Expert decries unfair criticism of Clinton health-care plan

By Mark Reutter

Seven months after President Clinton unveiled his health-care plan, scare
tactics and dire predictions have obscured the merits of national health-
care reform, a UI expert argues.

"Up to this point the tone and content of the debate have been truly
unfortunate," says Robert F. Rich, the director of the UI Institute of
Government and Public Affairs and a co-editor of a book on health care.
Writing in the Policy Forum, published by the UI, Rich faults the ad
campaign that predicts that 40 percent of Americans will pay more for
health care under Clinton's plan.

In truth, Rich argues, health-care costs will go up whether or not Congress
adopts the Clinton plan. "The relevant question is not whether costs will
increase; instead, how will these costs be distributed? And what role will
savings from cuts in other areas play in paying the bills?"

Similarly, the "choice" question is bogus, he writes. Choice of physicians
and health plans are increasingly limited under private insurance - and the
trend will only accelerate as more companies respond to the escalating
costs of medical insurance for employees.

"Traditional fee-for-service arrangements are capturing less and less of
the market," Rich notes. "Such arrangements accounted for 89 percent of the
national market in 1984, 44 percent in 1987, and will account for only 10
percent in 2000. At the same time, 40 percent of the market will be
captured by HMOs [health maintenance organizations] and 35 percent by PPOs
[preferred provider organizations]."

The criticism that a national program would ration health care and
overwhelm citizens with bureaucratic red tape also is based on false
assumptions. "The current system is heavily involved in rationing.  Those
who can afford to pay receive all the care they want, and those who can't
are much more limited in their options," Rich writes.

It is important for Congress, private industry and the media to focus on
the core questions facing America, Rich notes. One such question is whether
the nation should alter the basis of its medical delivery from a market
system, where the payer determines his or her level of care, to one where
care is based on medical and therapeutic principles.

Clinton's principle of equality - that all Americans are entitled to equal
health care - marks a major departure from most public policy and should be
vigorously debated.

 "In elementary and secondary education," Rich writes, "we guarantee each
child access to a publicly financed education; we do not guarantee the same
education or a high-quality education for everyone. By mandating health
insurance for everyone at an equal level of care, we would be fundamentally
changing the way we organize, finance and deliver health-care services in
this country."

Rich is a co-editor of "Competitive Approaches to Health Care Reform,"
published last fall by the Urban Institute Press in Washington, D.C.