IN SICKNESS AND IN HEALTH WITH HILLARY

by Alexander Cockburn

Just like the architect of the Tower of Babel bustling out of his studio with a fresh set of drawings, Hillary Clinton has produced a new health plan. Politicians don't care to admit they messed up, and Mrs. Clinton is no exception to this rule. The most she would concede during the roll-out ceremonies earlier this month is that the last time she took on the health industry, she was too ambitious. This is a most forgiving posture toward one of the great political disasters of the 1990s.

In the dawn of the Clinton era, many Americans actually believed the new president might do something to fix the mess optimistically described as the health care system. Bill Clinton's pledge to do so was a prime reason he got elected. In the dawn hours of his presidency, he announced he was handing the big assignment to his wife. The political conditions were favorable. In early 1993, 70 percent of all Americans favored a system of national health care, a sound base on which to build a national coalition powerful enough to cow the insurance and pharmaceutical lobbies -- two of the most powerful forces on the American political scene.

Mrs. Clinton is not a populist by temperament. She had been a powerful corporate lawyer in Little Rock, accustomed to covert deals behind closed doors. As she embarked on her mission, all the early headlines concerned her obsession with secrecy. By the time Mrs. Clinton's 1,342-page bill landed in Congress later in 1993, she had managed to offend the very Democratic leadership essential to making health reform a reality. The proposal itself, under the mystic mantra "Managed Competition," embodied all the distinctive tropisms of neoliberalism: a naive complicity with the darker corporate forces, accompanied by adamant refusal to even consider building the popular political coalition that alone could have faced and routed the opposition.

Fourteen years after that debacle, health care in America has gotten steadily worse. Critics trumpet endlessly the bleak statistic that nearly 50 million people are without any form of health insurance at all, but it is not clear whether this is quite the disaster it is cracked up to be. Go to a doctor florishing your Blue Cross card, and three months later the insurance company notifies you that deductibles and other conditions laid out on the policy in two-point type mean the company is ponying up only 5 percent of the bill.

Get in a car crash -- a major reason to have health insurance -- and the surgeon debating whether to sew you together again checks the amount of coverage on your policy, and if it's below $2 million, the surgeon may let you die in the waiting room. It nearly happened to a friend of mine, though in that instance, the hospital found he was covered up to $3 million and so the operation went forward.

Costs are now so high that the middle class is being priced out of the game. It's cheaper to head for Panama or Costa Rica or even India and pay cash on the barrel. Many Russians now naturalized as Americans simply head back to the former Soviet Union for any serious surgical or dental procedure. Even taking a $2,000 Aeroflot ticket into account, it works out far cheaper. Those with no sanctuary in another country head for Chinese herbalists, dose themselves with homeopathic nostrums or smoke marijuana to keep the pain at bay.

Reformers florish the Canadian system as the model. Michael Moore's recent film, "Sicko," dwelled on its allurements. But Canada has a social democratic tradition. America has none. The sole surviving relic of the New Deal era is Social Security, and that is under constant assault. So "health reform" in the present age means at best a slight cosmetic adjustment, and so it is with Mrs. Clinton's new plan, modeled as a scheme adopted in the Commonwealth of Massachusetts, whereby everybody is legally compelled to have some type of health insurance. This spells out as compulsory ruin. A couple in their 50s face a minimum annual premium of $8,638. Their policy has no coverage for prescription medicines, and there's a $2,000 deductible per person before the insurance even kicks in. In other words, they're destroyed by the insurance costs before they are plunged into bankruptcy with the arrival of any serious illness.

So, for all these reasons, no one -- probably not even its author -- takes Mrs. Clinton's plan very seriously. They all know that in this decade, far more than in the early 1990s, the darker forces are firmly in control and, whoever is president in 2009, there's not a chance in a million that there will be any substantive rearrangement of the furniture.