Given her history, it was inevitable that Democratic presidential candidate Hillary Clinton would one day have to tell the nation how her views have changed on health care.
As the wife of then-President Bill Clinton, she drafted a plan for health care in the early 1990s that ultimately helped elect a Republican Congress in 1994. She now says she learned from that unhappy experience; but did she?
After her first effort, her husband promised the nation that everyone would soon be getting a card that would allow them to get health care. Mrs. Clinton’s plan this time around is not quite so simple, but the promised results are certainly similar.
In her American Health Choices Plan unveiled this week, Clinton promises to provide health insurance for all Americans and to do so with “no overall increase in health spending or taxes.” That promise, to borrow a phrase from Clinton herself, invites “the willing suspension of disbelief.”
It is not the only artful use of language in the plan. For example, nowhere does it specify what constitutes an “American.” Her plan would automatically provide insurance coverage to the 47 million uninsured, although that figure includes tens of millions of non-citizens, including most of 12 million illegal immigrants.
Nor does she specify how people who say they can’t afford health insurance will be able to afford it in the future. She does say that the government will give a “refundable tax credit” to those who can’t afford insurance. That’s the same as a government check, but Clinton doesn’t say what portion of the insurance will be paid by taxpayers. One section of the plan says that buying the insurance can’t become a “crushing burden,” and that its cost should not exceed “a percentage” of income.
None of that is very helpful. Is the government going to pay the whole bill for those now lacking health insurance? If it doesn’t, what level of enforcement would be necessary to find those without health insurance and force them to sign up and make the necessary payments?
In fact, sprinkled throughout the Clinton plan are many references to increased government involvement in health care, but these efforts are apparently not going to cost anything. Large corporations are going to be “expected” to continue their current insurance programs.
There are no estimates in the plan on what the costs of enforcement might be. The federal government is going to make sure drug companies “offer fair prices and accurate information,” but again, no cost is attributed to these efforts.
Mrs. Clinton promises to end the payments that now go to hospitals for providing health care to the indigent, thus saving $7 billion annually. But it is a safe bet that hospitals would greet this news by declaring they won’t provide the care without compensation.
The provision of what amounts to universal health care will cost, by Clinton’s estimate, about $110 billion annually. These costs are to be paid by repealing the so-called Bush tax cuts on the top two brackets of taxpayers. This act would produce about $52 billion annually. In addition, unspecified savings from “modernizing” the health care system would produce another $35 billion.
This last figure appears to be produced out of thin air and justified with sentences like this one: “The plan will improve quality as it improves the value of care.”
Still this much must be admitted: The Clinton plan is better than the one offered by John Edwards, Clinton’s rival for the Democratic presidential nomination. Edwards wants to cancel health insurance for Congress and the executive branch until they get together to enact universal health care paid by the government.
As the debate over health care develops and the promises get more and more extravagant, it would be well to remember that while the demand for health care may be infinite, medical resources are assuredly not.
Al Knight of Fairplay (alknight@ ) is a former Post editorial board member.
