Challenge to Government Secrecy Continues
On March 23, AAPS attorneys filed a Motion for Summary
Judgment in AAPS v. Clinton, the lawsuit challenging the
secrecy of the Health Care Task Force, accompanied by nine
volumes of exhibits.
Despite White House stonewalling and evasions, AAPS
accumulated evidence that more than half of the members of some
63 working groups and cluster groups had a potential conflict of
interest. Yet only 35 of about 1,000 participants filed the
required financial disclosure forms, and many of these had
irregularities suggesting they were filed late. (None of the
members of the bioethics group filed an ethics form.)
Ira Magaziner declared under penalty of perjury that ``only
federal government employees serve as members of the
interdepartmental working group.'' Because more than half the
participants had private employment at the time of their service,
AAPS requested to take Magaziner's deposition. No response has
been received from the Administration.
The AAPS brief documents the role played by grantees of tax-
exempt foundations in many groups of the Task Force. Commenting
on a column by Tony Snow, who attended our March 23 press
conference in Washington, D.C., RWJF Vice President Frank Karel
writes: ``The Robert Wood Johnson Foundation has always
maintained absolute neutrality regarding the various proposals
for national health-care reform'' while making grants totaling
almost $1 billion over the past 23 years.
Karel also stated that RWJF Health Policy Fellows are
``neither agents of the foundation nor influenced by the
foundation-they were on leave from academic institutions as
participants in a yearlong career-development program conducted
by the Institute of Medicine of the National Academy of
Sciences.'' The purpose of the fellowship program is to
``increase understanding of the Washington policy process'' while
``increasing the level of health expertise available in
congressional and executive branch offices.''
``And there's a simple explanation why these fellows do not
appear on Congressional staff payrolls, as `charged' in [Snow's]
column'' [and despite being called full-time government employees
in a sworn statement by Ira Magaziner-ed.]. ``They aren't paid
by the Congress. The fellows are paid by their home
institutions, which receive grants from our foundation in support
of their fellowship'' (Arizona Republic, 6/8/94).
According to the 1993-1994 RWJF Health Policy Fellowships
brochure, RWJF Fellows ``develop legislative proposals,
arrange hearings, brief legislators for committee sessions and
floor debates, and participate with staff in House and Senate
conferences. They take part in all areas of the policy process,
not as onlookers, but as full-time working participants.'' (The
role of congressional staffers is further explained in this
month's legislative supplement.)
AAPS welcomes Colorectal Surgical Associates of Lexington,
KY and Drs. Albert Ackil of Canton, MA; D.P. Alagia of
Washington, DC; Charlotte A. Alspach of Avalon, NJ; Kerry Anders
of Monroe, LA; Michael W. Anderson of Orlando, FL; Robert
Anderson of Fort Worth, TX; Khawaja N. Anwar of Gainesville, TX;
Joseph B. Aquilla of Chesterton, MD; Bruce and Barbara Baker of
Grand Rapids, MI; Barry Bakst of Wilminton, DE; Theodore Barton
of Soldotna, AK; David Bawden of Chicago, IL; John B. Baxley of
Augusta, GA; Delfin J. Beltran of Andover, KS; Monica Vial Benson
of Luling, LA.; Bruce M. Berkson of Riverwoods, IL; Kenneth A.
Bisson of Angola, IN; James D. Blake of Birmingham, AL; Susan
Kelly Blue of Fort Worth, TX; Viorel Boborodea of Ashland, KY;
Byron Bohnn of Houston, TX; N. A. Bologna of Greenville, MS;
Wayne P. Bones of Berryville, AR; Robert F. Bossard of Dallas,
TX; William Bradway of Cape May Court House, NJ; Patrick J.
