industrial country in the world, except the US.
The Clinton plan is called “managed competition.” What is that, and
why are the big insurance companies supporting it?
“Managed competition” means that big insurance companies will
put together huge conglomerates of healthcare institutions,
hospitals, clinics, labs and so on. Various bargaining units will be set
up to determine which of these conglomerates to work with. That’s
supposed to introduce some kind of market forces.
But a very small number of big insurance conglomerates, in
limited competition with one another, will be pretty much in charge
of organizing your healthcare. (This plan will drive the little
insurance companies out of the market, which is why they’re
opposed to it.)
Since they’re in business for profit, not for your comfort, the big
insurance companies will doubtlessly micromanage healthcare, in an
attempt to reduce it to the lowest possible level. They’ll also tend
away from prevention and public health measures, which aren’t
their concern. Enormous inefficiencies will be involved—huge
profits, advertising costs, big corporate salaries and other corporate
amenities, big bureaucracies that control in precise detail what
doctors and nurses do and don’t do—and we’ll have to pay for all that.
There’s another point that ought to be mentioned. In a Canadian-
style, government-insurance system, the costs are distributed in the
same way that taxes are. If the tax system is progressive—that is, if
rich people pay a higher percentage of their income in taxes (which
all other industrial societies assume, correctly, to be the only
ethical approach)—then the wealthy will also pay more of the costs
of healthcare.
But the Clinton program, and all the others like it, are radically
regressive. A janitor and a CEO pay the same amount. It’s as if they
were both taxed the same amount, which is unheard of in any
civilized society.
Actually, it’s even worse than that—the janitor will probably pay
more. He’ll be living in a poor neighborhood and the executive will
be living in a rich suburb or a downtown high-rise, which means
they’ll belong to different health groupings. Because the grouping
the janitor belongs to will include many more poor and high-risk