Here's the thumbnail: Clinton's plan is of the "individual mandate" variety, in which universal coverage is achieved by mandating that every American purchase health care. In order to ensure that that's both possible and affordable, the Clinton plan creates a few new coverage options, reform the insurance industry, limits coverage costs to a percentage of income, and washes your car.Regardless of the merits or shortcomings of the plan, the Republicans will go ballistic and rip it to shreds because it's proposed by Hillary Clinton, and they're still paying residuals to the actors who played "Harry and Louise" in the commercials the insurance companies ran back in 1993 that defeated Ms. Clinton's first attempt to reform health care. They will seek out the tiniest flaw ("Look! There's a split infinitive in this paragraph!") pronounce it as totally unworkable, socialized medicine, and that it will lead to man-on-dog sex in the streets of Philadelphia. It does put Mitt Romney in the uncomfortable position of having to attack a plan that is remarkably similar to the plan that he signed into law when he was the governor of Massachusetts ("They made me do it!"), but for the most part it will provide a distraction from the fact that none of the Republicans have put forth any sort of health care reform other than to suggest that there are always emergency rooms that will provide for the truly needy. That certainly doesn't obligate them from not attacking the plan as the slippery slope to "Canadian-style" (i.e. single-payer) health care. Guess what; we've had that in some form or another for generations. It's called Medicare. And it works. (What's ironic is that when I was in Canada in August I saw campaign commercials for the Liberal Party in the upcoming provincial election in Ontario. One of their themes was telling voters to reject the Conservatives who wanted to bring in "U.S. style" health care.)
Okay, it doesn't wash your car. It does open the Federal Employee Health Benefits Program to everybody, ensuring that anyone can access the same menu of regulated private options that federal employees get. FEHBP is the program that already insures millions of current government employees, including the members of Congress, by offering a variety of regulated private options to choose from. Throwing the doors to that program wide open is the most basic and ubiquitous of coverage solutions.
More importantly, the plan also creates a new public insurance option, modeled off, but distinct from, Medicare. That's a big deal: The public insurer offers full coverage and is open to all Americans without restriction. Public insurance is what I feared her plan would avoid, and instead, she embraced it wholeheartedly. The concern with a plan like this (as with the Edwards plan), is that insurers will market coverage to the young and healthy and subtly tilt the public plan's risk pool towards the old and sick (the check is that governmental plans are, for reasons related to administration costs and care incentives, cheaper). At the end of the day, there's not much that can be done about that, unless you want to tax insurers with overly healthy pools, as they do in Germany. Come to think of it, that's exactly what they should do -- it was even in the 1994 bill.
As David Brooks notes, the plan isn't perfect and it will require a change in the political lay of the land because, as Sen. Clinton's plan envisions, the disparate groups that make up the health care industry -- insurance companies, governments, doctors, big pharma, the patients -- will have to get together and try to achieve a common goal. Forget the actual points of the plan; it's the politics and the profits that are at stake here, not the actual health and well-being of both the citizens of the United States and the economy.
