March 13, 2016

Where Hillary Clinton really stood on healthcare back in the 90s

Sam Smith, October 1993 - The administration, recovering the semiotic advantage it lost during the first months of its tenure, has thoroughly iconized its proposed health care policy, forcing anyone who wishes to challenge it to deal not only with an exotically complex proposal but with the carefully massaged image of the president's wife.

Since the promoted image is one of a intelligent, charming feminist paragon, it becomes difficult to suggest that Ms. Clinton might be involved in one of the largest economic giveaways since the government handed the railroads 21 million free acres in the late 19th century. Or that much of her defense of the program comes down to uncredible versions of "trust us" or "excellent question, Senator" or "we will be sensitive to that" or "we share your concern." Or that the plan will primarily benefit a few large American corporations well positioned to take advantage of it. Or that the administration's cost accounting for its policy assumes a level of accuracy never before seen in Washington fiscal projections, let alone in any of Clinton's number-crunching to date. Or that the policy Ms. Clinton defends would, to varying degrees, replace medical decisions in healthcare with fiscal ones, supplant the traditional doctor-patient relationship with a highly institutionalized system, reduce greatly a patient's choice, and generally remake medicine along corporate lines.

Ms. Clinton developed the administration's policy in a secrecy that was at times maintained in defiance of the courts and the GAO. Her task force included individuals with serious conflicts-of-interest (many of whom never filed the required forms identifying these conflicts) and it gave only a token nod to consumers, advocates of alternative approaches, or doctors.
Nonetheless, with considerable assistance from the media, the canonization of Ms. Clinton began in earnest late last spring as the healthcare task force was trying to complete a plan so complex that the congressional briefing book ultimately was 239 pages long. Reported the New York Times on May 7:
Suddenly Hillary Rodham Clinton is back dominating the news stands, from Family Circle to the cover of People, from Time to the Washington Post. Her aides insist that the timing is all coincidental, but some political professionals see it as a useful exercise in image-burnishing for the release of the Administration's long-awaited proposal for health-care reform.

The Times quoted Democratic poll taker Geoffrey Garin, who said: "This is going to be a very complicated plan, and in those circumstances people's faith in the author will be pretty important. If you don't know exactly know what a `health alliance' is all about, at least you know whether you trust Hillary Clinton."

It worked. A study of the first six months of the Clinton administration found that 79 percent of Ms. Clinton's network TV coverage was favorable as opposed to only a third of her husband's.

The Hillary hype escalated as Ms. Clinton spent several days on Capitol Hill the end of September fielding softball questions from members of Congress. Gone was all memory of the attorney who once blithely represented clients before agencies of her husband's government in Little Rock, explaining, "For goodness sakes, you can't be a lawyer if you don't represent banks." Absent was any sense of the irony about using a lawyer for corporate interests as a national role model in the first place. Even conservatives were cowed and feminist leaders, despite erstwhile demands for control of their own bodies, smiled or applauded as Ms. Clinton proposed turning the bodies of all Americans over to the care of a handful of huge corporations.

The media did no better, and willingly adopted the White House symbolic thrust, the import of which was that since Ms. Clinton was so wonderful her health plan must be likewise. Other media ignored the Washington Times Sept 29 story reporting that Ms. Clinton's former law firm had generated what "a Union County, Iowa, judge and a lawyer assigned to investigate the case described as 'excessive profits' for a client in the 1989 sale of 41 nursing homes in Iowa." Among the lawyers involved was now Associate Attorney General Webster L. Hubbell, whose duties in the Clinton administration include cracking down on healthcare fraud. Said the investigating attorney: "This is probably the worst case of excessive profiteering I've seen in 20 years of looking at these kinds of cases." According to the Times, White House staffers William H. Kennedy III and Vincent Foster (who committed suicide in July) worked the case as well. There is no evidence that Ms. Clinton was actively involved, but as a senior partner she would have profited from it.

The syrupy encomiums that substituted for journalistic coverage of the president's wife also obscured the fact that one week after her congressional testimony, the Rose firm was scheduled to open an office in Washington a few blocks from the White House. One of its clients is Prudential, a major potential beneficiary of the Clinton plan.

