PERSPECTIVES ON HEALTH CARE : In Form and Belief, the Clintons’ Plan Rings True : The GOP alternatives, though worthy, do not control costs or provide a framework to fix the system as a whole.
President Clinton is trying to break through decades of paralysis in Washington with his blueprint for health-care reform. He has articulated a fundamentally sound set of principles--security, simplicity, savings, choice, quality and responsibility--and a fundamentally sound set of structures for getting there. The alternatives being put forward by Gov. Pete Wilson and the Republican congressional leadership are piecemeal by comparison.
First and foremost, Clinton has insisted on universal coverage that is not tied to employment status. This is not just a moral imperative; it is the only practical way to avoid the current system’s disastrous “cost shifting.” For example, the uninsured now get urgent and emergency care in hospital emergency rooms--the most expensive possible setting--and the cost is absorbed by all other participants in the health system. Similarly, some insurance customers (large businesses; the young; the healthy) pay far less than others.
The President also has insisted that the benefits provided to all Americans be comprehensive; that consumers have the opportunity and knowledge to choose among providers, courses of treatment and health plans; that costs be distributed fairly; that much of the administrative waste in the health system be eliminated; that the resources available to the health system stay in balance with society’s other needs; and that states have discretion to design and implement their own health systems within the federal framework.
This system would operate according to these new and fairer ground rules, but would build on the private health-care delivery that most Americans know and rely on, including the plans and providers that have delivered the best medicine in the world.
Which brings us to the alternative--known as “incremental” insurance reform--proposed by Gov. Wilson and congressional Republicans. It is too little, too late for America’s real needs.
Most incremental proposals focus on insurance market reforms--limiting the ability of insurers to reject groups or individuals with undesirable health histories; eliminating or limiting the imposition of “pre-existing condition exclusions;” and limiting the difference in premiums charged to sick and healthy groups. Market reforms may also create voluntary “purchasing pools” for small employers or even individuals.
I strongly supported the enactment of insurance reforms in California last year and am vigorously enforcing the reforms that passed. But, while these do prohibit some of the worst abuses in the private insurance market, by themselves they cannot remedy our health care system.
The Republican proposals would not make health coverage universal, control wildly escalating costs, eliminate cost-shifting from one segment of society to another or make insurance affordable for people outside the work force or whose employers do not cover them. In California, the majority of the uninsured are workers or their dependents, many of them in low-wage, high-turnover jobs where employers are unlikely to provide insurance.
True, some of California’s reforms are noteworthy, particularly the establishment of a voluntary, statewide purchasing pool for small employers that began providing coverage July 1. Gov. Wilson has made the program the centerpiece of his reform effort, but its director, citing universal coverage as the real goal of reform, says bluntly: “We’re doing wonderful things here, but it isn’t enough.” While the pool offers good benefits at attractive rates, employers are not required to join.
In contrast, one of the key contributions of the Clinton plan is his emphasis on a uniform package of comprehensive benefits for all Americans.
Finally, while all small-group reform proposals limit rate differentials between the highest-risk and lowest-risk groups, they do not curb overall spending or administrative duplication. There is ample reason to believe that a rationally constructed comprehensive health system would cost substantially less per capita than we pay today. Every other major industrial country provides health care to all of its people for 10% or less of gross domestic product, compared with our own 14%. The portion of our health insurance premium dollar paid for administrative costs is estimated at about 25%, an inappropriate amount by the calculations of all sides.
No one ever said that achieving universal coverage would be easy. The hovering army of policy analysts, number crunchers and lobbyists would be remiss if they did not scrutinize all aspects of any proposal to overhaul our health system, starting with the adequacy and fairness of the financing, its most controversial aspect.
But true health-care reform must meet the needs of every American, including workers who have seen their benefits erode from year to year, the catastrophically ill who have been excluded from small-business coverage so that everyone else in the group could afford coverage, parents of multiply disabled children who have exhausted their lifetime caps in the first year of life, small-business owners who cannot afford coverage at all, corporate executives whose international competitiveness is threatened by escalating health costs and providers whose ability to treat patients is compromised by paperwork and bureaucracy.
Clinton has wisely made it clear that he welcomes the inevitable debate and discussion that his proposal has set in motion and that he seeks the partnership of Congress and of all who have an interest in the crafting the legislation. He deserves the unstinting support of all Americans, since all of us, as individuals and as a nation, will benefit from the adoption of a national health plan.