Brandner of Las Vegas, NV; William H. Bray of Quincy, IL;
Roderick B. Brown of Glenwood, MN; Joseph F. Bryan II of San
Angelo, TX; John Bryant of Chattanooga, TN; Pat D. Bryant of
Wausau, WI; Deborah K. Bublitz of Highlands Ranch, CO; James
Buese of Pasadena, CA; James L. Bumgartner of Charleston, SC;
G.L. Busenkell of Mesa, AZ; John A. Butler of Wausau, WI; James
H. Butler of Winston Salem, NC; Carolyn M. Buttross of Ocean
Springs, MS; R. B. Caldwell of Bellevue, WA; Fernando Campos of
Phoenix, AZ; Robert Lee Caudill of Louisville, KY; Jeff Ceschi of
Brookfield, WI; Todd H. Chaffin of Rockford, IL; James N. Childs
of College Station, TX; T. Terry Chutinan of Altamonte Springs,
FL; Frederick W. Clevenger of Albuquerque, NM; Daniel D. Coelho
of Torrington, CT; Stephen L. Comite of New York, NY; T. M. Cone
of Las Vegas, NV; Edgar C. Cordero of McKeesport, PA; John
Crawford of Utica, NY; Keith H. Crawford of Paducah, KY; Bruce
Crossman of Maitland, FL; W.G. Dalzell of Hemet, CA; Thomas C.
Darrell of Fuquay-Varina, NC; Raymond P. Decorte of Metairie, LA;
Nadine A. Degnan of Concord, CA; Jeffrey Dell of Fullerton, CA;
Ronald C. Demas of Charlotte, NC; Donald D. Doussan, Jr. of
Madisonville, LA; Jeffrey D. Downing of Zanesville, OH; Douglas
P. Dozier of Macon, GA; Richard W. Dunlop of Kingston, MA; Dennis
Charles Eckel of Scottsdale, AZ; David Edmonds of Birmingham, AL;
Arthur Efros of Southfield, MI; Robert Egert of Chico, CA; Roger
W. Evans of Wichita, KS; N. R. Evans, II of Burlington, NJ;
Leomard S. Fagan of Park Ridge, IL; Lawrence A. Fagarason of
Baytown, TX; Timothy J. Fallon of Columbus, OH; Morton Farber of
Short Hills, NJ; Donald C. Faust of New Orleans, LA; E. Ronald
Finger of Savannah, GA; Calvin H. Fischer of Hoffman Estates, IL;
John J. Fitzgerald of Indianapolis, IN; Alexander S. Foltz of
Wausau, WI; William C. Foote of El Paso, TX; Robert Foster of
Roxboro, NC; James R. Fraser of Jupiter, FL; Paul S. Fricoman of
Elkins Park, PA; Robert Frischor of Wichita Falls, TX; Angela M.
Garcia of Boca Raton, FL; Richard Gasser of Fort Worth, TX;
William A. Geary of Indianapolis, IN; Carolyn Gerster of
Scottsdale, AZ; David A. Giordano of Sarasota, FL; Richard G.
Glogau of San Francisco, CA; Robert Goiney of Seattle, WA; Justo
Gonzalez of Washington, D.C.; Victor D. Gonzalez of Houma, LA;
Robert L. Gordon of Warwick, RI; Richert E. Goyette of Rolla, MO;
Mark A. Grathwohl of Brewster, NY; Robert F. Graves of Phoenix,
AZ; William Robert Green of Jonesboro, AR; Donald H. Green of
Clifton, NJ; Douglas Grier of Edmonds, WA; Don R. Guzzetta of
Metairie, LA; Ken Hager of Selma, AL; Michael E. Hamilton of
Englewood, OH; Irving L. Hammerschlag of Old Westbury, NY; G.
Robert Hanson of Custer, SD; Robert W. Harding of Rutherfordton,
NC; Monique Harize of Scottsdale, AZ; Leonard R. Harrison of New
York, NY; Robert S. Hattner of Mill Valley, CA; Anne M. Hawkins
of Tucson, AZ; Philip S. Henkle of Rice Lake, WI; Edward P.
