Jeff Jacoby's Canadian-style mistake. Boston Globe columnist Jeff Jacoby's main quarry today is Senator John Kerry, whose essay in last week's Phoenix Jacoby mocks as "a masterpiece of meretriciousness -- one gaudy bromide after another, paragraph upon paragraph promising everything while saying virtually nothing." (My only complaint about Kerry's piece is this sentence: "We must begin by demanding a different, better, fairer economic policy that grows [sic] jobs and creates wealth for all Americans." Oof! The decline of the language continues apace.)
But Jacoby also takes a swipe at Al Gore's recent endorsement of a Canadian single-payer health plan -- and manages to make the sort of whopping mistake that distorts the debate over what to do about 40 million uninsured Americans. He writes:
A Canada-style single-payer scheme would mean a major decline in US health care -- just ask a Canadian who has had to wait weeks for the results of an AIDS test, or months for cancer radiation therapy, or more than a year for a hip replacement -- and I doubt that Americans are any keener on the idea now than they were when Hillary Clinton was peddling it eight years ago [emphasis mine].
This is very interesting. The actual merits of Canadian-style universal health care aside, the truth is that the plan devised by Hillary Rodman Clinton and Ira Magaziner was, in fact, its exact opposite. The principal feature of the Canadian system -- its crowning attribute, according to proponents -- is that it does away with private insurance companies. The Clinton-Magaziner plan, by contrast, was designed specifically to achieve universal health care while preserving a prime role for private insurers.
James Fallows explained this clearly in a January 1995 post-mortem on the defeat of the Clinton-Magaziner plan that was published in the Atlantic Monthly:
A Canadian-style single-payer system has two big virtues. It is simple to administer, since doctors, hospitals, and patients no longer have to worry about dozens of insurance companies with scores of different payment plans. The single-payer approach also guarantees that everyone in the country has medical coverage. But [Bill] Clinton was dead set against a single-payer plan, arguing that it would require sweeping new taxes and would, in effect, abolish the entire medical-insurance industry.
Fallows doesn't say it, but there were also reports at the time that President Clinton was hoping that, by spurning a Canadian-style bill, he could enlist the political support of the insurance industry. It didn't happen, of course, as the insurers savaged the bill with those misleading "Harry and Louise" ads. And the proposal that Hillary Clinton and Magaziner crafted was much more complicated than would have been necessary if the administration had simply embraced the Canadian system. (By the way, Fallows's piece was titled "A Triumph of Misinformation." The triumphant march on. It's still worth reading, and is freely available online through public-library databases.)
Now, I've got my own doubts about a Canadian-style system. As the father of a child who's at some risk of running into high-cost medical problems that would have to be dealt with immediately rather than on a health bureaucracy's leisurely schedule, my personal inclination is to find a way of helping uninsured Americans without taking any flexibility away from us, thank you very much.
But the debate is corrupted if we can't agree as to what's on the table and what isn't. Eight years after its defeat, the Clinton-Magaziner plan remains toxic. Senator Clinton herself disavows it. Jacoby, by describing it as something that it wasn't, makes it more difficult to talk about the still-vexing problem of health care in a rational and honest way.