A few months ago, many on Capitol Hill were pronouncing the Clinton plan "dead." It was commonly assumed that mandatory alliances and other features of "managed competition" were also dead. But as we learn more details about the four versions of the Clinton plan that have emerged in congressional committee bills, it is clear that the reports of the demise of managed competition were premature.
Managed competition is the central idea behind the Clinton administration's plan to reform the nation's health care system. It is also the main idea behind the four versions of the Clinton plan reflected in four different congressional committee bills. [See the NCPA Brief Analysis, "Managed Competition Is Back."]
Four congressional committees have now produced versions of the Clinton administration's health care plan. Three of the bills would force all Americans and their employers to purchase a health insurance package that has become increasingly bloated with costly, special-interest benefits.
Medical Savings Accounts, also called Medical IRAs and Medisave Accounts, have more support in Congress than any other proposal to control health care costs.
Under "community rating" health insurers are required to charge the same premium to every policyholder, regardless of their expected health care costs. Under "modified" community rating, premiums may be adjusted by age and sex. Both types of regulation allow people who are already sick to purchase health insurance for the same price as those who are healthy.
Senator Bob Dole (R-KS) has just proposed a health care reform plan. The Dole plan builds on key reform ideas developed by the National Center for Policy Analysis. However, some benefits of the reforms would be diluted by unnecessary insurance regulations that should be dropped from the proposal.
One problem with our health care system is that many sick people who lose their health insurance find it impossible to purchase new coverage. Insurers may classify them as uninsurable, offer them a policy that excludes payment for medical services for their preexisting conditions or set their risk-rated premium so high they cannot afford it.
Relatively simple reforms would go a long way toward solving our most pressing health care problems without creating new ones. Unfortunately, the underlying debate is not about how to solve our health care problems. It's about how our health care system should be organized.
Are employer mandates the best way to pay for health care reform? Virtually all studies of mandates conclude that they kill jobs. Even the Clinton administration agrees.
The new crime bill is now in the hands of a congressional conference committee, which is resolving differences in the House and Senate versions. Despite some beneficial provisions, many are convinced we would be better off without any bill.
A common assumption in the current health care debate is that universal health insurance coverage requires an employer or individual mandate. Either directly or indirectly, these mandates would require individuals to obtain health insurance, whether they want to or not.
In his 1994 State of the Union message, President Clinton said the goal of his health care reform proposal is "to give every … American the same health care security they have already given to … federal employees." The Federal Employee Health Benefits Program (FEHBP) also has been held up as a prototype for reform by Stanford professor Alain Enthoven, father of managed competition. Liberal Senator Edward Kennedy has advocated allowing individuals and small business employees to join the FEHBP. And the program has been praised by a number of conservative Republicans.
All across the country, private employers are discovering a new way of controlling health care costs. It works so well that at some companies health care costs are actually going down. The secret: giving employees incentives.
Responding to polls that show crime to be the number one concern of Americans, Congress is about to act. What is certain to emerge is a bill providing for spending between $15 billion and $22 billion over the next five years.
Canada tries to control health care spending with price caps and global budgets similar to those proposed by President Clinton. How well does the Canadian health care system work? Not bad – as long as you're not sick.
In his State of the Union address, President Clinton said he would veto any health care bill that does not create "universal health insurance coverage." If so, the President would have to veto his own bill. Neither the President's plan nor any other proposal that requires individuals to pay part of their own health insurance premiums will cause everyone to be insured.
As part of its anticrime plan, the Clinton administration is endorsing a ban on the importation, manufacture, sale and possession of "assault weapons." Yet if passed, this legislation would do nothing to reduce the crime rate. Instead, it would give the American people the erroneous impression that the federal government was doing something serious about crime.
The myth that punishment has failed to deter crime is being advanced by those who argue that we imprison more and more people without a significant reduction in crime. The facts say otherwise. From 1950 to 1974 " a period during which imprisonment for serious crime declined sharply " the crime rate soared. In 1974, the rate of imprisonment began increasing and, as a result, the crime rate leveled off in the 1980s and has actually declined in recent years. Still, the rate of serious crime remains distressingly high.
Texas is entering the 1990-91 fiscal period with a projected deficit of almost $1 billion. Because of this deficit, Texas taxpayers face an almost certain increase in taxes in the next biennium, including the possibility of an income tax.