Herman of Phoenix, AZ; F. Michael Hindelang, Jr. of Lafayette,
LA; David P. Holder of Carrollton, TX; Richard F. Honden of
Skippack, PA; David L. Hoversten of Sioux Falls, SD; Nick
Hrisomalos of Indianapolis, IN; Mary E. Hutchins of Abingdon, MD;
James J. Hutchins of Somerville, NJ; Caryl H. Hyland of
Pensacola, FL; Arnold Ison of St. Petersburg, FL; G. Jacknow of
Austin, TX; Lisa M. Jamison of Kingston, PA; G. Arthur Janssen of
Tucson, AZ; Ron Jenks of Bremerton, WA; Carl R. Jenson of Coos
Bay, OR; Richard R. Jobe of Seattle, WA; Dale K. Johns of Fort
Walton Beach, FL; Bruce D. Johnson of Springboro, OH; Sylvia P.
Johnson of Guagas, PR; David M Jones of Hickory, NC; Suresh B.
Katakkar of Tucson, AZ; Michael Jon Kell of Atlanta, GA; James E.
Kelley of Easton, MD; Elton Kerr of Woodbridge, VA; Bhupinder S.
Khaira of Gainesville, TX; Glen Kietzer of Seattle, WA; Dawn
Knight of Monroe, LA; Rodney N. Kreider of Forest Park, GA;
Dhanalal Krishnanaik of Warren, MN; Timothy Kross of Coraopolis,
PA; Markus S. Kryger of Forsyth, MO; Joseph M. Kuhn of Payne, OH;
Jane Lacey of Montgomery, AL; W. Pennock Laird of Dallas, TX; M.
Wendell Lawson of Oak Ridge, TN; Stanton Lebouitz of York, PA;
Michael M. Lee of San Diego, CA; Edward A. Lelonek of Fort Wayne,
IN; Jose M. Ligarte of Kingsville, TX; James Loddenguard of
Torrance, CA; Frederick T. Lohr of Chestertown, MD; George E.
Long of Fairfax, VA; Robert F. Lorenzen of Phoenix, AZ; Judith K
Lowe of Pasadena, CA; David R. Luetheke of Houston, TX; William
Maguire of La Mesa, CA; Robert L Maiello of Fruitland Park, FL;
John Marcus of Uniontown, PA; Nancy Marshall of Port Huron, MI;
Bill Martin of Lawrenceville, GA; Randolph S. Martin of
Springfield, IL; Neal A. Mask of Tulsa, OK; Ronald Mason of St.
Louis Park,, MN; Seth L. Matarasso of San Francisco, CA; F.
Matheu of Princeton, IL; Donald Mathews of Summit, NJ; Mary F.
Maturi of Virginia Beach, VA; Marc Mauney of Seattle, WA; Chuck
McCarver of Phoenix, AZ; Scott M. McCloskey of Hickory, NC;
William McGeehin of Torrington, CT; Joe S. McIlhaney, Jr. of
Austin, TX; Faber F. McMullen, Jr. of Houston, TX; Thomas M.
McNorton of Kaneohe, HI; Daniel N. Mergens of Omaha, NE; Mark J.
Mertens of Portland, OR; Andrew L. Messenger of Lansing, MI; A.
E. Miller, Jr. of Blackfoot, ID; Philip L. Minor of Richmond, VA;
Steven Mlodinow of Everett, WA; Robert A. Modic of Mesa, AZ; John
F. Moffett of Lake Charles, LA; R. Anthony Moore of Dallas, TX;
Thomas F. Moore of Phoenix, AZ; A. James Morgan of Santa Clara,
UT; Richard Allen Morrison of Independence, MO; Albert R. Munn
III of Raleigh, NC; Dick J. Newell of Mossyrock, WA; Douglas
Newton of Kennewick, WA; S. Ross Noble of West Reading, PA; Chris
Noonan of Kenosha, WI; F. R. Nusbickel of Thomasville, GA;
Michael P. O'Mara of Chicago, IL; Michael J. O'Reilly of
Marietta, GA; Joshua S. Obak of Fresno, CA; Richard C. Olney of
Lincoln, NE; Reggie D. Osbon of Macon, GA; Raymond L. Osborne,
Jr. of Hamden, CT; Anthony R. Palmer of Arlington, TX; Jerry Patt
of Columbia, MD; Luzviminda K. Peredo of Boaz, AL; David Peterson
of Auburn, WA; Ralph B. Piening III of Mt. Plesant, SC; Sherri
Pinsley of Lake Worth, FL; Neal A. Pock of Tucson, AZ; Thomas D.
