The Commentariat Weighs In on HillaryCareII

Ron Brownstein of the Los Angeles Times (he'll soon be joining David Bradley's National Journal/Atlantic Monthly empire) suggests (like me) that her carefully crafted centrist proposal can avoid overt hostility from the usual opponents of universal health care:

Although Clinton recognizes that "there will be features" insurance companies won't like, and that many Republicans will recoil from any expansion of government's role, she's optimistic the plan can attract a coalition that includes elements of both groups. "People are much readier for change than they were in 1993 and 1994," she said in an interview. "There is a greater appreciation of what is at stake."

Amid the hurricane of words responding to Clinton's proposal, two reactions suggest that her analysis isn't just wishful thinking. In 1994, John Breaux, a skilled deal-making Democratic senator from Louisiana, helped design a bipartisan Senate alternative to the Clinton plan, which he considered too partisan and rigid. Breaux, now a lobbyist, says her new proposal "is something that can find support in both parties."

The other intriguing response comes from Karen Ignagni, president of America's Health Insurance Plans, the industry trade association. She didn't like the rhetorical broadsides that Clinton gratuitously directed at the industry on Monday. But Ignagni praised Clinton's tax credit and said her insurance reforms might be acceptable to insurers as long as they are linked to a mandate on individuals to buy coverage. "It's a whole new game when you bring everyone into the system," Ignagni said.

Much of the Democratic healthcare debate is turning on which candidate will be toughest on insurance and drug companies. The better question is who is shrewd enough to reform those firms' practices without provoking them into a full-scale war that would also preempt the possibility of meaningful support from congressional Republicans.

Meanwhile, Steve Pearlstein of the Washington Post asks Sen. Clinton specifically and the Democrats generally to commit political suicide. He writes:

there are lots of trade-offs implicit in version 2.0 of the Clinton Health Plan, and it would be better for the cause of health reform, and for Clinton's candidacy, if she began to educate the public about them.

Everyone agrees that automated health records are a great idea and will save a ton of money. But someone (the government) has to set the standards and require that doctors, hospitals, and labs invest the upfront money for software and equipment.

And while everyone can rally around paying for performance, shouldn't someone point out that, in practice, that will mean some providers will be paid less while others may be forced out of business?

Mandating that everyone have basic and affordable insurance is the easy part. Less easy is acknowledging that an affordable policy may not cover everything you'd like.

The reality of Sen. Clinton's plans are that she kicks most cost-saving measures off into the future. Press accounts suggest her plan would pour an additional $110 billion into health care to cover the uninsured. It would spell out the basic package that all plans must cover, including mental health parity and dental insurance. It is, in essence, an expansion of coverage for many if not most Americans. The cost savings in her plan that might come from electronic medical records reducing duplication and medical errors or limits on certain tests and procedures because they've been shown through research to be the same or less effective than less costly approaches are off in the future.

To begin educating Americans now about those limitations on "choice" would put a big fat bullseye on her or any candidates' back. Look at what the Wall Street Journal had to say on its editorial page this morning:

HillaryCare II is designed to cause minimal disruptions to current private insurance coverage in the short run, while dressing up the old agenda with slightly different mechanisms and rhetoric. Rather than fight small business, this time she is trying to seduce it with tax credits for small companies that provide insurance. Only later when costs rise will the credits shrink or other taxes rise. To court large manufacturers, like the auto and steel industries, she'll offer another, "temporary" tax credit to subsidize their health-care liabilities. Her plan, in short, is HillaryCare I in better clothes -- a transitional platform to shift people to the default option, which is government insurance.

As usual, the Journal's news columns get right what its editorial page misconstrues. Its headline reads: "Why Clinton Embraced Employer-Based Insurance; Candidate Discovers Workers and Bosses Attached to Status Quo." The story quotes Clinton: "We looked at every permutation of how you get to universal health care. There's great attachment to the employer-based system, even though it is eroding."

The Journal editorial fulminates at its conclusion that the only creativity in Clinton's plan is its political shrewdness. I definitely agree with that sentiment. It's going to take political shrewdness if we're ever going to get universal health insurance in this country. And I'm increasingly convinced, along with Clinton, that we're going to have to get that job done before we can turn to the more critical task of delivering better health care that is affordable.

Posted by gooznews at September 19, 2007 08:44 AM