09/17/2007 04:49 pm ET Updated May 25, 2011

Sen. Clinton's Health Plan: A First Look

Sen. Hillary Clinton has offered an initial look at her plan for health care reform. It's not likely to change anyone's mind about her candidacy, or about health care reform, but at the overview level it's well-designed and thorough. Her plan is solidly in the center of Democratic proposals. It emphasizes mandated coverage, cost reduction measures, and the elimination of predatory insurance underwriting. At first review, it reinforces the sense that she and her staff are knowledgeable, highly competent, and incrementalist in their approach.

We'll look at the plan's details, and then quickly touch on the Republicans' (predictable) responses.

Sen. Clinton has abandoned the regional health alliances that were a hallmark of her 1994 proposal. That makes the Edwards plan, with its regionally-based Health Markets, more traditionally 'Clintonian' than Sen. Clinton's new proposal.

Here are the highlights of the Clinton plan, based on an initial review:

Like the Edwards plan and Mitt Romney's Massachusetts plan, mandates are the centerpiece of the Clinton program. Every American will be required to have health insurance. To offset this new requirement, the Clinton plan promises future cost savings to ensure affordability.

I'm not a fan of mandates, for reasons discussed here, although I understand the thought process behind them. There are fundamental issues of fairness that are easy to address in theory, using subsidies -- but most policymakers so far have failed handle premium and copayment structures in a way that does so effectively. I also suspect that Republicans will have a field day running against the mandate concept.

The Clinton plan -- like those of Edwards and Obama -- apparently offers a public insurance alternative, although details are sketchy at this point. The long-term impact of a public/private competitive model is potentially very significant: If private insurance companies can't compete on price and value, and if they're policed effectively enough to avoid their use of unfair underwriting advantages, they could potentially wither and die. That would leave the country with a de facto single-payer system -- one created by market forces. Yet there are many potential hurdles between a mixed system and a fair outcome.

Sen. Clinton's program is administered through the Federal Employee Health Benefit Program (FEHBP). She takes a page from John Kerry's playbook (and Ron Wyden's) by saying that this will provide "benefits at least as good as the typical plan offered to Members of Congress, which includes mental health parity and usually dental coverage." There will also apparently be also a public Medicare-like system, although details on that are sketchy at this point.

The problem is that, as Joe Paduda points out, many Americans can't afford the copayments and deductibles in the congressional health plan.

It will be difficult to light a fire under the political base with this plan, or for that matter with Edwards' or Obama's (although Edwards took the rhetorical lead today by promising to cancel coverage for the executive and legislative branches if health reform isn't enacted).

Sen. Clinton's plan appears to handle taxation issues in depth, and addresses the ongoing (and often neglected) issue of retiree health benefits. And Clinton has been ahead of the curve in addressing health IT issues.

Republican reaction was predictable:

"If you've seen the report this morning on the latest version of Hillarycare, you'll see that version 2.0 is not like to have any more success than 1.0," former Massachusetts Gov. Mitt Romney told reporters in New York. "Hillarycare continues to be bad medicine."

Yet, of all the candidates, Romney is the only one who has tried to enact health reform. As we've discussed before (here, here, here, and here), his record so far hasn't earned him any bragging rights. And Giuliani indulges in a typical attack of red-baiting, saying ""If you liked Michael Moore's Sicko, you're going to love HillaryCare 2.0. " That may not be a smart move, since a lot of people did like Sicko (a movie that condemned the "new Hillary").

As with any of the health proposals, the Clinton plan can't be fully assessed until more details are provided on knotty issues like premium calculations and benefit design. We'll be looking for more information, and will provide more details as we get them.

A Night Light
The Sentinel Effect: Healthcare Blog
RJ Eskow at the Huffington Post