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Politics : American Presidential Politics and foreign affairs -- Ignore unavailable to you. Want to Upgrade?

To: Peter Dierks who wrote (19087)	9/19/2007 10:43:07 AM
From: Peter Dierks	Read Replies (2) \| Respond to of 71588

HillaryCare's New Clothes Different means but the same political destination. Wednesday, September 19, 2007 12:01 a.m. EDT Hillary Clinton has been blasted for months by her Democratic Presidential rivals because, until Monday, she hadn't delivered her formal campaign promises for "universal" health care. But John Edwards and Barack Obama were unfair. She beat them to the punch by at least 13 years. The former first lady's 1993-94 health-care overhaul ended disastrously. Still, it poured the philosophical and policy foundations of the current health-care debate. As she unveils HillaryCare II, Mrs. Clinton likes to joke that it's "deja vu all over again"--and it is, unfortunately. Her new plan is called "Health Choices" and mentions "choice" so many times that it sounds like a Freudian slip. And sure enough, "choice" for Mrs. Clinton means using different means that will arrive at the same end: an expensive, bureaucratic, government-run system that restricts choice. Begin with the "individual mandate." The latest fad after Mitt Romney's Massachusetts miracle, it compels everyone to have insurance, either through their employers or the government. Not only would this element of HillaryCare require a huge new enforcement bureaucracy, it is twinned with a "pay or play" tax on businesses that don't, or can't afford to, provide health insurance to their employees. The plan also creates a new public insurance option, modeled after Medicare, and open to everyone, regardless of income. To keep insurance "affordable," HillaryCare II offers a refundable tax credit that limits cost to a certain percentage of income. Yet the program works at cross-purposes, because coverage mandates always drive up the price of insurance. And if the "pay or play" tax is lower than a company's current health insurance costs, a company will have every incentive to dump its employee plan and pay the tax. Meanwhile, the private insurance industry would be restructured with far more stringent regulations. Mrs. Clinton would require nationally "guaranteed issue," which means insurers have to offer policies to all applicants. She would also command "community rating," which prohibits premium differences based on health status. Both of these have raised costs enormously in the states that require them (such as New York), but Mrs. Clinton says they are necessary nationwide to prevent "discrimination" that infringes "on the central purposes of insurance, which is to share risk." Not quite. The central purpose of insurance is to price, and hedge against, reasonably predictable risks. It does not require socializing every last expense and redistributing wealth. No liberal reform would be complete without repealing the Bush tax cuts of 2001 and 2003; Mrs. Clinton would foot the bill for her plan with this tax increase. The rest of the estimated $110 billion per year in new government spending would be achieved by "modernizing" health-care delivery and "promoting wellness," though this $35 billion in savings is speculative, if not fanciful. Further tax hikes would be required: That $110 billion is a back-of-the-envelope calculation, and Team Hillary is keeping the specifics in its pocket. Given how poorly "universal" policies fared the last time around, who can blame them? Mrs. Clinton and Ira Magaziner headed a health-care task force with more than 500 members that eventually produced 1,342 numbing pages of proposals. It's hardly surprising this boondoggle died without so much as a Congressional vote. Yet Mrs. Clinton insisted that the public had been spooked by Rush Limbaugh, an article in a marginal political journal and advertising campaigns such as "Harry and Louise." In other words, the lessons she learned were political, not substantive. She thought she had overreached with too-sweeping changes. So she and her husband began to slice their universal health-care ambitions into smaller initiatives like the 1997 State Children's Health Insurance Program (Schip). This is her strategy now. HillaryCare II is designed to cause minimal disruptions to current private insurance coverage in the short run, while dressing up the old agenda with slightly different mechanisms and rhetoric. Rather than fight small business, this time she is trying to seduce it with tax credits for small companies that provide insurance. Only later when costs rise will the credits shrink or other taxes rise. To court large manufacturers, like the auto and steel industries, she'll offer another, "temporary" tax credit to subsidize their health-care liabilities. Her plan, in short, is HillaryCare I in better clothes--a transitional platform to shift people to the default option, which is government insurance. What's striking about all this is how little new thinking there is. Like the other Democratic proposals, HillaryCare II would mark another major government intrusion into health care. It would keep all of the system's current problems, most of them created by government policies, and entrench and expand them. The creativity is all in the political repackaging. opinionjournal.com

