Hillary Offers Everything but the Kitchen Sink

September 18, 2007 | Author: John Goodman

Thirty years ago Michael Dukakis campaigned for president with the boast, "I have insured everybody in Massachusetts." Of course he hadn't, and three decades later, everybody in Massachusetts is still not insured. Along the way there have been many other plans to create "universal coverage." They haven't worked either.

This is why candidates don't get any points from me for "the thought was there." Universal coverage at a minimum requires a credible plan. So far, no presidential candidate has come up with one, unless you count Dennis Kucinich's plan to give health care away for free to everyone.  This includes Hillary Clinton's latest effort announced with fanfare Sept. 17.

Her last foray into health reform was a convoluted national takeover of the health care system.  It was so complicated that even her staunchest supporters couldn't describe it.  It crumbled under the weight of its own flow charts.

In the decade and a half since there have been countless proposals from the left.  The problem, especially for a Democratic presidential candidate, is: no matter what you propose, a significant number of the party faithful are not going to like it.

Yet having staked her reputation on health care reform, Hillary doesn't have the luxury of ignoring the issue.  It is expected that she will offer a new plan, or be accused of running from her past.  So what does she propose?

Think about every bad health care idea that has been proposed over the last couple of decades: individual health insurance mandates, employer health insurance mandates, expansion of Medicaid, expansion of S-CHIP, creating Medicare for non-seniors, allowing outsiders access to the federal employee's health system, creating new tax subsidies, imposing limits on old tax subsidies, forcing insurers to take all applicants, no matter how sick, etc.  Now imagine all of these ideas wrapped into one proposal.  That's Hillary's latest health care effort in a nutshell.

In one fell swoop she has cut the Gordian knot of health care reform.  The obvious solution: propose everything!

Further, there is all pleasure and no pain in this grab bag of proposals.  No one has to make any difficult choices between health care and other uses of money.  There is no rationing.  No managed care.  Everyone will have access to all that medical science has to offer.

While there is something for everyone on the left in this proposal, it is her individual and employer mandates that have led the news.  She will get everyone insured by requiring it.  The brilliance of its simplicity is undone by the reality of its ineffectiveness.

Employer mandates don't work.  Hawaii has had an employer mandate for more than 30 years; and the uninsurance rate in Hawaii is higher than in several states that have no mandate.  A mandate is a tax on labor.  Employers respond by economizing on labor as well as by turning to part time and contract workers.  Pay or play mandates (insure your employees or pay a fine) have the same effect.

Individual mandates don't work either.  All but three states mandate auto liability insurance.  Yet the national uninsurance rate for drivers is only a point or two below the national uninsurance rate for health.

Making individuals pay more in taxes if they are uninsured is not unreasonable.  In fact, we do that already under federal income and payroll tax laws.  But as Massachusetts is currently finding out, many people will pay the fine and remain uninsured anyway.

Enrolling more people in government health care programs is also not a solution.  The most important barrier to care for low-income patients is not lack of insurance or price rationing.  It is rationing by waiting.  Further, the uninsured and Medicaid and S-CHIP enrollees often get care from the same doctors and same facilities.  Indeed one reason why so many eligible people fail to enroll in government insurance plans is that enrollment often doesn't expand access to care.

If not Hillary Care; what should we do?  We should reject Hillary's love affair with bureaucratic institutions and focus instead on the value of empowering patients and doctors and creating a real market for medical care.