Monday, September 17, 2007

Clinton-care Redux

Health care reform is back, and so is Hillary Clinton. In 1993, she played a prominent role in developing the Clinton administration's plan to reform the health care system. At the time, change seemed inevitable due to rising costs and growing ranks of uninsured. Everyone was offering reform plans (I remember attending a presentation of a universal health insurance plan from the right-wing Heritage foundation!). However, the Clinton plan did not get through Congress, there was no "reform," and 14 years later costs are higher and even more Americans are uninsured.

The ill-fated reform attempt seems to have entered national mythology as follows: In 1993, a secret cabal led by the First Lady - Bill's "liberal" (gasp!) wife - concocted a complicated scheme to impose "socialized" (gasp gasp!) medicine on the United States. That's basically what many people seem to think, but its simply not true.

In The American Prospect, Paul Starr provides an extremely useful debunking of "The Hillarycare Mythology." He knocks down a number of misconceptions about the 1993 episode. Most importantly, the Clinton plan was not "socialized" medicine - it gave consumers choices among private insurers. Here's Starr's characterization of the way the plan would have worked:
The basic idea was not complicated. Consumers, not employers, would choose health plans. Firms would pay into a regional health insurance purchasing cooperative (later called an "alliance" in the Clinton plan), which would offer private plans of varying types to all residents under age 65 in an area (Medicare would remain separate). The alliances would be required to offer traditional, fee-for-service insurance as well as health maintenance organizations and preferred provider plans. Benefits, copays, and other features would be standardized so as to make it easier for consumers to compare prices and get the best value for money. Health plans would have to offer coverage to everyone without exclusions of preexisting conditions, and they would be paid according to the characteristics of the population they enrolled...
Once more into the breach, candidate Clinton has offered her plan. Here's the NY Times story, and an assesment by Ezra Klein.
Another useful thing to read on this topic is "The Health of Nations," a comparison of national health care systems in The American Prospect by Ezra Klein.

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