Senator Hillary Clinton (D., N.Y.) has unveiled a fairly comprehensive health proposal that differs in key respects from her 1993-model. The new proposal covers a vast amount of territory: health-insurance options for employers, employees and the uninsured; new national rules for health insurance; new mandates on employers as well as individuals; new financing arrangements, and promised savings from a variety of measures, including targeted cuts to private health plans in Medicare and government drug pricing. Each one of these items could fill out a health policy briefing book a foot thick, and at some point those three-ringed volumes will appear.
It will be some time, though, before the details - and the devils lurking within them - will emerge. While the outline is certainly different from the earlier model, one detects similar themes:
- The financing relies on targeted Medicare reduction, employer
mandates and, of course, "revenue enhancements" that will come with
the promised end of the hated Bush tax cuts. It is unclear just how
many times Washington can expect to repeal the Bush tax cuts.
- The plan would further the centralize Washington's control over
health-care delivery, including detailed federal regulation of the
health insurance markets,
- Government is expected to trump competition when it comes to eliminating economic inefficiencies. The plan seems to envision a brainy bunch of experts gathering anew in the West Wing or HHS to hammer out all the fine points of arcane insurance regulations-including complex underwriting rules and the right "stop-loss" ratios-that will produce health policy Nirvana: "the provision of high quality care, not excessive profits and marketing."
That old-fashioned central planning is objectionable on philosophical and practical grounds. Moreover, Senator Clinton's timing is wrong. Insurance markets differ radically in the states, and innovative state leaders are experimenting with different insurance rules for expanding both consumer choice and competition. Washington did not know best in 1993, and it still doesn't.
Robert E. Moffit is director of the Center for Health Policy Studies at the Heritage Foundation.
First appeared in the National Review Online