The new Hillary health-care plan is very different from the old 1993-1994 Hillary plan. It is far slyer, and far cleverer, far more well-packaged. The same arguments that applied to the old Hillary plan do not necessarily apply to the new plan. But the new health plan ends up in the same place as the old health plan — with the government running everything.
Here are the primary problems with the new Hillary health plan:
What Entitlement Crisis?
As everyone should know by now, our nation faces a dramatic entitlements crisis that will play out over the next 30 years. Federal spending has been hovering in a fairly stable manner, around 20-percent of GDP (Gross Domestic Product), for over 50 years now, since the early 1950s. But the Federal government’s own official projections show that over the next 30 years or so, federal spending will soar to 40-percent of GDP, requiring total federal taxes as a percent of GDP to double. This is due to the exploding costs of the entitlement programs we already have, primarily Medicare, Medicaid, and Social Security.
Hillary Clinton and other Democrats respond to this overwhelming crisis by proposing that we not reform any of the existing entitlements. Rather, they suggest that we endorse massive new entitlements, including for instance, National Health Insurance. Policy suggestions like this force one to wonder, are the democrats numerically illiterate?
The Individual Mandate
Hillary Clinton’s plan starts out very simply: she will mandate under federal law that everyone in America must buy health insurance, and by this she supposedly achieves universal coverage. The catch, of course, is that once you start down the road with this mandate, you end up with government-run health care.
If you are going to require people to buy health insurance, then the next question which follows is, exactly what do they have to buy to fulfill this requirement? Suppose they buy the Fraternity Plan that pays only for unlimited beer and pizza during the weekends? Have they satisfied the requirement?
The serious point is if you are going to require people to buy health insurance, then you are going to have to specify exactly what health-plan people will have to buy to satisfy this requirement. So the government has gone from telling you that you need health insurance, to telling you what kind of health-insurance coverage or plan you must have. And with Hillary, we can assume that this will be no basic, minimum plan. But Hillary continues to insist that this is not government-run health care.
And this, of course, is only the beginning. Special interests will swarm to get their favored coverage in the required plan. People will merrily get used to billing everything in the plan to the insurance company. And costs will rise.
People will start complaining that they can’t afford paying for this costly coverage, and whining that the government must do something. The government itself will already be paying for a lot of this coverage, and budgets will therefore explode.
So the government will do something to control costs. It will start rationing. It will start telling people what services and treatments they can have, and when. It will start delaying access to new innovations. It will squeeze payments to health care providers so much that the providers will start rationing what they provide. Government guidelines will start dictating to these providers that they ration care, and how to do it. After a while, people start to realize, “hey, we have government run health care.”
Don’t doubt it. This is exactly what happens with every other country that tries to mandate or provide coverage through government. They realize ultimately there must be some way to control costs. There is no market in these plans to control costs. So the government must do it through the only alternative – rationing. Indeed (we will see below), Hillary’s plan already includes the machinery for this rationing.
It doesn’t help that a small band of too clever conservatives have been supporting just such an individual mandate since 1993-94, when broad objections from conservatives defeated their plan. Congratulations to these folks today. Hillary Clinton has adopted their plan, just as they were forewarned.
The Employer Tax
Since workers would now have to buy insurance under the Hillary plan; employers would have to pay for it wherever possible. All large companies would be required to provide health coverage for their workers (a plan, again, specified by the government), or pay a tax to the government. Already paying among the highest corporate tax rates in the industrialized world, this is just what our corporations need — another tax. Once the politicians get used to raiding this corporate cookie jar, the tax will soon be higher than the corporate income tax. When that tax burden leads to unemployment, no problem, we will just raise taxes on the rich again, and pay for more welfare. All of this will just improve the economy, the Clintons promise.
The Refundable Tax Credit
Where employers don’t pay for health coverage, the government will. Hillary proposes a refundable tax credit for the purchase of health insurance that will leave workers paying no more than a specified percentage of their incomes for the coverage. Hillary’s campaign is already calling this “A Net Tax Cut for American Taxpayers.”
The problem with this is that the bottom 40-percent of income earners do not pay any income taxes, and the middle 20-percent now pay for very little (this is the end result of all those Republican tax cuts for the rich all these years). But the tax credit is refundable, meaning that if you don’t have enough tax liability to take advantage of the credit, the government will still send you a check for the entire credit. So the tax credit here is not giving you back your own tax money. It is giving you back other people’s tax money. So this is not, in fact, a tax cut. It is a new spending program, a new entitlement program, in fact.
We already have a huge program called Medicaid to pay for health coverage for people who are too poor to pay for it themselves. The federal government is now spending close to $250 billion on this program, in addition to probably another $150 billion from the states. And these costs are just projected to explode and explode again over the next 30 years. In other words, we already can’t afford the Medicaid program as it currently stands. But what Hillary is proposing with these tax credits is a massive expansion of it. And we are back to the democratic chimeras again.
