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Bush and Clinton Plans Both Faulted By Health Policy Journal

September 5, 1992

WASHINGTON (AP) _ President Bush has failed to confront rises in health care costs and the ranks of the uninsured while the only sure thing in Bill Clinton’s reform plan is a bigger government role, says an analysis released Saturday.

Bush’s overall record was rated as mixed by editors of the Journal of American Health Policy. Clinton, the Democratic presidential nominee, was praised for steps he has taken as governor of Arkansas.

The editors called Clinton’s vague national reform plan an ″attempt to meld heavy-handed regulation with a half-hearted nod at market competition.″ What he wants ″does not fit into a neat ideological box other than a more activist role for the federal government,″ they said in the September-October issue of their magazine.

Editor-in-chief Richard Sorian said the Bush administration ″has been behind some progress in health care″ starting with the 1990 Americans with Disabilities Act.

He said Bush also has pumped money into disease and disability prevention programs, including immunization and screening for lead poisoning and cancer; community and migrant health centers that serve the poor, and the National Health Service Corps.

″But Bush’s critics are right when they say his administration has ignored the more perplexing - and expensive - problems of the uninsured and escalating health care costs,″ Sorian wrote. He said it took Bush three years to put together a health reform proposal ″and even then the core parts of it were never sent to Capitol Hill.″

Sorian said that while Bush touts increased spending for AIDS on his watch, most of the victims were entitled to the extra money anyway as Medicaid, Medicare and Social Security disability benefits. He said Bush did push hard for a federal statute barring discrimination against people with the virus. It was part of the disabilities act.

Bush jettisoned a 1988 campaign promise to let the uninsured purchase coverage through Medicaid and opted instead for a series of studies on reform, Sorian noted.

The plan that emerged calls for $35 billion in federal tax credits to help the poor buy coverage, along with insurance and malpractice reforms aimed at bringing down costs. Gail Wilensky, Bush’s health adviser, told Sorian the plan could be financed without tax hikes. Administration officials are trying to line up support from conservative Democrats, Sorian wrote, in preparation for an aggressive second-term drive.

Cathy Tokarski and Melissa Jee, two other journal editors, said Clinton’s main achievements in Arkansas have been creating a network of rural clinics; expanding Medicaid to cover many more poor women and children; and setting up 20 health and family-planning clinics in elementary and secondary schools.

The state infant mortality rate dropped from 12.5 deaths per 1,000 live births in 1980 to 9.3 in 1990 and some statistics show slowing of the teen pregnancy rate, Tokarski and Jee report. On the other side of the ledger, they note that 21 percent of Arkansas residents are uninsured, largely because of the state’s dependence on small businesses that can’t afford to cover employees.

As a presidential candidate, Clinton has supported a version of play or pay - requiring businesses to insure their workers or pay government a 7-9 percent payroll tax to do it for them. The authors quote Democratic sources as saying Clinton wants to scrap that approach but hasn’t under pressure from organized labor.

As it stands, Clinton’s plan would combine play or pay with creation of large managed care organizations that compete for business. He would also have a ″politically insulated″ board set an annual cap on national health spending.

Basing its assessment on an interview with Clinton health adviser Atul Gewande, the magazine said that as more uninsured Americans were phased into the public program, ″a tax increase still might be needed ...″

″I’ve never heard Gov. Clinton say there will be no kind of tax necessary in the future,″ it quoted Gewande as saying. ″He has never done a ‘read my lips’ kind of comment because we know that’s unrealistic.″

Clinton spokeswoman Max Parker said Saturday, however, that the Democratic nominee does not believe that a tax would be necessary and that Gewande did not mean to suggest that he did.

″How much does it matter that the candidate is keeping many of his policy options open, leaving serious analysis of their impact up in the air?″ the authors ask. Not much, they conclude.

Clinton would feel pressure to come up with details quickly, they said, and whatever he proposed would likely win cooperation from a Democratic Congress ″desperate for a way out of the policy gridlock″ on health reform.

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