Hillary Clinton frequently portrays herself as "ready on day one." Here's one reason why not to believe it.

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Hillary’s Past Leadership Failure in Health Care Repeated In Plan for Universal Insurance Company Prosperity.

Hillary Clinton frequently portrays herself as “ready on day one.”  In fact, her “Health Care” platform proves she has no better skills today about how to lead health care change than she had in 1993, when her ineptness destroyed the chance to reform U.S. health care.

Recall those heady days of 1992-93, when Bill Clinton took office on the wave of national disgust over George H.W. Bush’s ballooning deficit and shallow world view.  As a health care executive, I was thrilled to think that U.S. health care might soon become more comprehensive in scope and funded far more rationally.

On January 25, 1993, President Clinton announced the formation of The President's Task Force on National Health Reform. The job of the Task Force, he said, was to "prepare health care reform legislation to be submitted to Congress within one hundred days of our taking office." He also announced that Hillary would head the task force and that Ira Magaziner would be its day-to-day operating head.

Well, that was how it started.  Never mind that Hillary’s only related job experiences were as congressional staff attorney and partner in a private law firm.  Forget that Ira Magaziner was a “business” consultant, not a health policy expert, not even a provider.  Ah, we had such naïve hopes!

Hillary and Magaziner Were Blind-Sided by Predictable Reaction of Vested Interests

Any leader, executive or manager understands that planning and implementing organizational change are among the primary challenges of leadership.  Innovation, anticipating issues, co-opting parties with differing perspectives, finding winnable compromises, shaping coalitions for change—these are all bread-and-butter skills that differentiate real leaders from “bosses”.

But in 1993 Hillary Clinton and Ira Magaziner chose to exclude any physician, hospital, insurance and pharmaceutical industry players from their preliminary discussions.  Guess what?  Faced with exclusion from the discussions, these powerful industries marshaled massive advertising and lobbying campaigns to protect their vested interests.

The resulting debacle was both predictable and avoidable.  Experienced leaders would have anticipated and planned for the inevitable reaction, but not Hillary and Ira.  Instead, they were flattened by the “Harry & Louise” ads and the ridiculous phrase, “They choose, we lose.”

Hillary and Magaziner Were Blind-Sided AGAIN by Predictable Resistance from Congressional Interests

Inside Washington, Hillary & Ira Magaziner similarly failed to implement a plan for reform.  For example, they were blind-sided by Sen. Robert Byrd, whom they should have prepared for the omnibus reconciliation budget approach they chose to use, and they were again blind-sided by Rep. Pete Stark’s (Ways & Means) temper tantrum when he was briefed on their fait accompli financing plan.  Rather than consulting Congressional power brokers, Hillary and Ira naively tried the amateur’s end-run, and predictably failed in their implementation.

By the way, Hillary had three consultants helping [sic] her with this debacle in 1993:  Mandy Grunwald, James Carville, and Paul Begala.  Sound familiar, right?

Today’s Plan Institutionalizes Insurance Industry Costs, Avoids Funding Reforms, And Leaves Vested Interests in Complete Control

Hillary’s plan for health care includes very few health-related elements.  Instead, its basic focus is on keeping your insurance plan, if you like it.  Her only “big idea” is to offer the Federal Employee Health Benefits Plan (FEHBP) to all Americans—through commercial insurance brokers, of course.  (But that was really John Edwards’ big idea.)

The few medically relevant points in the plan are quoted in these sample phrases from Hillary’s health care platform (HillaryForPresident.com) below:

(1) “Providers: will work collaboratively with patients and businesses to deliver high-quality, affordable care;” 

(2)  “Strengthen Medicaid and CHIP: The Plan will fix the holes in the safety net to ensure that the most vulnerable populations receive affordable, quality care;”

(3) “Create an Independent "Best Practices" Institute to Empower Consumers, Providers and Health Plans to Make the Right Care Choices;” and,

(4) “Implement Smart Purchasing Initiatives to Constrain Excess Prescription Drug and Managed Care Expenditures.” 

