When it comes to health care, Hillary Clinton is never going to let her name be associated with the words "radical overhaul" ever again. Or, if she can help it, with massive bureaucracy or new taxes. That's what happened in 1993 with her health-care plan as first lady, and, as she never tires of saying, she has "the scars to prove it."
HillaryCare 2.0 is an entirely different enterprise, or so she would have us believe. It's the "American Health Choices Plan." It "builds on the current system to give businesses and their employers greater choice of health plans," while imposing "no overall increase in health spending or taxes." It's the all-things-to-all-people, sweetness-and-light, all-benefits-and-no-costs health-care plan of 2007.
It's also a sign of how she has wised up since her famous debacle early in her husband's first term. For a liberal seeking to expand government-run health care, it's not necessary to create new, elaborate governmental mechanisms that are vulnerable to parody and frightening to voters. Simply building on the status quo is enough to hasten us toward national health insurance.
That's because we have a hybrid system of private insurance and government health care that is increasingly tilting toward government. As the conservative writer Ramesh Ponnuru points out, only 12 percent of health-care costs are paid out of pocket, and the government already pays almost half of health-care costs. Liberals need only push this system toward its logical conclusion.
Because the private health-insurance market doesn't function properly, the government is left to pick up the pieces. But it is government policies that distort the health-insurance market in the first place. Ideally, people would pay for their own health insurance, the way they do with, say, auto insurance. But the tax code favors insurance that people get through their employers.
This creates all sorts of problems. Because employers pay for their insurance, for most people the costs of health care are essentially hidden. They have no incentive to shop around for cost-effective plans. Meanwhile, when people lose their jobs, they tend to lose their insurance -- exactly when they probably need it most.
This creates an expensive system that's anxiety-inducing for people who worry about losing their insurance. The way the system is set up makes it difficult and expensive for individuals to buy insurance, which is one reason why 47 million Americans are uninsured.