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Placebo.

President Clinton's long-awaited health-care address to Congress and the American people, delivered toward the end of September, was a masterful presentation. The President spoke with warmth and vigor and conviction, superbly articulating the concerns that most Americans feel about a health-care system that has been dysfunctional for many decades. He outlined the major problems that must be addressed, and made it clear that reform could no longer be put off. Political analysts were all but unanimous in their judgment that Bill Clinton had delivered the best speech of his career.

A few days later, Hillary Rodham Clinton, who had presided over the Administration's health-care task force during its many months of deliberations, began making the rounds of Congressional hearings. She, too, received rave notices for her command of an incredibly complex subject and for her engaging and quick-witted performances. Before Senators and members of the House of Representatives, as well as on the talk-show circuit, she presented in graphic detail the inadequacies of our health-care system.

Thanks to the Clintons, more Americans than ever before understand the urgency of the health-care crisis, and a substantial number of them have even begun to comprehend some of its arcane details. They understand that health care in this country is enormously expensive--$2,556 a year for every American, as compared with $1,770 for Canadians and $972 for Britons. They know that some thirty-five million Americans are not covered by health insurance, mainly because they cannot afford it, and are, therefore, at high risk of being wiped out financially by a serious illness if, in fact, they can obtain treatment for it at all. They recognize the reality that members of "high-risk groups" and those suffering from "pre-existing conditions" can be denied insurance or assessed exorbitant premiums. They are aware that worry about health coverage compels people to remain in jobs they would rather leave, or to take jobs they would rather turn down, or to refuse retirement to which they are fully entitled.

For diagnosing the sickness of our health-care system, and doing so in an effective and persuasive manner, the Clintons deserve our appreciation and gratitude. But what have they proposed as a cure? A placebo.

A placebo, says our dictionary, is "a substance having no pharmacological effect but given merely to satisfy a patient who supposes it to be a medicine." Precisely. The Clinton health-care plan can't and won't effect a cure, but thanks to the President's and First Lady's profoundly sympathetic bedside manner, it has already satisfied many millions of Americans that at long last recovery is within reach.

Why won't it work? Because it deliberately and decisively refuses to deal with the root cause of all the ailments so admirably described by the Clintons: the fact that the health-care system in the United States is market-oriented and profit-driven. At every level and in every aspect, health care in our country is provided on the basis of someone's ability to turn a buck--be it the insurance industry, the pharmaceutical manufacturers, the producers of high-tech medical devices, the hospitals, or the physicians, whose incomes set them far apart from the common mass of their patients. As Marcia Angell put it recently in the New England Journal of Medicine, "Unlike most other Western countries, the United States treats health care as a market commodity, not as a social good. It is distributed according to the ability to pay, not according to medical need."

In its in-house debate over health-care reform, the Clinton Administration and its task force ruled out from the very beginning any notion of developing a U.S. version of the single-payer plan in effect in Canada. Single-payer means a system based on general taxation, where the government pays all medical bills--a system that has no need for the ministrations of the insurance industry. Does it work? A Harris Poll of Canadians found that 97 per cent wouldn't trade their system for ours. "Under a single-payer system like Canada's," health-care expert Melvin Konner wrote recently on the op-ed page of The New York Times, "we, the people, would be the owners. The for-profit insurers would at last be where they belong: out of the health business altogether."

But the system preferred by the Clinton Administration, called "managed competition," would leave the insurance giants in greater control of health care than ever before. Bill Link, an executive vice president of the Prudential Insurance Company, said earlier this year, "For [Prudential], the best-case scenario for reform--preferable even to the status quo--would be enactment of a managed competition proposal."

"Managed competition has never worked anywhere," note Drs. Steffie Woolhandler and David U. Himmelstein of the Harvard Medical School in a detailed analysis of the Clinton plan. They point out that the single-payer approach "would sharply cut the $50 billion spent annually on insurance overhead by eliminating marketing costs, efforts at selective enrollment, stockholders' profits, executives' exorbitant salaries, and lobbying expenses. In contrast, Clinton's plan is likely to increase administrative costs, since savings from planned computerization and standardization of billing will be dwarfed by the added costs of private insurance and ... bureaucracies."

In its eagerness to protect the prerogatives and profits of the insurance industry and other market sectors that derive enormous earnings from the present system, the Clinton program would institute a cumbersome, complicated, and costly scheme of private insurance paid for by employers, who would be required to come up with 80 per cent of the average premium cost. Employees would pay the remaining 20 percent--or more, if they chose a costlier-than-average plan. In a tax-based, single-payer plan, the costs would be borne progressively, with the rich paying a larger share. In the Clinton scheme, the average worker and his company's chief executive officer would pay the same premium.

That premium is likely to rise to extraordinary heights. Our country has a rapidly aging population, and the recourse to expensive medications and elaborate technology will continue pushing the cost of health care to catastrophic levels. Even some of the Administration's insiders admit that the projected "savings" of the Clinton plan are wildly optimistic. What this means is that even the most positive aspects of the Clinton program--insurance for the uninsured, for those who change jobs, for those whose physical problems now render them uninsurable--will be jeopardized because of a lack of funds. And those who now enjoy more or less adequate health coverage are likely to wind up paying more for less.

"The plan is a lobbyist's dream," say Drs. Woolhandler and Himmelstein. "Removing almost any sentence from the 245-page document would open loopholes worth billions."

From the beginning, the Administration's healthcare planners insisted that there was no point in even thinking about a single-payer approach because it was politically unattainable. So the Clinton White House did what it seems to do best: It abandoned its strongest bargaining position before the bargaining even began, a method perfected in the handling of gay and lesbian rights in the military, as well as in the President's more controversial appointments. It is appalling that the feeble health-care reform now on the table is likely to be further enfeebled before final action is taken in a year or two.

But it doesn't have to be that way. As more individuals and organizations come to understand the meaning of "managed competition," a single-payer system is finding increasing support. About ninety members of the House of Representatives, a half dozen Senators, many consumer organizations, labor unions, and even some health-care professionals have endorsed the Canadian system. The fight isn't over unless we let it be.

On due reflection, many Americans may conclude that the Clinton plan isn't really a placebo, which, after all, does no harm. It's a poison pill.
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Title Annotation:Clinton health care reforms
Publication:The Progressive
Article Type:Editorial
Date:Nov 1, 1993
Words:1284
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