an image she has had among doubters -- at least since her 1993-94 healthcare push -- as imperious, committed to big government and certain that she knows best.

A recent Kaiser Family Foundation survey showed that healthcare ranked second in the minds of voters as the most important problem for government to address, after the war in Iraq. Republicans, Democrats and independents all gave healthcare the same weight. In previous polls, the issue had been tied with or slightly behind the economy as an area of concern.

President Drew Altman of the Kaiser Family Foundation -- a national, independent health philanthropy unrelated to Kaiser Permanente -- said voters were having trouble identifying which presidential candidate would best address their concerns on healthcare. But Clinton has a head start on the issue, he said.

“Even though there was a great failure in the ‘90s, voters associate her with the issue and know she cares deeply about the issue,” Altman said.

A rival for the Democratic presidential nomination, Sen. Barack Obama of Illinois, is expected to lay out his own vision Tuesday for bringing down healthcare costs and expanding coverage. Former Sen. John Edwards (D-N.C.) has already proposed insuring all Americans by 2012. Currently 45 million are uninsured.

On Thursday, Clinton argued that healthcare costs were out of control. Among the evidence she cited: Premiums have almost doubled since 2000; the nation spends 16% of its gross domestic product on healthcare; 30% of the cost increase is related to the doubling of obesity among adults during the last two decades; and administrative costs are the highest in the world.

“If we spend so much, why does the World Health Organization rank the United States 31st in life expectancy and 40th in child mortality, worse than Cuba and Croatia?” she asked.

As president, Clinton said, she would focus on prevention -- keeping people well rather than treating them after they become sick. Treatment is more expensive, she said.

“Under my reforms, all Americans will have access to comprehensive preventive care, which will save money in the long run,” she said, noting that only 38% of adults were getting screened for colorectal cancer and that about 20% of children were not getting immunized against preventable diseases.

She said she would require all insurers that participated in a federal health program such as Medicare or Medicaid to cover prevention, such as cancer screening and immunizations. Switching from paper medical records to electronic records would also save money, she said.

Clinton said she wanted individuals and small businesses to have access to larger insurance pools to reduce costs and stop insurance companies from discriminating against those with preexisting conditions.

“The whole point of insurance, lest we forget, is to spread risk across a group of enrollees,” she said. “It’s one of the reasons that the administrative costs of Medicare are so much lower -- because they are actually insuring everyone.”