HILLARYCARE'S 'GROUNDHOG DAY'Phil: Do you know what today is?
Paul Howard, Ph.D.
New York Post
September 18, 2007
Rita: No, what?
Phil: Today is tomorrow. It happened.
— "Groundhog Day" (1993)
"I've tangled with this issue before, and I've got the scars to show for it." — Sen. Hillary Clinton, 2007
IN "Groundhog Day," Bill Murray plays an arrogant, self–obsessed weatherman who is condemned to relive Groundhog Day until he learns to care more about others than himself. For better or worse, health care is Hillary Clinton's Groundhog Day.
Ever since the Clinton administration's bid to enact universal health care imploded in 1994, Hillary has been linked to that failure—accused of handling the plan in a way too secretive, too arrogant and, ultimately, too bureaucratic to get it past Congress.
Yesterday, Sen. Clinton released her "Health Choices" plan, an attempt to prove that, as a presidential candidate, she's learned from her earlier mistakes and can craft a consensus plan that will generate broad popular support. If it succeeds, she can recast her image and put the past behind her. If it fails, she's doomed to experience the same failure and frustration she did 13 years ago.
Clinton's rivals for the Democratic nomination were quick to criticize her new plan. Sen. Barack Obama jabbed that "the real key... is the ability to bring people together in an open, transparent process that builds a broad consensus for change." And ex–Sen. John Edwards said, "If you're going to negotiate universal health care with the same powerful interests that defeated it before, your proposal isn't a plan, it's a starting point."
Does that mean Sen. Clinton is doing something right? Certainly, she seems to have learned some lessons.
First, her plan starts with a mandate requiring that individuals buy their own health insurance, along the lines of the 2006 Massachusetts reform. The individual mandate drives home a message of personal responsibility—a selling point that has been popular with independents and some conservatives. The jury is still out on the Bay State experiment, but several other states, including California, are considering similar laws.
Second, this plan builds on today's system rather than replacing it with a government–mandated plan. "If you like the insurance you have now, you won't have to change a thing," she promises. That's smart: Americans complain about health care in general, but surveys show that they're usually happy with their own coverage. Fear of being thrust into a government–run plan and losing your own doctor helped sink HillaryCare in '94.
Finally, Sen. Clinton co–opts conservative rhetoric by couching her plan in terms of individual choice. She'd allow Americans who don't receive health coverage through their employer, or who don't want that coverage, to buy their own plan through a "Health Choices Menu," including the "same set of insurance options that their member of Congress has." The menu of plans would be offered through the Federal Employees Health Benefit Program—which, Clinton says, means no new federal bureaucracy.
Several other parts of the Health Choices plan, however, harken back to HillaryCare. The plan goes out of its way to bash the insurance industry, and calls for guaranteed issue (meaning no one can be denied insurance) and community rating (meaning insurers couldn't significantly vary their rates according to age or health status).
This will raise prices for younger, healthier applicants—which tends to drive them out of private health–insurance markets altogether. That has already happened in guaranteed issue/community rating states like New York and New Jersey, which have some of the nation's highest health–insurance rates in the country.
Second, Clinton aims to offer a public plan (perhaps modeled on Medicare) to compete with the private plans, in order to "provide a more affordable option, in part through greater administrative savings." Translation: a subsidized plan that will be cheaper than the private plan offerings, and thus will tend to undermine private insurance markets.
Third, in the name of prevention, the government would mandate many more health–care services of dubious value—which would drive up the cost of private insurance and lead to longer waits for many services.
America is in the midst of a shortage of primary–care docs (partly because the low reimbursements paid by Medicare and Medicaid have driven physicians out of the primary–care field). Yet Hillary plans to launch tens of millions more patients into mandatory preventive services—services provided by primary–care doctors.
At the end of the day, while Clinton's "Health Choices" plan poses as centrist, it's still a top–down program that sees government as the ultimate solution for America's health–care woes.
In April, Hillary spoke at a small gathering in New York. The Politico reports that she was asked why "she continues to see the solution... as private insurance, rather than a single-payer national system?"
"Well, I didn't say that," she told the audience. If Democrats pick up several more Senate seats in the next elections, she said, "Medicare for All... would be to something to be considered."
Sen. Clinton is a smart, pragmatic political operator, and her latest health–care plan reflects that savvy. But, when push comes to shove, her agenda hasn't changed.
Welcome to Groundhog Day.
Paul Howard is a senior fellow at the Manhattan Institute's Center for Medical Progress and managing editor of its health-care Web site, MedicalProgressToday.com.