Pope of Morganton, NC; Hugo C. Pribor of Nashville, TN; L.
Purcell of Bluffton, IN; Pervaiz Rahman of Gainesville, TX;
Philip Dale Ranheim of Snohomish, WA; John Reifsteck of
Charleston, WV; E.J. Reineberg of Flagstaff, AZ; Robert Rewes of
Hemet, CA; Jose R. Rivas of Carrollton, TX; Howard Robertson of
Gilbert, AZ; Dennis J. Robinson of Farmington, NM; Timothy M.
Roddy of Edmonds, WA; Peter J. Romano II of Ft. Lauderdale, FL;
Samuel Ruby of Ridley Park, PA; George R. Ruiz of Homewood, IL;
Fred H. Sabhar of Glendora, CA; Robert Saga of Sioux Falls, SD;
Robert G. Saide of Phoenix, AZ; James E. Saltz, Jr. of Tucumcari,
NM; Melchior F.R. Savarese of Washington, DC; Allan T. Sawyer of
Glendale, AZ; Howard L Schreiber of Houston, TX; Paul Schwaegler
of Seattle, WA; Peter G. Sellei of Longmeadow, MA; June
Serravezza of Atlanta, GA; Robert S. Sexton of Tucson, AZ; Seth
Brian Sherman of Florence, AZ; R.R. Shivpuri of Elgin, IL; Wright
S. Skinner III of Georgetown, SC; N.D. Smith of Media, PA; David
E. Smock of Naples, FL; Jerry Allison Snow of Washington, D.C.;
Thomas Sonne of New Albany, IN; Franklin M. Soriano, Jr. of
Chesapeake, VA; I. Page Sowers of Newport Beach, CA; Thomas J.
Spallino of Wailuku, HI; Lenny Spivak of Reedley, CA; A. E.
Stefanelli of Bloomfield, NJ; Joseph L. Steinem of Connersville,
IN; Stanley Stern of Phoenix, AZ; J. Martin Stewart of Houston,
TX; Ronald Gene Stockstill of Germantown, TN; Manfred A. Strott
of Cedar Grove, NJ; Peter V. Sundwall of Murray, UT; Howard E.
Sweeney of Chicago, IL; Paul Brenden Tartell of Boston, MA; John
Paul Theo of Lubbock, TX; Gregory G. Theodore of Odessa, TX; John
P. Thomas of Trinidad, CO; Norman L. Thompson of Phoenix, AZ;
John Anthony Tirpak of Ebensburg, PA; Rafael Toledo-Ruiz of
Arecibo, PR; David C. Tower of Berkley, CA; Robert L. True of
Arlington, TX; Carol F. Truitt of Richland, WA; Nicholas
Tsambassis of California, PA; Lynn Z. Tucker of Baton Rouge, LA;
James H. Turk of Corpus Christi, TX; L. Eduardo Vega of Tucson,
AZ; Michael C. Vidas of Peoria, IL; Lee Vliet of Tucson, AZ;
Kenneth E. Wagner of Carpinteria, CA; Albert L. Waldman of
Milford, PA; Tom Walsh of High Point, NC; W. Lorraine Watkins of
Atlanta, GA; Stephen J. Weddel of Longmont, CO; Virginia L.
