The Clinton Health Care Plan

Presidential aspirant (and likely Democratic nominee) Sen. Hillary Clinton has announced her proposed health care plan:

DES MOINES, Iowa – Democratic presidential candidate Hillary Rodham Clinton is unveiling a sweeping health care proposal Monday that would require everyone to carry health insurance and offer federal subsidies to help reduce the cost of coverage.

Fulfilling a pledge to bring health care to all, Clinton’s “American Health Choices Plan” has a price tag of about $110 billion per year. It represents her first major effort to achieve universal health coverage since 1994, when the plan she authored during her husband’s first term collapsed.

“It is long past time that Americans and the richest of all countries realize that health care is a right and not a privilege,” Clinton said at a labor forum in Chicago. “And that goes especially for people who work hard every single day.”

The former first lady says she has learned from the 1990s experience, which almost derailed Bill Clinton’s presidency and helped put Republicans in control of Congress for years to come. Aides say she has jettisoned the complexity and uncertainty of the last effort in favor of a plan that stresses simplicity, cost control and consumer choice.

The centerpiece of Clinton’s plan is the so-called “individual mandate,” requiring everyone to have health insurance — just as most states require drivers to purchase auto insurance. Rival John Edwards has also offered a plan that includes an individual mandate, while the proposal outlined by Barack Obama does not.

More details of the plan are here. I’m disappointed that the plan seems to have little to say about health care supply and delivery.

I’m concerned about advocating health care as a right and about affirmative rights, generally. I have no objection on our agreeing as a nation to make a commitment to extend health care to all as a benefit of living in the United States, the largesse of a wealthy country. I see no way to reconcile a right to health care with health care providers’ rights to set their wages or regulate their own work.

The underlying assumption of any plan promising universal coverage is that the present system has excess capacity. This is manifestly not true and, further, the supply of health care is not distributed across the country according to need but according to a variety of other preferences. That’s the reason I continue to harp on the need to increase the supply of health care in the United States dramatically. In this light the emphasis on coverage is a distraction from the necessary discussion on cost control. It’s a sad reality that citizens of the U. S. have only a limited willingness to pay for other people’s health care cf. TennCare. The problem with TennCare was not that it wasn’t achieving its objectives; the problems were that costs were rising too fast and too many people were going onto TennCare’s rolls.

Other Voices

Ezra Klein who, more than anyone else in the blogosphere has made health care reform his own, is favorably disposed to the plan:

Her plan is very, very good. Indeed, it’s very similar to Edwards’ plan.

I’ll add other links as they emerge and as time allows.

Ezra Klein has produced a more detailed analysis of the plan and likes what he sees.

Maggie Mahar, too, writing at TPM, likes what she sees:

I’ll write more about “shared decision making” here and on my blog ( but suffice to say that Hillary’s plan is impressive because she has such a clear, in-depth vision of how we can rein in health care inflation while improving the quality of care.

I can only assume that Ms. Mahar is making different assumptions about the sources of rising healthcare costs than I am. If I’m right and supply and demand are significant, Sen. Clinton’s plan will increase costs and increased costs will drive down political support.

2 comments… add one
  • “If I’m right and supply and demand are significant, Sen. Clinton’s plan will increase costs and increased costs will drive down political support.”

    I’m not sure. We have the situation of concentrated benefits and diffuse costs. The benefits go to new health care consumers, and higher rates to suppliers. Both groups have an incentive to be passionate advocates.

    The costs get fudged in the campaign, and even when the chickens come home to roost they just further bloat the swelling national debt. The electorate as a whole never makes the connection.

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