That would amount to another broken promise from candidate Clinton. Throughout the campaign, he repeatedly said he could pay for extending health coverage to the 36 million uninsured Americans simply by eliminating waste, fraud and abuse in the system, which he estimated to be more than $200 billion. But even if the rest of his reform plan does hold down costs, which is by no means certain, most of the savings would go to private businesses and insurers. Clinton never mentioned that he’d have to recapture those savings to cover the government’s costs. The NEWSWEEK Poll last week found that 65 percent of Americans do favor paying higher taxes for reforming and expanding the nation’s health-care system. But how much will they support? In samples by Clinton’s pollster Celinda Lake 50 percent of Americans said they would pay $20 more a month to provide universal coverage, but only 20 percent would pay $50 more.
With less than 11 weeks left before its scheduled unveiling, the full reform plan is still being formed, and the 300 experts advising the president’s task force have been sworn to secrecy. But insiders say the fundamental decisions have been made: “Clinton wants managed competition with a global budget. That’s what he ran on,” Sen. Jay Rockefeller said last week. To date, those concepts remain as fuzzy as they were during the campaign: managed competition would theoretically involve setting up massive health-purchasing cooperatives (known as HIPCs) to pool large groups of consumers and negotiate favorable insurance rates. Doctors, hospitals and other providers would compete for their business on cost and quality, with HMOs having an edge. A new national health board, representing consumers, providers and insurance companies, would design a basic minimum package of benefits for workers. The board would also set a limit for total national spending on health each year (the “global budget”) and allocate it among the states. How much money, if any, this would save is unknowable: the HIPCs alone would create another giant layer of bureaucracy. And it’s unclear how hundreds of thousands of providers would be made to stay within their piece of the budget, short of strict price controls. Leaked working papers from the task force indicate that such controls are in fact an option, a prospect that infuriates doctors.
For now, though, most interest groups are holding their fire. “We want to know what the total package will be when the mother of all battles occurs,” said AMA board chairman Raymond Scalettar. The elderly lobby was uncharacteristically quiet about the $62.2 billion in proposed Medicare cuts, perhaps because they are hoping that Clinton’s final health-reform proposal will give them greater benefits. The public has “enormously high expectations” for the plan, says Lake, and that may lead to inevitable disappointment. Lake has also found that most Americans don’t like the idea of managed competition (“It sounds like a laughable concept”) and they are nervous about global budgeting: “They think it will lead to rationing.” There is one reality the public will have to accept. You cannot have top-quality health care for all Americans-and not pay more for it.
Would you favor additional taxes to pay for reforming and expanding health care in the United States?
65% Yes 32% No
NEWSWEEK Poll, Feb. 18-19, 1993