Weimar of Moline, IL; Rita Weinstein of East Brunswick, NJ;
Jeanne F. Weisenburger of Pemberville, OH; Thomas Weiss of Miami
Beach, FL; Dan Whipple of Indianapolis, IN; Marilyn V. Whitney of
Warsaw, IN; Clarence L. Wilson II of Wilmington, NC; Earl C. Wood
of Owingsville, KY; Marilyn Wood of Vancouver, WA; Theodore E.
Yaeger, IV of Daytona Beach, FL; Robert H. Young of Weston, MA;
Mohammed K. Zahra of Carson Reg. Rad. Center, Norfolk; Michael
Zammit of Seattle, WA; Daniel L. Zimmerman of Antioch, CA; and
Anthony L. Zoprito of Cape Girardeau, MO.
Legislative AlertThe More They Know About the Clinton Plan,
the Less People Like It
At least, that is what Members of Congress continue to
report back from their districts, where congressional town hall
meetings and seminars and forums on health care reform are
bringing back bad political news. Folks do not believe-and will
not believe-that the Clinton Plan pays for itself. They fear they
will be saddled with huge tax increases down the line to pay for
yet another runaway entitlement program. Members are also
perceiving hostility to Congress itself, making these town hall
meetings even more unpleasant.
Distracted by the continuing ``Whitewater'' affair, the
White House team thinks that the reason for their trouble is that
they are not ``selling'' the plan properly. For example, they
think they need to revamp the language. Instead of talking about
``employer mandates,'' which has an oppressive tone, the White
House team will henceforth emphasize ``health benefits guaranteed
What Members are telling each other in the House and Senate
Cloakroom is broadly reflected on recent national polling. The
March 2 Time/CNN Poll shows that only 41% of Americans
approve of the Clinton Plan and 45% disapprove. The March 4
Wall Street Journal/NBC Poll shows that only 37% favor
the Clinton Plan, but 45% disapprove.
Beyond these general polls, the abortion issue continues to
simmer. Members of Congress hate to debate this volatile issue.
But it is inescapable. The Clinton Plan includes mandatory
taxpayer payment for abortion coverage.
Members of Congress are worried about the potential impact
of the abortion issue on the disposition of any health care bill.
While the Cooper Plan (HR 3222) is silent, the managed
competition proposal leaves the decision to include abortion
coverage in the hands of a presidential commission charged with
developing a standardized health benefit package. The language of
the bill authorizes the commission to include procedures that are
``medically appropriate''-translated, that means abortion. Last
year the Harris Poll (October 1993) revealed that 62% of all
respondents opposed coverage for abortion in a government,
standardized health benefits package, and 27% favored such an
inclusion. Likewise, the CBS/New York Times Poll (June
1993) found 66% of respondents said that abortion should not be
covered as part of a basic benefits package, while 25% favored
inclusion in a basic benefits package. None of this daunts
Planned Parenthood, the leading champion of abortion in
Washington. The organization has pledged to run a $10 million
media campaign to promote abortion as an elemental part of health
The Stark Alternative
Congressman Fortney ``Pete'' Stark of California,
Chairman of the House Ways and Means Subcommittee on Health, has
reported a bill out of his subcommittee by a vote of 6 to 5. In
essence, the Stark Bill is an expansion of the Medicare program
to cover the uninsured. The slim margin is an indication of the
problems that Stark has been having: solid Republican opposition
and defections from key Democrats fearful of employer mandates
and future costs and the angry voters.
Before the final vote, congressional Republicans on the
panel offered the Clinton Plan itself as a substitute to the
Stark bill and the Clinton Plan ended up getting zero (0) votes.
The Democrats complained that the move was nothing more than an
attempt to embarrass the White House. The Republicans voted
against it, and the seven Democrats on the panel voted
``present.'' The Democrats were right: It did embarrass the White
The 6-to-5 vote is a harbinger of the tough political
battles to come. Members are finding the issues more complex
than anything they have ever tackled. Reputable analysts on both
sides of the issue are preparing charts and graphs, but the
Democrats have resorted to role playing in their private sessions
to help them understand how changing one provision would affect
another. In one exercise, Levin played Stark's spouse, Cardin
became Stark's boss, and they passed around a slip of paper in
different directions to visualize the funding flow. This kind of
decision-making on Capitol Hill is not a exactly a confidence
builder for America's taxpayers.
