Back to the Health Care Future

Published November 14, 1996

President Clinton has opened the health care reform crypt with his recent announcement of a “National Commission on Health Care Quality.”

Make no mistake about this. It marks the beginning of a new thrust for complete government regulation, if not outright control, of health care. The banner likely will be carried by Health and Human Services secretary Donna Shalala, who will be assisted by a twenty-member commission comprised of the same “consumer advocates” who just two years ago sought to eliminate consumer choice in health care.

To further insult our sensibilities, the commission will include insurers, who will be judges in their own cause; labor leaders, who are fans of a single-payer health care system; and business leaders, who want to transfer the cost of corporate retirees onto the federal taxpayer.

At first glance, it appears the commission was formed to “protect” consumers from the shortcomings of managed care and evidence of consumer abuse. The abuses include outright denial of medical care deemed inappropriate by an insurance “gatekeeper”; the use of “gag rules” to limit a physician’s right to discuss alternative medical treatments with his or her patients; and the increased cost of insurance caused by community-rated premiums.

Ironically, the Clinton commission aims to protect consumers from the very same flaws that led to the demise of the original Clinton reform plan: health coverage established through large regional alliances of hospitals and doctors, financed by an employer mandate, at a premium cost shifted to the young and healthy by community rating.

The new team of health care reformers will hold “public” hearings across the country, “showcasing” the weakness of “free market” health care and the abuses visited on patients by privately run managed care plans. Expect to see recommendations for tougher government regulation, perhaps even plans to scrap the whole managed care idea in favor of a bloated version of Medicare frighteningly similar to a national single-payer system.

Advocates of such a health care monstrosity are building strong grassroots organizations in every state by tapping into the fears of middle America. They claim to support the old system where healers and consumers together are in charge of health care decisions . . . but then they insist that the government-controlled Canadian health care system is the “model” for us to copy.

Attacking the failings of managed care, like attacking the welfare system, makes for good politics, crafted to appeal to a broad swath of middle America. As President Clinton moves to the “right” with symbolic, picture-perfect rhetoric, his policy actions will follow the script Shalala will write–a script that will take this country to the far left on health policy.

All this government intrusion could be avoided . . . simply by getting employers out of the health insurance business and eliminating a fifty-year-old tax code accident. First, ownership of health insurance coverage should be transferred from employers to their employees. Doing so puts the employee in control of insurer’s actions and guarantees complete portability of coverage from job to job and into retirement.

Second, health insurance premiums should be made fully tax-deductible for employees–not employers. The current employer-friendly tax code has turned the workplace into an inefficient marketplace for insurance. The employee is largely excluded from the insurance selection process, restricting freedom of choice. Giving employees the tax deduction expands their health insurance choices and makes premiums more affordable for everyone, including the uninsured (two-thirds of whom are low- and middle-income workers).

The managed care approach is obviously failing, but Clinton’s proposed solution is nothing but a smoke-screen. His plan replaces a private-sector middle-man with a government-sector middle-man. The fundamental flaw in managed care remains: Someone other than the patient is doing the managing. Until and unless that flaw is corrected, tens of millions of middle Americans will remain helpless as their quality health care slips away.

Conrad F. Meier, Rhu is a health policy analyst for The Heartland Institute. He is the former State Chairman of the Health Insurance Committee of the National Association of Life Underwriters and a retired health insurance consultant. He can be reached by email at [email protected].