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p>Fourteen years ago, as First Lady, Hillary Clinton unloaded a health-care plan on the country. Complex, confusing, and restrictive, the thousand-page proposal outlined a radical overhaul of the nation’s health system, and a small band of grassroots activists quickly rose up to successfully oppose it. At 1,342 pages, it was the Hindenburg of health-care plans, and it went down in just as grand a fashion.
Now, Clinton is back with yet another health care plan, and she has learned some lessons. She is touting her plan as sleeker, leaner, more palatable to both businesses and individuals. But despite her claims, it is little more than the same ugly gift wrapped in different paper.
It is true, of course, that Clinton is a better salesperson this time around. Her time in the Senate has made her a shrewd, formidable political operator. Her current plan has been calculatingly formulated to avoid the appearance of bureaucratic complexity that helped doom its previous iteration. But whatever simplifications appear are more than likely mirages. In place of the labyrinth of programs and agencies that cluttered her last plan, Clinton has opted for vagueness. Many key decisions have been left up to Congress. And many of the plan’s points remain a mystery.
Those mysteries, however, have a purpose: to increase the role of the federal government—despite the fact that it already accounts for 44% of the nation’s health-care expenditures. Questions in the plan abound: What, exactly, will be covered? Are wigs, for example, a necessary treatment? When treatments are necessary, but resources are scarce and expensive, who decides what will be done—who will be treated and who will wait? Government-managed health care will never solve the problem of prioritization, but it will put those key, often life-saving decisions, in the hands of bureaucrats.
Hillary’s plan provides no answers, but these are neither easy nor minor decisions. The planning process is sure to be fraught with hardball politics, as every industry and interest group with a stake in the outcome will undoubtedly push and prod to have their service included in the plan. In the end, health-care lobbying firms will reap a windfall from the millions that will surely be spent trying to influence the size and shape of the program. And ultimately, federal regulators will define and mandate a health-care benefits package. Clinton’s vision of health care prizes bureaucratic sprawl over simplicity.
She claims, of course, that it will create “no new bureaucracy.” But this may end up being Clinton’s version of the elder Bush’s “read my lips” pledge. Her plan clearly calls for an army of new regulators and bureaucrats to monitor state-to-state insurance rules (so much for federalism) to the “fairness” of drug prices. How, exactly, the government will determine what is “fair” is unclear, but Clinton aims to do it.
Like her husband, Clinton seems remarkably adept at making words mean what they do not. Clinton’s calls her plan “Health Choices,” and the word “choice” figures large into her health-care rhetoric. Yet what she offers is the furthest thing from choice: It is a mandate. Her plan would require every American to purchase private insurance, and though she has been unwilling to list out penalties for those who do not, it’s a strong bet there will be some.
Meanwhile, insurance mandates are hardly a proven success. In California, despite a mandate that every driver have insurance, nearly a quarter do not. And in Massachusetts, where Gov. Mitt Romney has enacted a similar health-insurance mandate, fewer than 11% of the 170,000 residents who do not have insurance but make too much to qualify for subsidies have signed up. Without enforcement, Clinton’s plan would likely be a messy failure; with it, it would be an authoritarian nightmare.
But the government strong-arming does not stop there. Clinton’s plan would force price controls on drug manufacturers, almost certainly resulting in steep cuts in the research and development of new drugs, the kind that sustain and enrich the lives of millions today. Research has shown that even when Congress merely discusses such controls, the results are steep declines in the growth of pharmaceutical R&D budgets. Under Clinton’s plan, the miracle cures the drug industry steadily produces today could become a thing of the past. Yet still she claims that this is a plan geared toward providing “choices.”
She does, however, make one choice obvious: rejecting her plan, and indeed, her entire vision of government-managed health care. In a time when excessive spending tops the nation’s concerns, she freely admits that she would spend $110 billion each year in order to further entangle the government in medical care—and she would pay for it by raising taxes.
Yet Clinton, ever the careful politician, continues to sell her plan as if all of this was of no concern. As she travels the country promoting her candidacy and her plan, she sounds like a Hollywood movie director vigorously touting an upcoming summer sequel. But like most sequels, this one promises merely to be redundant, gaudier, and more expensive. Clinton’s $110 billion behemoth is a budget-buster, not a blockbuster, and it deserves to be a flop.