Chairman Dan Rostenkowski, the old congressional warhorse of
liberalism who pulled an upset by surviving a tough Chicago
primary, said that the full Ways and Means panel will report out
a ``more conservative'' bill, whatever that might mean coming out
of Ways and Means.
The House Education and Labor Committee, chaired by
Congressman William Ford (D-MI) will probably report out a bill
that most closely matches the original Clinton Plan. The House
Energy and Commerce Committee, chaired by Congressman John
Dingell (D-MI) will also move legislation, but it might be far
less like the Clinton original. In the Energy and Commerce
Committee, and just about everywhere else on Capitol Hill, the
Clinton ``regional alliance'' structure is gone, and there is no
way the Administration can bring it back. Dingell was supposed
to have his mark-up on March 4th, but that date came and went
without any significant action.
The fun will start when the comprehensive and conflicting
pieces of legislation, imperfectly understood by the Members, go
to the House Rules Committee. There, a panel with no substantive
expertise in health care policy will attempt to cut and paste the
products of the three major House panels for a floor debate.
Senate Retreat in Annapolis
While the Democrats in the House of Representatives have
been organizing their hearing and mark-up schedule, Senate
Republicans retreated once again to colonial Annapolis, Maryland,
to try once again to find common ground. Senator John Chafee (R-
RI), who Chairs the Senate Republican Health Task Force and is
author of the key managed-competition proposal in the Senate
(S1770), tried to get his colleagues to rally around his bill or
a version of it and present a united front. The meeting got off
to a bad start when Chafee's agenda was criticized by
conservatives for having Stan Jones, a former Kennedy staffer, as
the introductory discussion leader. Chafee has been strongly
encouraged by Dole, but Senate conservatives, notably Senator Don
Nickles of Oklahoma, the Chairman of the Senate Republican Policy
Committee, and Senator Phil Gramm of Texas want to restore market
incentives in medicine. Nickles, with 24 cosponsors on his bill
(S 1743), is pushing a ``consumer-choice'' health plan based on a
national system of tax credits. Gramm wants to put medical
savings accounts (S 1870) at the center of reform.
The result of the Annapolis Meeting: GOP Senators generally
see no need to compromise with the White House on the terms of
``managed competition.'' They see the Clinton Plan as a sinking
ship. Indirectly, this helps Senator Daniel Patrick Moynihan (D-
NY), Chairman of the Senate Finance Committee. Moynihan is
looking toward crafting his own bill, and Dole is expected to be
Moynihan's chief collaborator.
In the meantime, Clinton, through Senator George Mitchell,
met with top Senate Republicans, including Dole of Kansas,
Packwood of Oregon, Chafee of Rhode Island, and Nickles of
Oklahoma, for a dinner at the White House to discuss health care.
While in principle, all of the participants agreed on the ideal
of ``universal coverage,'' the breakdown came on the specifics of
how to attain it. Nickles, for example, told Senate colleagues
that ``universal coverage'' has become a mantra in the ongoing
debate, like saying that everybody should have a good job and a
nice house. But after consulting with his Senate colleagues,
Nickles himself is backing off the enforcement of an individual
mandate, in favor of letting tax incentives work to expand
voluntary coverage of the uninsured.
Senate Finance Committee Chairman Pat Moynihan is trying to
hammer out a consensus among his colleagues. But beyond the
general desire to achieve ``universal coverage,'' there is little
agreement on the details.
While Senators are trying to figure out the right mix of
detailed recommendations, Sheila Burke, Senator Bob Dole's health
policy analyst, is grabbing a larger share of the spotlight. The
one major fact about Capitol Hill that the public generally does
not understand is the enormous power and influence of
congressional staff. The higher the degree of specialization and
expertise required for the more complex questions of public
policy, the greater that congressional staff influence becomes.
