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<text id=93TT1771>
<title>
May 24, 1993: Better Hold Onto Your Wallets
</title>
<history>
TIME--The Weekly Newsmagazine--1993
May 24, 1993 Kids, Sex & Values
</history>
<article>
<source>Time Magazine</source>
<hdr>
HEALTH CARE, Page 32
Better Hold Onto Your Wallets
</hdr>
<body>
<p>By JANICE CASTRO--With reporting by Michael Duffy and Dick
Thompson/Washington, with other bureaus
</p>
<p> As President Bill Clinton's health-care reform plan takes shape,
two things have become clear: everyone will be covered, and
everyone with a job could pay more. If his plan passes, those
37 million Americans who have no insurance--more than half
of them small-business employees and their families--will
be covered. No one will lose insurance simply because they have
a medical problem. The new benefits will be "portable," which
means that when someone changes jobs, or is between jobs, the
coverage will continue. The poor will get about the same coverage
as the rich. People will not go without medical care simply
because they are unable to pay high doctor fees. Elderly Americans
who are partly disabled by disease will have some coverage for
home health care.
</p>
<p> The trouble is, by solving just about everyone's problems, the
White House has come up with a plan so generous that it is going
to be enormously expensive. Most Americans who already enjoy
medical coverage may discover that they will have fewer choices
than they have and less control over how they seek medical care.
</p>
<p> Will they be able, for example, to choose their own doctor?
The White House says yes. Well, sort of. Under the Clinton plan,
Americans will join large insurance pools and will be able to
choose among several different types of health plans, depending
on how big a share of the costs of care they are willing to
pay. Some will join health-maintenance organizations, which
treat patients for a flat fee. Others will sign up with a group
of doctors and hospitals. Most people will be able to choose
among the doctors working for the plans, but that does not mean
everybody will be able to continue seeing the doctors they know.
</p>
<p> For those who currently have no family doctor, this approach
is an improvement. But the majority, who may want to stick with
their present doctors, will have to wait and see. Since the
plan may give states great flexibility in designing local health
plans, some states could allow citizens who want to remain with
their family doctor to pay a little more to do so if that physician
is not signed up with the local health plan. But other states
may limit the choice to the doctors in the designated health
plan.
</p>
<p> The basic benefits package guaranteed to all Americans will
be more generous than most people's current coverage. It will
probably cover mental health, dental benefits, hospitalization,
outpatient care, doctor visits, annual checkups, prescription
drugs, prenatal care, preventive medicine such as mammograms
and more. While the details are still somewhat vague, most patients
are likely to pay a low fee for each service, while the health
plan picks up the balance. All medical care will be budgeted;
then doctors and other providers can determine prices to make
the budget work.
</p>
<p> Most people will pay more for coverage than they do now, in
part through new taxes and fees, and much of that money will
go to provide care for less fortunate Americans. Luxury care
will become very rare, since almost no coverage will pay for
it. Nearly all doctors will probably be salaried employees of
plans, and the rest will operate under a government-imposed
fee schedule. As more family doctors and clinics spring up in
neglected rural areas and scruffy urban neighborhoods, many
Americans will find basic medical care readily available for
the first time.
</p>
<p> The health-insurance pools will manage their budgets closely.
Health administrators will discourage visits to the doctor when
the complaint is something minor like the flu or a bad cold.
Doctors will face more second-guessing by health-plan bureaucrats
regarding their decisions on how to care for patients. For these
reasons, the more than 200 million middle-class Americans who
already enjoy full medical coverage may feel the plan is both
too extravagant in its reach and uncomfortably restrictive to
use, especially when they find out how many new taxes they are
going to have to pay to finance it for themselves and everyone
else.
</p>
<p> Patrick Hobart, 62, just retired from his job as an appliance
salesman in Seal Beach, California. Says he: "I think that Clinton
has a wonderful idea, but I don't think it's realistic. I mean,
who is going to pay for it?"
</p>
<p> The answer is basically everyone, but especially middle-class
and upper-income Americans. The President is considering requiring
companies to divert health premiums to the insurance pools;
taxes on some company benefits; levies on wine, liquor and cigarettes;
and other taxes.
</p>
<p> Workers at many small companies may be relieved that they will
finally get first-class medical coverage, but not when they
find out that some of them will probably lose their jobs as
a result of the requirements. For many small businesses, the
new costs alone may be greater than annual profits. If the Federal
Government requires mom-and-pop shops, retail stores and restaurants
to provide extravagant benefits to every dishwasher and waiter
and clerk, those firms may cut staff, or ask workers to take
pay cuts.
</p>
<p> Terri Healy, who owns an exercise studio in La Jolla, California,
is reluctantly planning her strategy for dealing with the Clinton
health plan. While she does not provide medical benefits, she
does give her 42 employees cash contributions toward their coverage.
If the Clinton plan is enacted, Healy says she will slash working
hours so that many of her employees will not meet the minimum
required to qualify for the new benefits. Paula Brown, president
of JB Chemical in North Las Vegas, Nevada, employs 17 people
and says the burden of providing such coverage would be ruinous.
She explains, "My obligation is to make sure I'm solvent, so
I can service my customers and pay my staff. As a business person,
I'm going to do whatever it takes to accomplish those goals."
</p>
<p> At least one large group of Americans clearly will benefit immeasurably
from the plan. Medicaid, the much criticized federal system
responsible for providing coverage to the poorest citizens,
will gradually be folded into the new health-care system. Once
it is, millions of impoverished Americans will enjoy better
care and greater access to doctors. That alone would be an accomplishment
the White House reformers could point to with pride.
</p>
</body>
</article>
</text>