Hillary Rodham Clinton had it right all along.
Every new initiative from the White House, every counter-move by the Republican Congress, all point to the wisdom of the health insurance reform that the first lady and her task force proposed back in 1993.
Hardly anybody concedes this, not even her husband. It’s still uncool to support a big plan from Washington, especially one from a strong, intelligent woman. (The latter still being a handicap in American pop/political culture.)
But Mrs. Clinton pretty much covered all the bases. Which would be water over the dam . . . were it not for the likelihood that a much worse system is headed our way.
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Or did you think we could limp as is?
Not that it’s that bad. Everyone gets care in America, whether you’re filthy rich, dirt poor, in jail or just off the bus from someplace else. Not everybody gets Cadillac care and there’s a scandalous lack of preventive services for the poor, but our emergency rooms don’t turn people away.
The problem is paying for it all.
The situation was desperate in 1993, following a decade of double-digit annual increases that hurt our economic competitiveness and punched holes in federal and state budgets.
Hillary & Co.’s plan, though likened to “Mein Kampf,” was deceptively simple for its book length: 1) Make America’s existing private, employer-based health-care system universal by mandating that all companies, directly or indirectly, contribute toward their employees’ health insurance; and 2) set up a government-regulated arena for “managed competition” in which both HMOs and regular indemnity plans would compete for business, including the business of those whose premiums would be paid by the government’s Medicare and Medicaid programs.
There were drawbacks, especially its imposition of price controls that would have led to the rationing of care. These problems could have been ironed out in congressional negotiations. Instead, politics and special interests ruled the day. Non-insuring employers, whose workers’ medical bills are shifted onto everybody else, didn’t want to give up their free ride. The doctors’ lobby didn’t like Hillary’s promotion of managed care. The insurance industry, in a move it will one day regret, savaged the proposal with “Harry and Louise” TV ads, no doubt hoping their slice of medical inflation would keep rising forever.
So “Hillarycare” went down. And then, something unforeseen happened.
Big corporations seized on managed care and HMOs as the most efficient way to get maximum care for minimum dollars. Premiums stabilized. Soon a majority of working Americans were enrolled in managed care, and the doctors’ lobby, which would have had considerable influence under Hillary’s plan, became marginalized. Indeed, the medical associations have been reduced to begging Congress and state legislatures to force HMOs to hire their members and abide by their medical opinions.
The only winners have been those non-insuring employers, whose workers still ride free in what the policy wonks call “cost shifting.”
But the do-nothing option of 1993 is coming unglued. HMOs don’t like to pay the bills of non-members, so they are not letting hospitals pad the tab with shifted costs. Hospitals are failing and patients are complaining. And all the while, the number of uninsured people continues to climb as corporations downsize their core (full benefits) work forces, and as more small companies drop coverage, preferring to be subsidized rather than subsidize others.)
Not surprisingly, the number of uninsured Americans–43 million and rising–is becoming a political force in its own right. No longer confined to burger flippers and day laborers, the new uninsured include millions of laid-off managers and self-employed “consultants.” With assets to protect, like houses and 401(k) balances, they are desperate for coverage yet can’t afford outlandishly priced individual premiums.
This is the force Bill Clinton hopes to tap with his proposal to let the laid-off “buy-in” to Medicare, beginning at age 55.
But that’s just the beginning. As insurance anxiety spreads, a new majority will clamor to go on Medicare, or something like Medicare. The wonks will call it a universal, single-payer system. Corporations will welcome it, glad to have the health care monkey off their backs. A handful of the largest insurers will survive . . . but only as contractors to administer the federal program. It will be totally tax-funded, impersonal and expensive. Very expensive, because government, the single-payer, won’t be able to say no to patients (voters) or providers (special interests).
So good-bye balanced federal budget. Hello, Medicare for all.
All because we wouldn’t take advice from a strong woman.