To the editors:
On the occasion of the National Magazine Awards, Mickey Kaus attacked my prize-winning tnr articles for presenting a "misleading" view of the Clinton health bill ("No Exegesis," May 8). He promised to "resolve" the controversy, and to do so, he says, he waded through all 9,000 words of the articles and " tens of thousands more words of controversy that followed." Is this Mr. Kaus's confession that he did not read the bill? Far from resolving the controversy, he only reiterated it. He raised no new issues, so my response can be brief.
Mr. Kaus declared that you would have been able to buy whatever health care you needed and pay your doctor yourself. Insisting that even the White House press office got this point wrong, he claimed that the bill did not bar doctors from taking money from patients, only from charging patients extra after billing their health plan. The text proves Kaus is mistaken. The bill (on page 237) prohibits doctors from taking money from patients for most medical services.
As for the disclaimer on page 16 of the bill, that anyone is free to buy whatever health care is needed, the remainder of the bill makes that disclaimer meaningless. The bill prohibits doctors from selling care and calls for stiff fines and penalties against doctors who do. If you limit what the seller can offer, you limit what the buyer can buy. Page 16 does not offer a way out of the Clinton's "No Exit" health care system.
Mr. Kaus conceded that the bill empowered government officials to eliminate all fee-for-service (choose your own doctor) insurance plans, but he said there was no reason to worry. Officials wouldn't actually do it if it turned out to be unpopular. Kaus forgot why we have written laws--so that our rights will not depend on the discretion and good will of public officials. Passing a law that gives government power over your health care choices--or any other part of your personal life--on the theory that the government probably won't exercise that power is obviously dangerous. In this case, it is especially unconvincing because it is the administration putting forward the bill to enlarge its own powers.
Mr. Kaus chastised me for supporting managed care for New Yorkers now that I am the state's lieutenant governor, suggesting that I opposed managed care in "No Exit." Not at all. What I did oppose was government forcing you to buy a low-budget health plan and prohibiting you from spending more.
If the Clinton bill had passed, you would have had to settle for one of the health plans selected by the government. The law would have prevented you from going outside the system to buy a costlier health plan you thought was better, even after you paid the mandatory premium (page 244). Limiting how much you can choose to pay for a health plan limits how much money is in the pot to take care of you when you're sick. The Clinton bill's price controls would have forced HMOs to sell plans below what it actually costs to provide the medical services. The bill would have made HMOs the rationers of care, denying patients the tests and specialized care they need.
The purpose of New York's new Medicaid managed care program is to increase access to care, not deny care. It will mean that a frightened teenage mother who now sits in an emergency room for thirteen hours or more with a child on her lap waiting to see a doctor she has never met and might not see again instead will have a pediatrician she can call, who has her child's medical records. In New York, HMOs will price their plans based on what they think it will actually cost to care for patients.
Despite Mr. Kaus's adversarial tone, he and I share the same goal. I want all Americans to get the health care they need, regardless of how little they can afford to pay. Last year, the public recognized the dangers of the Clinton bill and rejected it. That debate is behind us, but the goal must still be met: health care, provided with quality and compassion, for those who turn to government for help.
Albany, New York
Mickey Kaus replies:
McCaughey can cite page 237 all she wants; it still doesn't say what she says it says. It decrees that a provider "may not charge or collect from an enrollee" an amount in excess of a health plan's fee schedule. My italics. The effect of this is clearly to prevent doctors from charging a health plan the set fee and then charging "an enrollee" in that plan extra. McCaughey ignores the word "enrollee" and claims, wrongly, this provision would stop you from going outside your plan to pay a doctor cash for care.
McCaughey says the bill "empowered" officials to "eliminate all fee for service" plans. Actually, the bill empowered officials to ban plans costing 20 percent above average. And what McCaughey's article said was that the bill "outlaws" such plans. Empowering officials to ban something is not the same thing as outlawing it. But I guess it's close enough for a National Magazine Award.
By Elizabeth McCaughey and Mickey Kaus