To: Peter Dierks who wrote (19087)	9/26/2007 1:22:04 AM
From: Peter Dierks	Respond to of 71588

HillaryCare Flops in California If Schwarzenegger couldn't get it done, how can Mrs. Clinton? Sunday, September 23, 2007 12:01 a.m. EDT SACRAMENTO, Calif.--Hillary Clinton is patting herself on the back for proposing a health-care plan that is much more politically astute than her 1993 Rube Goldberg effort. She told an audience in New York this week: "I think I have successfully thought through all of the objections and pre-empted them." She may want to think again. Last January, California Gov. Arnold Schwarzenegger proposed an eerily similar plan using the same rhetoric and even the same slogan adopted by Mrs. Clinton to describe hers: "Shared Responsibility." That's no coincidence. Both ArnoldCare and HillaryCare 2.0 are the product of the same advisers. But despite all of its clever political compromises, ArnoldCare is bogged down in trench warfare in California's liberal Democratic Legislature. If anything passes, it will likely be only a shell of a bill without any financing component. Legislators will hope voters approve a general tax increase to pay for it in November 2008. The two plans have many features in common. ArnoldCare's $12 billion-a-year price tag represents about a tenth of Mrs. Clinton's estimate for the costs of her plan, roughly in line with California's share of the national economy. Both include mandates to buy health insurance, a ban on premium differences based on health status, Medicaid expansion, and a requirement that insurers have to offer policies to all applicants. All of this is the brainchild of Laurie Rubiner, who directed health-care issues at the liberal New America Foundation until she left in 2005 to become Mrs. Clinton's Senate legislative director. She was replaced by Len Nichols, who in 1993 served as the liaison between President Clinton's budget office and Mrs. Clinton's health-care task force. Ms. Rubiner isn't taking direct credit for selling Mr. Schwarzenegger on her plan, but aides to the governor confirm her role. Steve Clemons of the New America Foundation acknowledges that Ms. Rubiner "incubated and hatched" the ideas at the heart of the governor's plan. Ms. Rubiner declined to respond to a request for an interview. Given the similarities, here are some political lessons that ArnoldCare might teach us about how Mrs. Clinton's plan might be received: • The claim that no new bureaucracies are created will be challenged. Like Gov. Schwarzenegger, Mrs. Clinton envisions requiring everyone to prove they have health insurance. But she's vague on the details: "At this point, we don't have anything punitive that we have proposed." You can bet she will have some ideas. Even so, making certain people have insurance is easier said than done. California has had a law mandating that drivers have car insurance since 1970 and has required physical proof of insurance to register a car for a decade. Even so, the Insurance Research Council says 25% of the state's drivers remain uninsured. • Illegal aliens and their access to health insurance will be controversial. Mrs. Clinton promises health care for all, but is punting on the issue of whether the illegal aliens, who often use emergency room services, will be covered. Ms. Rubiner admits it's a "huge issue," but says "that's one we're going to have to think through a little bit." Criticism of the governor's plans to cover illegal aliens forced him to drop the idea, but this week he fumed at those who raise such "Mickey Mouse"-type concerns. Mrs. Clinton's plan could be caught between populist forces opposing health care for illegal aliens and liberals who will insist on it. • Hoping for bipartisan support isn't the same thing as getting it. Gov. Schwarzenegger sincerely believed he could convince Republicans to support his plan. In the end, he couldn't find anyone from either party to push his plan in the Legislature. It was too tax-heavy for Republicans (his effort to call proposed tax hikes "loans" flopped) and not nearly interventionist enough for Democrats. "The governor got significant parts of the business community to sign on, from Safeway to the Los Angeles Chamber of Commerce," one adviser to the governor told me. "But that didn't move the antitax Republican base." • Nothing big passes Congress these days without bipartisan support. "The lesson from California is just how difficult it is to deal with so many players that have such disparate demands," says Dan Walters, a columnist for the Sacramento Bee. "The governor's original plan had the doctors opposing the fees it imposed on them and the nurses union upset because it wasn't single-payer. Having all the first responders who dress in white opposing your plan isn't politically healthy." Sen. Clinton claims she now realizes she'll need actual votes to pass something. But traces of the old Hillary remain. "I wish it were possible to just wave a magic wand and say from the White House, 'Here's what I want.' But that's not the way it works," she told the Associated Press. The real test may be her willingness to accept some market-oriented GOP proposals such as tax-free savings accounts for health care and a curb on frivolous liability lawsuits as the price for the bipartisan support she now claims to want. Now that really would be a New Hillary. opinionjournal.com

