Compromising Health Care

Published December 12, 1993 in North Shore Sunday.

First the good news:  We're no longer arguing over whether to adopt a national health care plan – we're just arguing over the plan's details.

The bad news is the man behind the plan is President Clinton, aka Captain Compromise.

Clinton's willingness to backpeddle showed up early in issues like gays in the military and sending troops to Bosnia.

Then there was the BTU tax, which he insisted was dear to him right up to the day he compromised it out of existence.

Saying he compromised in Somalia and Haiti is being polite.

Even when smoking dope, he compromised by puffing and not inhaling.

And this is the man who is bringing the US its long-overdue national health care plan.  It's been said that by the time Clinton finishes compromising on this issue, the health plan will be reduced to about a dozen kindly grandmothers traveling around the country kissing boo-boos.

Clinton so badly wants to pass a health care plan – any health care plan – that he compromised the plan right from the start, devising a politically palatable health plan rather than a first-rate one.

Clinton's plan is based on "managed competition."  In a perfect world, competition between insurers is supposed to drive premiums down and quality up.  But in the real world, competition means cutting costs, and often that means cutting quality.  Where do you cut quality in health care?

Insurers have already found ways.  Right now, insurers can restrict the treatment your doctor thinks you need, or determine how long you can stay in the hospital (kicking you out "quicker and sicker," as the saying goes).  The first rule of medicine is "Do no harm."  The second rule is fast becoming "Treat 'em and street 'em."

With the flexibility insurers will lose under Clinton's health plan, insurers will have to hunt even harder for ways to cut costs.  I don't know about you, but I'm not real comfortable with my insurer wheeling and dealing with hospitals, scratching for bargains with labs, or peeking over my doctor's shoulder.  When I need tests, I don't want my doctor sending me someplace called The Radiology Barn, or Yvette's Hair and X-ray Emporium, because that's who the insurer has a deal with.

In the "managed" part of managed competition, government is supposed to control medical coverages and costs.  But keep in mind that Congress just passed a law that was supposed to lower cable TV bills.  Of course, my cable bill immediately went up.  Managed competition?  Don't believe it.

Among its other problems, the Clinton plan is too complex, given its multiple coverage packages, multiple payers, and multiple versions between states.  Instead of all this, Clinton should have applied the KISS principle – keep it simple, stupid.  In fact, this president should recite a litany of self-admonitions each morning, like:

• Keep it simple, stupid.

• It's the economy, stupid.

• Don't promise what you can't deliver, stupid.

• Lay off the fries, stupid.

Private insurers have no place in an efficiently-run national health care plan, due to the cost, complexity, and self-interest insurers add to the mix.  Instead, we should adopt a single-payer plan, like the one proposed by Representative Jim McDermott of Washington.

But a single-payer plan is a hard sell in this country.  That's why Clinton proposed a multi-payer plan (a leader leads, a compromiser compromises).    Single-payer is a hard sell because of America's two remaining dirty words – the T-word and the S-word.

In a single-payer plan, we essentially insure ourselves through taxes, like Medicare insures older Americans.  But health care has to be paid for somehow, whether through taxes or insurance premiums.  Better to pay through taxes and eliminate the cost and bother of all the middle men.

Then there's the dreaded S-word.  Of all the proposed health plans, single-payer is the one that most sounds like (gulp) socialized medicine.  I can hear Rush now – "I mean, come on, over in Russia they're finally burying Lenin, for pete's sake, and here we're talking socialism?"

But lots of people support a single-payer plan.  It's not the radical, unworkable idea that some would have you believe.  If you think you and your family deserve a quality health care plan, let your Congressperson know.  It's not too late for the McDermott plan, which has about 90 House co-sponsors.  But if Clinton's plan becomes law, the world's only remaining superpower will be stuck with a health care plan that's inefficient, confusing, and above all, compromised.