It was well reported that a lot of the seed money for the Clinton effort came from gay rights activists, and therefore that he had a political debt. Righting a wrong could have waited until he had some clout. He needed to satisfy members of his base with bold action, or be known as a welcher.
Clintoncare was the most glaring example of lurching to the Left in his administration, and it was largely to buy off Hillary and her constituency. It also was the most egregious attempt to socialize a major portion of the economy that the country faced in a long time. The "crisis" of the uninsured was largely manufactured, since the bulk of them are young people who choose not to carry insurance because they are at low risk, or people between jobs. Additionally, most of those who are genuinely poor are covered by Medicaid. Finally, there are numerous free- clinic programs, and an obligation on the part of emergency rooms not to turn away acute cases, and those in public hospitals not to turn away the chronic.
It is not true that proposals to deal with some of the legitimate outstanding issues have not been floated. There have been legislative initiatives to give more rights to patients in an HMO situation, for example. Also, preferred provider coverage has grown as an attractive alternative to HMOs. There has been legislation on portability and proposals about pre- existing conditions. One of the few good ideas from the Clintoncare debacle, the encouragement of larger insurance pools for small businesses to join in, is still kicking around, and, of course, is already partially implemented in the Blue Cross/ Blue Shield program.
But more than that, if one wants to reduce costs somewhat, the proposal to establish Medical Accounts similar to IRAs, with a certain amount for ordinary care deposited in pre- tax dollars, and the carrying of various forms of catastrophic insurance, would be a good way to go. Make the patient the consumer, let him make choices about medical consumption similar to those made for other goods and services, and only insure for cases requiring acute and/or extended care. This gets rid of the third party payer problem. (To work, the money deposited in the account must periodically become available for unspecified use, unless on elects to keep it as a medical accumulation). It also reduces the cost of insurance substantially, thus making catastrophic coverage more attractive to the hitherto uninsured.
Anyway, the Left has its theories of why it doesn't win more frequently, and therefore of the systemic changes which must occur to make "progress" more likely through democratic institutions. I think they are wrong. I do not think that corporations are buying candidates. I think that the public is not buying the Left. Given the character of the public, it did not take much to kill off Clintoncare. All you had to do was make it clear that it involved extreme government regulation of the medical economy, and would penalize people for trying to buy treatment outside of the system, and it was doomed. A more modest initiative would have worked, but Hillary and Ira Magaziner were politically tone deaf. |