To: Peter Dierks who wrote (19087)	10/12/2007 9:01:47 PM
From: Peter Dierks	Respond to of 71588

McCain's Medicine The Arizona Senator gets back in the reform business. Friday, October 12, 2007 12:01 a.m. EDT Riding low in the polls, it seems, has allowed John McCain to take some policy risks. At Tuesday's Republican primary debate, he talked about the need to junk the tax code to make it fairer and flatter. Then Mr. McCain followed up with a health-care reform announced in Iowa yesterday, perhaps recapturing the aura of political creativity that animated his Presidential bid in 2000. The Senator's views are panoramic, and he's looking at a health-care landscape grounded in free-market principles. His major proposal would change the tax treatment of insurance. To rehearse: Today's tax code allows businesses to deduct the costs of providing health insurance to their employees, but it doesn't allow the same for individuals. That creates third-party payer problems for the insured and makes coverage less affordable for everyone else. Mr. McCain would offer a refundable tax credit of $2,500 for individuals, and $5,000 for families. We'd prefer a standard deduction, which is cleaner as tax policy and causes fewer distortions, but some argue that a credit will more quickly aid lower-income families. In any case, the finer grains are at this point less important than the larger reform. Mr. McCain is climbing onboard with Republican opponents Rudy Giuliani and Mitt Romney, who have also identified tax bias as the overriding concern. One major difference among these front runners concerns insurance regulation, and here Mr. McCain comes out on top. Part of the reason coverage costs differ so sharply among states is because some have chosen to impose multiple rules and mandates. Mr. McCain would allow people to purchase policies across state lines, which is currently prohibited. That would let people choose the coverage levels that best serve their needs, and would make insurance far more affordable for people in mandate-heavy states like New York and Massachusetts. Mr. Giuliani says he'll allow for this eventually, with some caveats, and Mr. Romney goes out of his way to trash it. Mr. McCain takes a false regulatory lunge when he says he wants prescription drug re-importation, which could harm U.S. pharmaceutical innovation. However, he's on firmer ground when he emphasizes medical malpractice reform, coordinated preventive care, and price transparency, all of which will help control health-care costs. These are also the natural complements of tilting the health-care system toward a more market-based model. The Senator emphasizes that reform will require "fundamental change--nothing short of a complete reform of the culture of our health system and the way we pay for it." He seems to mean it, too: He's also proposing a major change to Medicare, thus becoming the only candidate, Republican or Democrat, to confront America's runaway entitlement spending. Medicare spending grew by 11% last year. Mr. McCain would do away with Medicare's creaking fee-for-service model, and the government would pay providers based on outcomes. While many of the details need to be worked out, partially this would act to focus doctors and hospitals on coordinated care for seniors, and partially to manage government expenditures. It would also get the government out of the business of setting reimbursement rates for thousands of individual procedures. Call it supply side medicine. While the proposal would leave the beneficiary structure intact, we suspect that Mr. McCain is setting up an even bolder reform. Changing the payment architecture could be used as a lever to move Medicare toward a defined-contribution health-care model, where the government would pay a certain amount per individual, and private insurance would compete to insure patients. This would be a major step toward free-market spending discipline. Mr. McCain has largely predicated his candidacy on national security, but his entrance into the health-care fray solidifies the intellectual progress conservatives have made on the issue. This isn't 1992 when Republicans had little to say. The "universal" health care ambitions of Hillary Clinton and her fellow Democrats rest on incremental steps that expand the role of government, add more mandates and taxes, and eventually create "Medicare for all." The stage seems to be set for a rousing, and much-needed, debate next year over the role of government in health care. opinionjournal.com