(5) Elsewhere in her plan, I found reference to training more nurses and nursing professors and to funding more research on HIV/AIDS.  Not much to cheer about, but way better than the nullity of McCain’s plan!

Almost everything else in Hillary’s plan relates to insurance markets, assuring three toxic outcomes: (A) a genuine bonanza for the same commercial insurance companies that have caused our problems, (B) lack of reforms that might offend physicians, hospitals, trade groups, medical device manufacturers, pharmaceutical companies, special interest groups (physical therapists, nursing and skilled care homes); and (C) perpetuating Americans’ need to continue paying 30%-35% more for their care than we should for insurance company profits and overhead.

What Really Drives Health Care Costs?

Hillary’s plan totally ignores other factors that have been driving health care costs for decades, including burgeoning medical technologies; obscene incomes for procedure-based specialists (e.g., ophthalmologists, cardiac surgeons, and orthopedists); grossly exaggerated profits for DME providers, implant and device makers; medical centers’ profligate investments in edifices and marketing ploys; $$billions in profit annually for pharmaceutical companies, many of which simply license pharmaceutical discoveries developed under Federal (tax-payer) grants at universities and research foundations; and the counter-productive “free-market” distribution of critical human and technological resources.

Why, for example, doesn’t Hillary’s plan confront the fact that there are more CT scanners in Seattle or Chicago than in all of Canada—yet all Canadians enjoy universal access, lower costs, and SUPERIOR MORBIDITY, MORTALITY, AND INFANT SURVIVAL RATES with respect to the United States? 

Why won’t Hillary’s plan question the cost implications of hospital beds/thousand ratios in New York City and Los Angeles vs. upper New York State or rural Vermont, or the disparate ratios of primary care providers per thousand population in Wyoming vs. Florida?  These are but two of the huge public health policy issues that we must examine in order to hope for a positive impact on the lives and health prospects of millions of Americans, yet Clinton’s much-touted health care plan ignores every one of them.  This isn’t leadership, this is pandering to the powerful.

And, of course, the essential premise of Clinton’s insurance boondogle is that Americans would be forced to suffer the continuing absurd, employer-based strangle-hold on health insurance that now costs us easily 30% of every health care dollar we spend through employer-based insurance.

As a former hospital, ambulatory surgery center, and group practice administrator I groaned every year when budgets were developed because I could see how eliminating fee-for-service insurance billing would save my facilities 30%.  I agonized over cuts in nursing, physical therapy, and many other essential services that were forced by the burdens of insurance plans’ low reimbursement policies (often as little as pennies on the dollar) and unnecessarily complex insurance claims processing requirements. 

Many medical centers spend millions of dollars annually for huge computers and proprietary software designed solely to spit out insurance claims by payer type.  Usually these systems come with major flaws which cost more hundreds of thousands of dollars to correct. 

Why are they “necessary?”  Because insurance companies routinely attempt to exclude payments for legitimate services, if possible, or at least to defer making payments in order to help their cash flow.  Hospitals, physicians, nursing homes, pharmacies, physical and occupational therapists—all these groups suffer endless hassles at the hands of commercial insurance companies (e.g., Aetna, Humana, United Healthcare, John Hancock, CIGNA, etc.) and their buddies with “Blue” and “Choice” in their names.

And it is this profit-thirsty pack of unscrupulous insurance companies to whom Hillary Clinton has entrusted nearly every significant portion of her health care plan.  Way to Go, Hillary!!

With a few exceptions Hillary’s plan is about tweaking insurance markets, while the terms “physician”, “hospital”, and “prescription drugs” scarcely appear at all.  Health INSURANCE is often described as simply a license to hunt.  In fact, having insurance does not assure obtaining care, nor does it promise optimal, cost-effective or competent care.

So on health care, Hillary’s style of “leadership” and change—both within government and outside in the “real” world—remains a dismal failure of nerve, deficient in results and devoid of real reform.

Authors Bio:
I am a progressive activist. After 28 years in health care management I left in disgust at the mess that commercial health insurance companies have created.

I must work to live (self-employed) and enjoy performing with several classical & jazz groups.