Unfortunately, some conservative Republicans have recently toyed around with the idea of refundable tax credits for the purchase of health insurance as well. They have rightly been trying to change tax code incentives to get workers to own their own health insurance rather than relying on employers. Realizing, however, that the tax changes would do nothing for at least half of all workers who now pay little or no income tax, they have been considering various refundable plans to expand the help to lower income workers. The fallacy here is trying to provide assistance to the poor, and to low income workers, through the tax code. This is what Medicaid is for, and lawmakers should focus on helping those with lower incomes through reforming that program.
But Hillary is not done with the refundable tax credits. She would provide such credits as well to small businesses who buy health insurance for their workers, paying for as much as 50-percent of premiums for firms with fewer than 25 employees. And she would also bail out big companies, who are now being crushed by foolish past promises to pay for health insurance for their retirees, with still more tax credits. In return, corporate big shots from these companies publicly intone that indeed, it is time for national health insurance. A better solution would be to just have the government take over these already socialized companies and finish running them into the ground.
Government-Run Health Care
Hillary wisely calls her plan the American Health Choices Plan. Accordingly, everyone will be “free” to choose one of the health insurance options in the Federal Employee Health Benefits Plan. But how is this not government-run health care? No company gets on the list of plans in the FEHBP without first complying with a host of federal requirements and controls. That’s alright when the government is providing insurance for its own employees. But should we be treating all workers in the economy as if they are government workers when it comes to health insurance? Is this not precisely what is meant by excessive government control?
While the FEHBP embodies good policy for the federal government dealing with its own employees, excessive rhetoric from the original designers of that system (about how it is a model for all health insurance) has now brought us to the point of believing that all workers in the private economy ought to be treated as government employees when it comes to health care.
Hillary will also provide, as another option, the choice of a completely government run, government financed health insurance plan. Why? And, again, how is this not government run health care? Moreover, how benign will this plan really be when she is done subsidizing it up the kazoo, and driving all the private plans out of business with her blizzard of regulatory requirements?
Bye, Bye Private Insurance
Hillary’s plan will also impose guaranteed issue on all private health-insurance plans. This means that insurers cannot reject anyone for their insurance, even on the grounds that the patient is already woefully sick and costly. Moreover, insurers won’t be able to charge more costly patients higher premiums.
Effectively, this would necessarily end any real private insurance in America. Under these requirements, companies are no longer insuring health costs, they are simply financing health costs. Health insurers would be like fire insurers who are required to issue new policies at standard rates to those who show up to buy coverage after their homes have already caught fire. Clearly, this is unworkable.
Hillary says the insurers are supposed to be in the business of spreading the risk, not cherry picking the most healthy. But when someone shows up to buy health insurance with cancer and heart disease, we are no longer talking about risks. We are talking about payout. This is not an insurance business.
Rest assured, moreover, that the healthy with health insurance do not want to see the “risks” of the irredeemably unhealthy spread to them. Those without health insurance who have become uninsurable can, and should, be served through other means, such as state uninsurable risk pools that do not involve trashing the health-insurance system for everyone else. But trashing the private health-insurance market is exactly what Hillary and her allies advocate.
Finally, there is the Best Practices Institute, which should be called the Ministry of Truth for health care. These folks will study all sorts of medical care, issue protocols, and standards for what is the best way to treat this or that. And don’t expect any insurers anywhere, public or private, to pay for anything other than what these folks say is the best practice. To oppose the Institute, of course, would just be to pay for waste and inefficiency.
So this is the ideal mechanism for imposing the inevitably necessary rationing. New, expensive medical breakthroughs will be overlooked, or delayed. If your doctor has a brilliant insight on how to treat you, no problem. All you have to do is go to the Best Practices Institute in Washington, explain why this treatment is the right one for you, and get the regs changed. In this brave new world, life insurance will be a lot more valuable to people than health insurance.
Insurers, now all under the control of government, will also impose rationing by squeezing reimbursements to health providers, with the limited funds the new system will allow them, until the providers themselves cut back. This is what the government already does with Medicaid, and increasingly with Medicare.
And there is so much more. In Hillary’s three speeches and three papers on her website, she outlines dozens of new health care requirements in her new system, which will not be government run. The government is all wise and all knowing, and just needs to make sure the rickety old health-care system gets it all right, as it is dragged into the 21st century.
And when Hillary gets done with those fascist drug companies, you can forget about any new breakthrough drugs coming to market in the future, running up costs.
But remember, the system is not government run, and don’t let those nasty Republicans tell you otherwise.
–Peter Ferrara is Director of Entitlement and Budget Policy at the Institute for Policy Innovation. He was recognized for fighting against the Hillary health plan in 1993-94 with awards from the American Conservative Union and Eagle Forum.