PRESIDENT Clinton is not scheduled to present his proposal for reforming America's ailing health-care system until later this month. But there is no need for suspense about what he will say. Nearly all the details of his plan have already leaked out.
Nor is there any mystery about what the critics will say. Right-wingers will say he is a radical who is leading us down the path to socialized medicine. Lefties will argue that he is a closet conservative who does not have the good sense to lead us down the path to socialized medicine.
The Clinton plan is complicated. Those who plan on watching the president's speech to Congress, which the networks will air live, would be well advised to begin stocking up now on a reliable source of caffeine.
The only folks likely to be riveted to their screens for the duration of his oration are those now working as health plan benefits managers in Fortune 500 companies. The rest of us will face the threat of what computer nerds call MEGO (my eyes glaze over).
So let me spare you some guilt about channel surfing away from the president's big speech and the verbiage that it will spawn.
Here is what the president will say you ought to get, here is how he thinks it should be paid for, here is what the critics will say and here is why they are wrong:
The president will tell Congress that every American must have access to a basic package of medical services that includes physician care, hospital care, emergency care and diagnostic testing. He will put special emphasis on making sure that every American has access to primary and preventive care such as vaccinations, well-baby care, prenatal care and periodic health exams.
Mr. Clinton expects employers and employees to share in footing the bill for universal coverage. If you work, your paycheck will get tapped to make sure that you get basic insurance through your place of employment. Your employer will also kick in some
dough. Expect to pay 20 percent of the insurance premium out of your pocket, with your boss kicking in the rest.
The administration will propose the creation of a massive subsidy program to help low-wage workers and small businesses pay for access to the same set of services that everyone else gets. If you are self-employed, working part-time, unemployed or on Medicaid, you can expect to pay on a sliding scale in order to get your coverage.
Can this plan work?
Those on the left will argue that the Clinton plan does not do enough to get rid of administrative waste and bloat in the existing system because it still relies on economic competition in the private sector to keep health-care costs down. They will wail for a Canadian-style, single-payer system.
Those on the right will say that the president's plan will wreck the economy by imposing more financial burdens on business. They will also deplore the heavy hand of government interfering with the marketplace. They will wail that this country cannot afford to move toward a single-payer system.
Do you need to listen to any of this blather? Nope. Oddly enough, the proof that the president's plan can work is sitting in the Pacific Ocean. The state of Hawaii already has the system the president wants to create for the rest of us.
The Aloha State has had a system of mandatory, employment-based health insurance since 1974. It covers basic services with a special emphasis on primary care and preventive services. The state added a subsidized, supplemental program for self-employed and part-time workers in 1989.
Has it worked? In many states, 10 percent or more of the population has no insurance at any given time. According to a just-issued report from the Office of Technology Assessment of the United States Congress, 97.5 percent of Hawaii's residents have insurance. Eighty percent have private insurance through their jobs, 10 percent are on Medicare and 7.5 percent are on Medicaid.
Will employer-mandated insurance be the end of small business and the ruin of our economy? Hardly. According to the OTA study, "There seems to have been little negative impact on businesses in Hawaii from its 1974 mandatory, employment-based health insurance legislation." In fact, for the past decade, unemployment in Hawaii has been lower than on the mainland.
Will retention of competition and private insurance leave gaping holes in the safety net? Hardly. Hawaii basically has universal coverage for all who live there. The emphasis on prevention has led Hawaiians to use less health care and pay less for what they do use than nearly all of us on the mainland.
Most interestingly, those who live in Hawaii have the highest life expectancy among all 50 states.
The Clinton proposal will generate enormous controversy. The debate will take many complicated and wordy turns. But Hawaii is the administration's ace in the hole.
Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota.