Insurers’ Ads on Health Plan Are On Target : A cap on spending requires rationing. And don’t try ‘bribing’ your doctor for extras.

They may be the most unrealistic commercials since Summer’s Eve cast mom and daughter chatting over breakfast about douches. But they’re working.

The Clinton Administration and its allies are apoplectic over the Health Insurance Assn. of America’s television ads, in which “Louise” frets about the Clinton health plan to her husband, her business partner, even her parents at Thanksgiving dinner. Wrinkling her forehead and shaking her head, she says, “There’s gotta be a better way.”

The President and Hillary Clinton have attacked the ads as misleading and the insurers as self-interested. And Rep. John Dingell (D-Mich.) is threatening to drag the HIAA before his investigative subcommittee. The ads, he charges, “frankly have been so rich in innuendo and, quite honestly, falsehood, that I thought that we might just have a little inquiry into the advertisements.”

The ads are indeed full of innuendo, but they aren’t dishonest. “The government sets a ceiling on spending and says, ‘That’s it,’ ” says Louise. “But what if there’s not enough money? I mean, what happens then?” asks her partner, “Libby.” Libby’s unanswered question suggests that Clintoncare’s cost controls and government-set health-care budgets will mean that patients won’t be able to get care when they want it.

Far from a “falsehood,” this idea follows logically from the health-care plan’s own details. The President’s plan does, in fact, propose severe cost controls and strongly suggests that patients will want care they can’t obtain, even if they can pay for it.

Start with the national health-care budget. The plan declares that health-care costs won’t be allowed to rise faster than gross domestic product after 1999. This is a frighteningly unrealistic goal.

As people get richer, they tend to spend a larger share of their income on health care (and on other services, such as education and entertainment). So while spending on many products, such as food and clothing, grows more slowly than the overall economy, spending on health care grows more quickly. Subsidies such as Medicare and Medicaid accelerate the trend, but they do not create it.

The only way to stop that natural increase is to institute very serious rationing and eliminate any thought of new technologies. Maybe you can have 1965 health care at 1965 prices. But would you want it?

Even in Canada--the land of months-long surgery queues, where they cure kidney stones the painful old-fashioned way instead of buying lithotriters--health-care spending growth far exceeds the Clinton goal. Canadian health-care costs rose 1.2 points a year faster than GDP from 1970 to 1990.

Other industrialized countries had an even larger gap: 2.2 points for France; 2 points for Japan; 1.7 for Britain; 1.6 for Germany. From 1980 to 1985, by this measure, U.S. costs actually grew more slowly than Canada’s--2.8 points ahead of GDP versus 3 points in Canada. (The Clinton caps also mean that during recessions health-care spending must drop as the economy slows.)

The Clintons often suggest that their plan will cut costs mostly by new efficiencies. But any savings in paperwork and overhead will be a one-time cut; it will lower the spending base from which growth occurs, but it won’t affect the rate of increase. The plan’s real cost savings depend on its cost caps. To work, those caps will require stringent rationing.

And, in case we had any doubts about just how strict that rationing could be, the American Health Care Security Act contains a smoking gun: its prohibition against bribery. The Administration’s bill makes it a federal crime to pay off health-care providers, such as doctors, to influence the delivery of medical care.

Whatever Administration planner stuck in this provision was thinking a few steps ahead. Under the current system, after all, bribery isn’t a big issue, much less a crime. The new anti-bribery law envisions a Soviet-style system in which health-care services are so hard to get that patients will try to pay physicians or hospital administrators to jump to the head of the line, or to get treatment that otherwise wouldn’t be available. Such a system is the inevitable outcome of cost controls that push health-care spending below the level Americans would choose if left to their own devices.

Prison time for paying a hospital to let your dying mother have an operation that could save her life. Just wait until Louise hears about this.