Ready to Operate

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Safeguard the security and "portability" of health insurance, even for workers who change jobs, get laid off or develop chronic illnesses. Though 86% of Americans have health insurance, White House polls have shown that many people are anxious that they will lose their coverage because of layoffs or cutbacks in employer-provided insurance. The Clinton plan would ensure that workers can get insurance at any new employer, at comparable prices, even if they already need medical treatment.

Make health insurance more affordable. At the heart of the Clinton plan is the concept of "managed competition." Health-insurance buyers would band together in large "alliances" to bargain with competing networks of doctors, hospitals and other health-care providers for the best service at the best price. The theory is that such bargaining will encourage lower costs and greater efficiency (fewer unnecessary tests, for example). Rather than simply trust in this theory, however, the Clinton plan would also strictly enforce limits on health-care spending through a powerful new National Health Board that would decide when health-care providers were charging "too much." Some providers warn that such cost controls will result in development of fewer new drugs and in rationing of care. Example: requiring that elderly patients in declining health be denied such operations as hip replacements and cardiac bypasses.

Require all employers to contribute to the cost of their workers' health care. Employers would pay 80% of whatever an average health-insurance plan costs. The White House estimates that in 1994 such policies would be $1,800 a year for an individual and $4,200 for a two-parent family. Workers who want this average plan would pay the remaining 20% of the premium. Those who want a more expensive plan would have the option of paying more out of their own pocket. And those willing to settle for a no-frills (HMO) could pay less.

Require that all Americans be given a greater choice of insurance plans at different levels of price and service. Under the current system, says Paul Starr, a Princeton health-care expert who helped write the Clinton plan, "most people don't have a choice of any plan. They just take whatever their employer gives them." Under the Clinton plan, people would be offered several options. The most expensive would be the traditional fee-for-service medicine from an individual doctor. Less expensive would be the so-called preferred-provider organizations (PPOs) that many companies are now using; these require that workers go to specified doctors and hospitals that are part of the plan. An even cheaper option would be the HMOs that provide health care for a fixed price, although often with some waiting and rationing of specialist's services. Given such choices, health-care economists believe, consumers will economize by shifting toward HMOs and PPOs, which will further drive down health-care costs.

Relieve consumers from the nightmare of medical billing and insurance-claim $ forms. Clinton's plan envisions a world of instant electronic billing before the patient leaves the doctor's office. Consumers will spend less time listening to Muzak on the phone while waiting for someone at the insurance company to track down their reimbursement, while care providers and insurers will spend less time and money processing piles of claims and bills and other paperwork.