Democrats’ Plan Is Hiding in GOP Clothes : Health care: Republicans will take the worst of the Clintons ideas, plus cut Medicare and Medicaid, to balance the budget.

If Americans actually thought the Clinton health care reform plan was dangerous to their health, wait till they see what the Republicans have in store for them.

The Clinton health plan was built on a new and still untested concept called managed competition. Like later Democratic proposals, it envisioned a collectivization of Americans into cooperatives, organizations called managed care HMOs. Surveys indicating that people strongly favored individual care and their own choice of doctors were virtually ignored. The public mood was, however, confirmed in the 1994 elections when control of Congress was voted to Republicans.

The Republicans were elected to prevent any Clinton-like health care legislation from again being considered. But now a Republican-dominated Congress, in an attempt to balance the federal budget, has opted for much of what Clinton proposed. Even though most Americans reject managed care and for-profit HMOs (not many join HMOs without government or private sector coercion) as a type of social engineering, this Congress is rushing to adopt them. If the Republicans retain these same techniques, the voters, who repudiated this type of collectivized health care in 1994, will reject the GOP in ’96.

In its “contract with America,” the Republicans neglected to mention that they would balance the budget by taking the money from health care. The public, for example, was strongly in favor of some kind of health reform. Princeton economist and health care expert Uwe Reinhart has explained: “When Americans speak of health system reform, they typically do not think of revamping the mix of professionals and facilities that render health care. Instead, they think of the way health care is financed.” The Republicans, however, are using health care reform to attain their goal of balancing the federal budget in seven years. By cutting federal health care programs they believe they can accomplish this.

But at what cost? There is no doubt that Medicare, the federal government health insurance program for the elderly, and Medicaid, federal and state health insurance for the poor and elderly, are already under assault, and will probably be among the first programs severely cut. According to the Republicans, Medicaid will be financed by the states alone, helped with block grants from Washington.

State-of-the-art care and especially the first-class research that Americans, and the whole world, have come to rely on are jeopardized, being lobbied away in order to get the public collectivized from individual care into group care. Both President Clinton and House Speaker Newt Gingrich (politics makes strange bedfellows!) have separately decided to collectivize Americans and rapidly and secretly push them into HMOs. Clinton and Gingrich argue, for different reasons, that a necessary element in any government plan to save money also requires fixed budgets for health care spending and price controls on doctors and hospitals. And the public will pay more and get less.

The first step in this approach is a “leveling down” or the “reforming” of Medicare. This “reform” is accomplished magically by first withdrawing $270 billion from health care for the elderly over the next five years. Seniors will, at the same time, pay higher premiums to retain their choice of doctor. Then Medicaid will be shorn of $175 billion.

This strategy, the Republicans insist, is the health care reform the public wants. But patients are not consumers and health professionals such as doctors and nurses are not vendors or providers, to be exploited only for profit at the expense of the sick. The Republicans are simply offering in the “private sector” essentially the plan offered by Hillary Clinton and Ira Magaziner in the “public sector.” Again, the public won’t buy it.

Managed care, as it’s practiced today, is merely a form of “substitution for profit.” It is the substitution of a cheaper, second-class and perhaps less effective form of therapy, at the patients’ expense, even though Americans already spend more than $1 trillion in health care and research. Managed care also means substituting a different and cheaper drug for the one prescribed by the physician; a family physician is substituted for a specialist; nursing aides and others for graduate nurses. Sending mothers and newborns home 24 hours or less after delivery is a financial, not a medical decision. It is ultimately made by the HMO.

Although there surely are changes we should make in our health care system, the American people need the best of it. We shouldn’t destroy it for profit posing as cost containment. The challenge of health care reform is not rationing by government fiat but expansion of our quality health care, research and technology to all Americans.