Top of the News: Commentary
THREE FIBS THAT WON'T HELP HEALTH REFORM
When a doctor brandishing a hypodermic says soothingly, "Now this won't hurt a bit," an anxious child isn't fooled. Any kid who has had shots knows better.
Drs. Hillary and Bill Clinton suffer a similar credibility problem as they urge their health-care elixir onto a worried nation. And there's ample basis for doubt. Clinton's health plan employs at least three lies--ranging from a fib to a whopper--in claiming the government's medicine won't sting:
"Everyone will have the right to choose his or her doctor." The Administration knows nothing will outrage the 85% of Americans who already have insurance more than an order to change physicians. So in a sales pitch made to Congress in late August, it pledges to "preserve choice of doctors" and slams employers for doing less: "To cut costs, many employers are forcing their employees into managed-care plans--often forcing employees to leave their doctor."
But how does Clinton aim to curb costs? Through health maintenance organizations and provider groups that restrict patients to doctors and hospitals within their network. The plan lets you pick and choose among networks. But if Dad's internist and Mom's ob/gyn wind up in different plans, they will have to leave one--or pay a stiff price to keep both.
The Clintonites try to get around that by requiring each geographic region to offer one traditional insurance plan that allows patients to pick their own physicians. In the early years of reform, doctors undoubtedly will flock to these plans in hopes of keeping the unrestricted practices--and incomes--most now enjoy. But even with higher premiums, such plans may not last. To stay competitive with cost-cutting managed care, traditional insurers will have to adopt ever-tighter fee schedules. Facing the same limited income as their HMO brethren, and lacking a guaranteed stream of patients, doctors will abandon the free-choice plans.
While swearing fealty to choice, the Clintons also extoll the efficient, high-quality medicine delivered by managed care. Conveniently, they ignore the contradiction that the care comes at the expense of restricting patients' choice of doctors.
"President Clinton doesn't want price controls." Headlines recently trumpeted the news: Clinton had rejected calls for fee schedules on medicine. Buried in the stories, though, was a troubling contradiction: The health plan still calls for "premium caps," or ceilings on health plans' annual fee increases. The caps, in effect, will limit what plans can pay doctors and hospitals. "It's a way to get the insurance companies to do the government's dirty work," says Ellen Goldstein, director of government relations at GE Medical Systems.
Clintonites won't admit it, but price controls are the centerpiece of their health plan. Unless the caps can cut medical inflation from 10% to less than 6% in just three years, the President's dream of health care for all with new taxes only for the few falls apart. If the White House is going to build its plan around controls, premium limits are probably the least harmful version to use. But claiming that caps aren't price controls won't bolster White House credibility.
"Our system depends on market competition." Senior White House aides claim the premium caps won't matter. Why? "We think the markets are going to beat the caps by quite a bit," says a top health adviser.
But the Clinton plan gives markets little room to operate. In each region, one huge buyer, the regional health alliance, will represent 70% of consumers, calculates the Employee Benefit Research Institute. Alliances will be quasi-governmental bureaucracies, politically appointed and empowered to force down insurance premiums and doctor's fees.
The result, many fear, could be more concentration--and less competition--among both buyers and sellers of health care. "It's helpful to have vigorous customers. It's not clear how vigorous alliances would be," says Dr. John M. Ludden, corporate medical director of the Harvard Community Health Plan, a big HMO in Boston. Clinton's plan lets only the 1,000 largest companies run their own benefit schemes; proposals from Republicans and conservative Democrats give smaller employers that option.
The Clinton Administration believes that the benefits of its reform program will far outlast the pain. Certainly, millions of Americans now enrolled in HMOs and other networks are satisfied with managed care. But the Clintons may discover they have set back their cause when angry voters realize the reform plan has been mislabeled. In the end, white lies from the White House won't make the medicine any more palatable.THIS WON'T HURT A BIT
(AND OTHER MISCONCEPTIONS IN THE CLINTON HEALTH PLAN)
Everyone will be able to choose their own doctor
The plan excludes price controls
Market competition will keep prices down
Mike McNamee McNamee covers health policy from Washington.