In his recent article, Jonathan Cohn defends the most controversial aspect of Hillary Clinton's 1993 health plan--government limits on what you would be allowed to spend on health insurance for yourself and your family ("Hillary was Right," June 4). Identifying the flaws in Cohn's argument may help guide the current debate on how to achieve an important goal--universal coverage--without giving government too much power over the health care choices we make as individuals.
The Clinton bill proposed that a National Health Board would decide how much the nation could spend on health care beginning in 1996 (the baseline year). Based on that national budget, the board was to set a budget for each region and a ceiling on what each family could spend on a health plan. The bill outlawed plans that would have caused a region to exceed its budget or that cost over 20 percent more than the average plan (for equality). After 1996, increases in health plan premiums would have been strictly limited by an "inflation factor" based on the consumer price index.
Even the bill's authors anticipated that capping what people could spend on health insurance would produce serious shortfalls in the money needed to care for them. The bill provided that when medical needs outpaced the budget and premium money ran low, state governments and insurers would be legally required to make "automatic, mandatory, nondiscretionary reductions in payments" to doctors, nurses and hospitals "to assure that expenditures [would] not exceed budget." These unambiguous words--calling for mandatory rationing--understandably frightened people.
Cohn claims that these fears of government rationing were "probably overblown." "[I]t was entirely possible," he says, that health needs "would not have exceeded the caps, at least not for a while." Cohn gives no data to support this claim. The truth is that national health expenditures grew rapidly after 1993, including a 9.1 percent annual increase in 2002, far more than the Clinton scheme would have allowed. Per capita health expenditures increased 7.2 percent in 2003 (6.1 percent without inflation) and 6.8 percent (5.1 percent without inflation) in 2004, far faster than the consumer price index.
Falling back on a second argument, Cohn claims "Congress always had the power to ease caps if they really threatened to disrupt medical services." To state the obvious: It's safer to prevent a draconian bill from becoming law in the first place than to trust a future Congress to repeal it.
More than a decade after the Clinton bill was rejected, presidential contenders from both parties are promising universal health coverage. Bravo. No family should lose a home or a lifetime of savings because someone in the family gets sick and doesn't have insurance. But read the fine print.
If a candidate also promises to control costs, insist on knowing how. Beware giving government the power to limit what you can spend on your family's health plan. Capping what you can pay for a health plan limits the amount of money in the pot to take care of you when you're sick. That could be dangerous to your health.
Let's hope this year's presidential contenders find a better way.
Elizabeth McCaughey, Ph.D.
New York, New York
By Elizabeth McCaughey