RECOVERED HISTORY: THE LAST HEALTHCARE FIGHT

Sam Smith, Shadows of Hope, 1994 - During the first months of the Clinton administration, one of the biggest national policy changes of the past fifty years was being forged by a secret committee led by Mrs. Clinton under procedures that periodically defied the courts and the Government Accounting Office and whose public manifestations consisted of highly contrived media opportunities, carefully staged "town meetings," and similar artifices.

Despite the contrary evidence of public opinion polls, the concept of Canadian-style single-payer insurance was dismissed early. Tom Hamburger and Ted Marmor in the Washington Monthly tell of a single-payer proponent being invited to the White House in February 1993. It was, he said, a "pseudo-consultation;" the doctor was quickly informed that "single payer is not politically feasible." When Dr. David Himmelstein of the Harvard Medical School pressed Mrs. Clinton on single payer, she replied, "Tell me something interesting, David."

In other words, write Hamburger and Marmor:

"Fewer than six weeks into the Clinton presidency, the White House had made its key policy decision: Before the Health Care Task Force wrote a single page of its 22-volume report to the President, the single payer idea was written off, and "managed competition" was in."

If there was any popular, grassroots demand for "managed competition" it never appeared. Managed competition had not been tested anywhere.

Nonetheless, reported Thomas Bodenehimer in Nation:

"Around Hillary Rodham Clinton's health reform table sit the managed-competition winners: big business, hospitals, large (but not small) commercial insurers, the Blues, budget-worried government leaders and the 'Jackson Hole Group,' the chief intellectual honchos of the managed competition movement. . . Adherence to the mantra of managed competition appears to be the price of a ticket of admission to this gathering."

What was finally proposed involved a massive transfer of the American health industry -- by some accounts now larger than the military-industrial complex -- to a small number of the largest insurance companies and other major corporations. These were companies that had the assets to play the game being offered -- a medical oligopoly that would dispense health-care under the rules of the Fortune 500 rather than according to those of Hipprocrates.

Clinton's position on health care had bounced around in the early months of the campaign, finally settling on a policy that would leave the big health insurers largely unscathed. It was not particularly surprising. Max Brantley, columnist for the Arkansas Times, noted that "Blue Cross owns Arkansas, and [Clinton] never did much to fight them."

The stakes would eventually become so high that a number of the biggest insurers -- including CIGNA, Aetna and Metropolitan Life -- would leave the industry-wide Health Insurance Association of America. Five of the largest insurance companies formed something called the Alliance for Managed Competition. In this new game one of the first targets of 'managed competition' was the smaller insurance companies that now account for nearly half of the health underwriting business. Said managed competition advocate Lynn Etheridge, "Ninety-nine percent of the insurance companies are going to be wiped out because they're only prepared to be insurance companies."

Mrs. Clinton, sounding like a 1980s takeover lawyer, said, "It's going to be a Darwinian struggle. Only the best and fittest of them will survive." Similarly, when asked how small businesses were meant to cope with the added costs of her plan, Mrs. Clinton replied, "I can't go out and save every undercapitalized entrepreneur in America."

Her interest lay with the largest companies, i.e. the ones with the ability to purchase or create the health maintenance organizations that would become de rigeur under the Clinton scheme. The new HMOs would be major profit-centers for companies, simultaneously subsidized by federal payments for the ailments of the poor, elderly and those without conventional insurance.

Not everyone shared the Clintons' enthusiasm for the plan. Washington Post columnist Tony Kornheiser wrote:

"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."