What You're Not Being Told

By Janice Castro

Lawmakers may be fighting over the best way to achieve health reform, but there is also plenty of argument over just what it is that President Clinton has proposed. Anyone who reads his 5-lb., 1,342-page Health Security Act may be surprised to see what's in it:

-- Choosing your doctor: The White House says that Americans will have more choice in health care.

That's not entirely true. For starters, no one will be able to choose not to buy health insurance -- which means that millions of young Americans will lose their ability to postpone buying insurance until they feel they need it. More important, while the bill says that patients should have the option of paying extra to choose their doctors, it also gives states the right to eliminate such choices; states could offer residents a single health plan and a limited list of the doctors they may see. For that and other reasons, millions of Americans could find that they could no longer see their physicians under their new insurance plan.

-- Feeding the bureaucrats: The President insists that his plan will be a private insurance system with less government bureaucracy than exists today.

Actually, the Clinton plan calls for a vast, multilevel new federal and state bureaucracy with enormous power to regulate all areas of medicine. The Federal Government will decide, for example, which benefits can be offered, * which new technologies and procedures will be made available to Americans, and how many medical students can pursue each specialty. The majority of students will be funneled into primary care; the limited training slots for cardiologists, neurosurgeons and the like will be awarded in part according to racial quotas, based on how "underrepresented" each ethnic group is in a particular field.

-- Rationing: The plan promises "health care that is always there," but there may not be enough to go around.

Doctors and hospitals say the rigid insurance caps would not leave them enough money to give patients what they need. Moreover, the plan cuts Medicare spending even as the Medicare population is growing. The only way to make ends meet will by to cut back on medical services. The danger is that patients may be denied critical help.

-- Fixing prices: The White House Press Office stated last week that "there are no price controls in the President's plan."

In fact, the plan is riddled with price controls. The government would be able to decide how much the alliances could spend on health care through a system of tight controls on insurance premiums. The government would also set prices for new drugs. Alliances would have the power to slash doctor and hospital fees in order to meet the rigid new budget limits.

-- Who will pay? The White House insists that its plan will require no "broad new taxes."

Since the Clinton plan will for the first time require employers to pay most of the cost of health benefits for their workers and will define which benefits must be made available, it is difficult to call the resulting payroll costs anything but a new tax. In addition, large companies that choose to operate their own health alliances for their employees will have to pay an extra payroll tax of 1% to support the benefits of other people who are enrolled in the local public alliances. Urban residents will be subsidizing the inner-city poor, the unemployed, the elderly, the disabled and others through more expensive new private insurance premiums. Finally, many economists agree with Senator Daniel Patrick Moynihan, the chairman of the Senate Finance Committee, who says the Clinton system might run out of money; in that case, Congress would have to come to the rescue by raising taxes.

-- Preserving jobs: The Administration says that the Clinton plan will create jobs.

Yet the plan gives companies every reason to fire workers: estimates run as high as 2 million jobs lost. Small companies say they will not be able to survive without layoffs. And because the Federal Government (translation: taxpayers) would pay part of the cost of benefits for part-time workers, employers say they would replace full-timers with part-timers, and part-timers with temps. After all, under the Clinton plan, the companies are not responsible for providing benefits to temps.

-- Universal coverage: President Clinton insists that his nonnegotiable bottom line is universal coverage and that his plan will achieve it.

It won't. Trouble is, in order to reach universal coverage, everyone must buy insurance under the plan. Many of the uninsured have no job; some have never had a job. A requirement that employers provide benefits will not reach those people. The Federal Government can require people to buy insurance, but no one knows how it can actually make many of them do it.