Hillary says that her program would provide "universal" coverage for all. In order to achieve universality, one must make the program compulsory. The bulk of the uninsured do not want to have to pay for insurance. They are healthy and don't want the added burden of health insurance. That is why about half of those who are eligible for free or low cost insurance under the State Child Health Insurance Program have not signed up. Their parents don't want to.
So Hillary's program, as she freely admits, would require health insurance as a pre-condition of employment. Not having health insurance would be a violation just as driving a car without automobile insurance is illegal. The resulting coercion would force millions to pay for coverage they do not want and feel they don't need. But to pay for her national program, Hillary needs everyone to be covered so she can use their revenues to subsidize the coverage of those who are ill.
But the main defect of Hillary's program is that it leaves out any attempt at cost control. With health care absorbing 16 percent of our economy, Bill Clinton's warnings of economic disaster if its share of our national income passed 12 percent back in 1993 sound almost quaint today. Cost control is a vital part of any plan for universal coverage. Indeed, without it, extending coverage just offers a blank check to patients and providers which would drive even higher the share of our economy that goes to health care.
It was Hillary herself who explained this concept to Dick in 1993. The reality has not changed. Hillary will be forced to control costs as the implicit and vital element of any health care reform. This control of costs belies her contention that she would leave the health care system untouched except to extend coverage to those who now lack it. Because she would need to limit utilization and lower costs, she would be forced to ration health care and to impose government mandated and controlled managed care on all Americans.
For the first time, the word "no" would come into our system. Do you need open heart surgery? Are you a poor risk because of smoking or diabetes or age? No longer would the bureaucrat at the other end of the phone say "we won't pay for it" or "you don't need it" or "we can't fit you in at our facility." The answer would simply be no — even if you pay for it yourself, you may not have one. It is this type of coercion that drives Canadians over the border to the U.S. in search of medical options denied them at home under their socialized medical structure. Now it would operate on both sides of the border.
Finally, Hillary seeks to finance the system by ending tax breaks for the wealthy, by which she means any household with $250,000 or more in income. Never mind that she has spent that money several times over. But why use income taxes to finance her system? Why not do what Democrats and Republicans are now pushing in Congress — to finance it by raising cigarette taxes? That way we get a double impact: higher tobacco prices cut smoking, particularly among teenagers, and reduce health costs and the revenues pay for her expansion of the system. The current Congress is passing legislation to raise cigarette taxes 61 cents per pack to pay for a $35 billion expansion of the State Child Health Insurance Program. Why not raise them $2 per pack to raise the $110 billion Hillary says her health care proposal will need?
In selling her program, Hillary seems to imply that she was under the hypnotic control of her advisers (presumably Ira Magaziner) in 1993 when she designed her previous health care reform. Now she says she is in charge. "I'm the decision maker now," she told The New York Times. "I have a plan that is 100 percent my plan." But what was the 1993 initiative but her plan, concocted in secret and foisted in toto on a Congress which wouldn't pass it?
Now she says she would not "have approached [health care reform] in the same way" as she did in 1993. Now she will be informed by "a greater dose of humility and empathy and understanding of what it takes to get things done in our political system."
That and a determination to conceal the true implications of her proposal until after she is elected.