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Hillarycare II: New and ImprovedThe health care primary, Part 4.

By Timothy Noah
Posted Thursday, Sept. 20, 2007, at 6:22 PM ET

(Continued from page 1)

How socialistic? Not enough for this pinko. (See above.) But it does contain the seeds of destruction for private health insurance, at least as configured today. I like that.

How disciplined? Only somewhat. Clinton pledges to end Medicare overpayments and unnecessary Medicare and Medicaid spending. She doesn't really spell out what the latter means, but I presume she's alluding to the phenomenon described in Shannon Brownlee's excellent new book, Overtreated: Why Too Much Medicine Is Making Us Sicker And Poorer. The ultimate solution to this problem is to eliminate fee-for-service medicine and put doctors on salary, but no mainstream politician dare whisper that. I give Clinton points for outlining in detail where the money to pay for her program will come from, even though she's probably overstating the savings.

Impact on employers: As with Edwards' and Obama's plans, the system is pay or play. Private employers must either provide their workers with health insurance or pay into a fund to support public health insurance. I remain convinced that this is an unfair burden on commerce. One of the main reasons we're even talking about health-care reform is that employer-based health insurance is a drag on the global competitiveness of U.S. companies, especially big rust-belt companies. Most other countries don't make private industry pay for their employees' health insurance. Clinton's plan eases the burden for small businesses with a tax credit, but I say throw off the yoke entirely. Among other benefits, it might help get U.S. industry behind a single-payer solution. Why does no one see the necessity of having one or two right-wing reasons to nationalize health insurance?

Longevity: Clinton's plan says all the right things about computerizing health records and routinizing preventive care. But if the patchwork of public and private plans remains in place—I think it won't—then insurers will remain fixated on procedures rather than patients as employers continue to shop around for the best plan.

Health Care Primary Archive:
Aug. 2, 2007: "Giuliani's Tepid Health Reform"
July 5, 2007: "Edwardscare: An Elegant, Laudable Trojan Horse"
July 1, 2007: "Health Costs Screw Business, Too"
June 19, 2007: "Obamacare: Better Than It Looks"
March 13, 2007: "A Short History of Health Care"
November 8, 2006: "Time To Socialize Medicine"
March 9, 2005: "Socialized Medicine, Part 2"
March 8, 2005: "The Triumph of Socialized Medicine"

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Timothy Noah is a senior writer at Slate.
Photograph of Hillary Clinton by Mandel Ngan/AFP/Getty Images.
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