Dole's top staffer is the acknowledged commander in chief of
congressional staff on Capitol Hill when it comes to health care
policy; it means that if there is a final compromise bill offered
in Senate Finance, one can expect Sheila Burke to have a strong
hand in crafting the technical details.
Senate Finance Testimony: How Workers Would Suffer
On March 15th, Senator Moynihan's committee heard more than
two hours of expert testimony from Alain Enthoven of Stanford
University, the intellectual godfather of managed competition,
Stuart Butler of the Heritage Foundation, and John Holohan of the
While Enthoven argued against an employer mandate, he added
that adverse selection and gaming by insurance companies will be
unavoidable without government standardization of benefits.
Butler outlined the results of an original and comprehensive
analysis of the job and wage effects of the Clinton Plan. The
study was conducted by Lewin/VHI, Washington's leading health
care econometrics firm, under contract from the Heritage
Foundation. Lewin found that under the Clinton Plan, in 1998,
there would be an aggregate cut of about $20.6 billion in wages
and the loss of 155,000 to 349,000 jobs. The average cut for
workers in firms that did not offer insurance would be $1,243.
Before taking the wage effects of the employer mandate into
effect, Lewin had estimated that the Clinton Plan would reduce
household medical spending by $26.5 billion. But after taking
wages into effect, the net health care spending by households
falls by just $7.7 billion.
According to Butler, 30.7% of working age households would
see a spending increase of at least $1000, once the wage effects
of the employer mandate are included. More than 53% of working
households would experience a net decrease in income under the
Butler also stated that under the tax-credit approach
outlined in the Nickles bill, 18.8% of working-age households
would see cost increases greater than $1000, while 39.4% would
experience a net reduction in costs (compared with 28% under the
CBO on Tax Credits
In a comprehensive March 1994 study, the Congressional
Budget Office considered the market consequences of employer-
based insurance and its tax treatment. The federal tax exclusion
on employer- provided health insurance (which covers about 75% of
working Americans) is calculated to be worth $74 billion in 1994
dollars. The CBO found that:
1. There is no free lunch after all. The employer share of
the cost of insurance is ultimately passed on to
workers in the form of lower wages.
2. The open-ended subsidy contributes to the nation's
current high level of spending for health care.
3. Tax credits are efficient and equitable: ``By providing
a larger subsidy for low income families, a credit
would encourage more people to secure health insurance,
reduce adverse selection, and discourage free riders.
As a result, the credit would avoid some of the
undesirable features of a tax cap.''
4. Tax credits would advance welfare reform by reducing
the current disincentive for welfare recipients to
enter the work force. (At present, welfare recipients
can lose most of their benefits when they go to work.)
A Guided Tour of the Clinton Plan
Multinational Business Services, Inc., a Washington-
based consulting firm, has just released a massive report, ``The
Regulatory Requirements of The Health Security Act,'' conducted
under the direction of Jim Tozzi, a former career official at the
Office of Management and Budget (OMB). Using conservative
estimates of the amount of staff that would be required, Tozzi
concludes there would be employment opportunity for 98,146 new
full-time bureaucrats at the federal, state, and regional
The report identifies 818 new regulatory mandates, requiring
an increase in the Code of Federal Regulations by 2,891 pages.
This is equivalent to ten times the numbers of Medicaid
regulations and 2.5 times the number of Medicare regulations.
Beyond the actual regulations, an additional 3,849 pages of
guidance would be required.
Universal Coverage Is Bad Medicine
While others argue over the details (the enforcement policy)
needed to achieve ``universal coverage,'' William Kristol,
Chairman of the Project for the Republican Future, states that
Republicans should not be intimidated by the Presidential
``Universal coverage,'' he states, ``necessarily means the
domination of our health care system by government and politics
and a degradation of the quality of American medicine.''