I'm sorry if I sound like a snob, but over the years I've developed fairly good relationships with a few doctors, and I have a feeling that if [the Clinton plan] goes into effect, I'll never see them again. I fear I'll end up in the teeming waiting room of an HMO, sitting on a cold folding chair, wearing those hideous paper slippers and a hospital gown that exposes your behind, shuffling down a bleak hallway, waiting to see the one doctor on call. We'll all be milling around, holding numbers in our hands, just like at an Eastern European fish market -- Tony Kornheiser in the Washington Post

If, in fact, this was merely a traditional case of fawning over some attractive public official, it would be barely worth mentioning. But what makes this different is that what we're supposed to be talking about is the quality and protection of every American life. The persona of Ms. Clinton sheds no light on the subject and, in fact, has greatly obscured many of the issues that should be under discussion.

Were it not so, the average American would be far more aware of the variety of ways Ms. Clinton and her husband are misleading the public on healthcare. Here are some of the things they haven't told you:

-- The plan is based on turning one seventh of the economy -- the medical industry -- over to an oligopoly of large corporations, led by the largest insurance companies but perhaps also including other mega-corporations that may wish to enter the profitable field the Clintons are proposing to establish.

-- Both the Clintons have claimed that their system will expand patient choices. This is blatantly untrue. As Harvard doctors David Himmelstein and Steffie Woolhandler pointed out in a letter to the New York Times, the Clinton plan would "'in effect obliterate private practice and other small-scale providers, leaving patients to choose from a menu offering only corporate care served up by insurance giants like Prudential and Aetna."

-- The Clintons' plan will force patients and doctors into health maintenance organizations. Not only will this produce an horizontal oligopoly but vertical monopolies as well. As Melvin Konner noted in the New York Times: "A few powerful insurers would control the delivery of care from the top down." According Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, a recent study found that eight companies already own 45% of the HMOs in the country. The eight are: Blue Cross, Cigna, Aetna, Travelers, MetLife, Prudential, Humana and United Health Care.

-- A study reported in the Journal of the American Medical Association found that a majority of HMO patients were unhappy with the system. In contrast only three percent of Canadians would trade their system for ours.

-- Part of Clinton's cost-accounting for his health plan involves an incredible fifty percent decline in the annual increase of funds spent on health care between 1996 and 1997. As Dr. Wolfe put it, "If you believe in the tooth fairy, you will believe in this."

-- The plan also assumes a $239 billion cost savings in Medicare and Medicaid between 1996 and 2000. How will these savings be achieved? Most likely by cutbacks in service. Further, as Dr. Himmelstein notes, Medicaid has a current overhead of 3-4%. Under the Clinton plan it would be run through the private insurance system with an overhead of 13%, an increase in costs that will have to come from somewhere, presumably from the Medicaid program itself.

-- Although the Clintons like to say they are sensitive to the concerns of small businesses facing large increases in healthcare costs, the Wall Street Journal quotes one congressmember as reporting he was told by Ms. Clinton: "I can't go out and save every under-capitalized entrepreneur in America."

-- From a recent article in Lancet by William Glazer, an international health expert: "HMOs were invented not by Americans but by Europeans; they are not new but were the most common way of organizing health insurance a century ago. At that time, workers joined a sickness fund, the fund hired its own doctors on capitation fees or salaries, the fund had agreements with certain hospitals; a patient consulted out-of-plan providers only by paying out-of-pocket. Because the public opposed lock-ins, subsequent national health insurance laws have guaranteed that every insured person can consult any doctor and hospitals. . . .HMOs can not survive under national health insurance laws. They endure only in the United States, which alone lacks the national health insurance laws that guarantee free choices by patients and doctors."

-- Under managed care, insurance companies are already pressuring doctors and mental health specialists to provide less expensive forms of care. For example, a therapist will be told by the insurer to prescribe a drug rather than continue with therapy sessions. Under the Clinton plan this sort of drug pushing could be expected to rise substantially.

-- It takes about the same number of people to run Blue Cross in Massachusetts as it does to run the entire single-payer system in Canada -- a system about ten times as large.

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