NRL News
Page 1
September 2007
Volume 34
Issue 9

THE NEW CLINTON HEALTH CARE PLAN: RATIONING ONCE AGAIN

On September 18, Presidential candidate Senator Hillary Rodham Clinton (D-NY) unveiled a proposal for universal health care. It was touted as a proposal much reworked from the ill-fated Clinton Health Care Rationing Plan of 1993–94 for which she had been largely responsible during her husband’s ad-ministration. But her proposal, in fact, still requires rationing.

The 1993–94 plan imposed price controls that would not allow premiums to keep up with the rate of health care inflation. The result would have been a steadily increasing rationing of care, including lifesaving medical treatment.

In a famous statement made while testifying before a Senate panel, the then-First Lady said that under the plan “people will know they are not being denied treatment for any reason other than it is not appropriate—will not enhance or save the quality of life.”

The 2007 Clinton health plan does not overtly include price controls on premiums. It would effectively impose price controls on drugs, through the fiction of government “negotiation” of their Medicare prices. NRLC has explained in detail elsewhere that this would drastically limit access to innovative drugs and significantly curtail research on new drugs. (See, e.g., NRL News, February 2007, p. 1.)

The new Clinton Plan also has apparently innocuous provisions calling for “chronic care management programs.” It states, “The American Health Choices Plan funds a Best Practices Institute that would work as a partnership between the existing Agency for Healthcare Research and Quality and the private sector to fund research on what treatments work best and to help disseminate this information to patients and doctors to increase quality and reduce costs.”

This proposal is prefaced by a telling statement: “Americans with multiple chronic diseases—including heart disease and diabetes—account for 75 percent of our total national health expenditures and are the leading causes of death in the U.S.”

Washington Post columnist Steven Pearlstein, in a September 17 commentary entitled “A Healthy Dose of Hillary,” remarked, “Certainly nobody is opposed to using objective medical evidence to manage the care given by various providers to patients with chronic disease or patients at the end of life. But what that means in practice is that a trained health professional ... is going to have to tell other doctors how to practice medicine and tell patients what drugs and tests and surgical procedures won’t be covered by insurance. If that sounds a lot like managed care and rationing, it’s only because it is.”

In the context of describing the need for its Big-Brother style “Best Practices Institute,” the Clinton Plan document notes, “In the past decade, there has been an 80 percent growth in the number of drugs prescribed, 100 percent growth in new medical device patents, 300 percent growth in teaching hospital procedures, and 1,500 percent growth in diseases with gene tests.”

This is evidence of the tremendous vitality of the U.S. health care system, which is the world leader in innovation, in developing increasingly effective ways to save lives and improve health. To Clinton, however, this is apparently a disturbing trend that, because of its expense, needs bureaucratic supervision and control to rein it in.

At the heart of the problem with Clinton’s current health care proposal is that it is unsustainable without rationing. That is because it aspires to replace the private-sector cost-shifting that at present pays in significant part for the cost of providing medical care to the uninsured (which it disparages as a “hidden tax”) with a system of tax credits from general revenues funded predominately from income taxes.

As explained in the story that begins on the back cover, our society in general can afford to devote increasing resources to health care because of increases in productivity in other sectors of our economy. But governmental budgets cannot easily make room for larger proportions devoted to health care by decreasing proportions allocated to such things as Social Security, income security, transportation, defense, education, veterans’ benefits, justice administration, and interest on the national debt.

Like the Clinton health care rationing plan of 1993–94, Hillary Clinton’s latest plan provides a recipe for rationing of lifesaving medical treatment.