Six Impossible Things


"I can't believe that," said Alice.

"Can't you?" said the Queen in a pitying tone. "Try again; draw a long breath and shut your eyes."

Alice laughed. "There's no use trying," she said. "One can't believe impossible things."

"I daresay you haven't had much practice," said the Queen. "When I was your age, I always did it for half an hour a day. Why, sometimes I've believed as many as six impossible things before breakfast."

-- Lewis Carroll, "Through the Looking Glass"

-- Chicago. President Clinton says he intends to present his health-care reform plan, now being drawn up by Hillary Rodham Clinton and her secret task force, to Congress the first week in May.

That leaves us about six weeks to practice believing at least six impossible things the proposal will apparently require us to do, on the basis of what is now known about task-force activities, on leaks, on comments by Mrs. Clinton and on President Clinton's campaign promises, which advisers say are the basis of the developing plan.

So take a deep breath. Shut your eyes. And practice believing these impossible things. You can have breakfast later:

* Hillary Rodham Clinton's health-care plan will save the nation money.

The staggering $912 billion annual cost of health care is a major reason President Clinton has been able to sell the public on the desirability and inevitability of enacting a national health-care plan that will hold spending in check.

But the Clintons propose to provide care for the 35 million people who now lack insurance -- at an estimated added cost of $33 billion to $60 billion -- and to help millions of others who are under-insured or paying more than they can afford for coverage.

Task-force members are talking about expanding mental-health benefits. Pressures are increasing to include long-term care. HMOs and other models of managed care yield only limited savings.

The costs of a new system may be hidden in an array of new taxes, new charges to employers and more deficit spending. But without serious rationing of care, costs won't decrease.

* New "sin taxes" on tobacco, alcohol and guns will provide the extra money needed.

There's strong support for the idea that those whose behavior puts them at risk of needing extra health care should pay for it. And, for example, steep taxes on cigarettes do discourage smoking, especially among the young. But even pushed to their practical limits, sin taxes will cover only part of the new spending being planned, and the anticipated decline in illness won't be fully felt for decades.

* Providing everyone a "basic benefits package" will give us all adequate health care.

"Basic benefits package" is, in essence, code for rationing. No one is saying what will be left out of the "basic" coverage. What if you, or someone in your family, have a rare illness or need expensive, experimental care not included in the basic plan?

Will very small newborns, the ailing old and the severely disabled be excluded from treatment -- as some of them were in early versions of the rationing plan developed in Oregon? Will those who can afford it find it necessary to buy supplemental insurance? What about those who can't afford it?

* A managed-competition plan that herds everyone into giant HMO-like groups that compete to get lower prices from providers will reduce health-care spending.

According to current theory, physicians and hospitals now paid on a fee-for-service basis can't resist the financial temptations to order unnecessary tests and over-treat patients, which runs up the nation's health-care costs. Managed competition is supposed to reverse these incentives and reward providers financially for treating patients less.

But many people may find it uncomfortable and worrisome if they have to give up their choice of doctors and hospitals and know they are being cared for by providers who have a financial incentive to under-treat them.

* Health care will be more easily available than it is now.

This should be true for the poor who now have problems finding good care, even with a Medicaid card. But everyone else may find access to a private physician of choice or to a specialist limited by the managed group one must join.

If this country's national health system develops as have those in other countries, access may also become limited by having to queue up for care, by long waits for elective surgery such as hip replacements and cataract operations, by shortages of expensive new technology and by age restrictions on costly procedures.

* A national health-care plan will cut administrative costs and red tape, saving billions of dollars.

It's not a good idea to try to believe this one until you've finished your 1992 income tax returns. Government and red tape are synonymous. Medicare and Medicaid are administrative and regulatory messes.

If the Clintons add global budgeting to their managed-competition mix as they are reported to be considering, the regulatory red tape will explode. If that comes to include price controls, which always have disastrous consequences, the quality of health care will deteriorate and rationing and black markets may follow.

And we will wonder why, given the federal government's horrible history of budget failures and inefficiencies, we trusted it with our lives and health.

Joan Beck is a columnist for the Chicago Tribune.

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