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Clinton's Health Plan : Health Plan: A User's Guide : Prospects of Reform Hit Home


WASHINGTON — Ever since President Clinton mounted the mahogany and marble podium in the well of the House of Representatives to present his blueprint for health care reform to a joint session of Congress, the plan has been getting the test that really counts in a far less august setting--the kitchen table.

Americans of all ages and circumstances are sitting down to try to calculate whether they would be winners or losers under the complex scheme. The President has promised to slow the runaway cost of the total U.S. health care bill and deliver good care for everyone, including the 37 million who do not now have health insurance.

But the proposal represents a series of trade-offs between benefits and cost saving, freedom of choice and out-of-pocket expense. What might be true for the country as a whole may or may not be true for any particular individual.

At this point, computing how particular individuals and families will fare can be no more than tentative. Clinton himself has yet to fill in all the details of his plan, Congress will undoubtedly modify the plan before it becomes law and sweeping change always brings unintended consequences.

"Over the long run, we can all win," Clinton insisted Wednesday in his address to Congress. "Some will have to pay more in the short run. Nevertheless, the vast majority of the Americans watching this tonight will pay the same or less for health care coverage that will be the same or better than the coverage they have tonight."

For many millions of Americans, Clinton's plan would be a resounding plus from the beginning. Included in this category are those who have no insurance, those who are locked in dead-end jobs because shifting careers would mean losing health coverage and those whose plans cover only the bare essentials. Even the elderly, already insured through Medicare, would gain coverage for prescription drugs.

John Stark, a 29-year-old uninsured bachelor in Fullerton, would be able to purchase peace of mind of knowing that if he got sick, his medical bills would be paid. The cost to him: as little as $30 a month.

Likewise, John F. Gominsky, 40, a Santa Ana man with a long history of cancer, would be able to change jobs without fear of being wiped out by medical bills. And Sherri Smith, 24, a Los Angeles welfare recipient who has trouble finding doctors who will accept MediCal patients, would move into the health care mainstream with benefits similar to those of privately insured people.

Not everyone may be happier, however.

Americans who are perfectly satisfied with their health care, young people who do not want to pay for health insurance, small business owners working on narrow profit margins, hospital administrators whose institutions depend on government payments, independent agents who sell health insurance--these people could see themselves as losers.

They include Carla Magarity, a Reseda insurance agent whose co-workers are already making grim jokes about being forced to go to work at fast-food restaurants; Ivan Calderon, who fears he would have to close his small Mexican restaurant in Costa Mesa if he were required to contribute toward his eight employees' health insurance, and Dr. Marvin Kaplan, who expects both lower fees and less work.

How individual Americans size up their prospects may determine the fate of the plan. Clinton has been counting on an outpouring of public support to help him overcome entrenched opposition from Republicans and some Democrats in Congress as well as lobbyists for the insurance industry, small businesses and other hostile special interests.

Already, the opponents have captured public attention with a television ad funded by the insurance industry. A husband and wife who are discussing the President's plan at their kitchen table conclude it would deprive them of their freedom to choose their own doctor.

"They choose, we lose," the couple says.

Clinton clearly had this ad in mind when he condemned "scare tactics by those who are motivated by the self-interest they have in the waste the system now generates."

In fact, the President's plan would not require Americans to switch doctors, although it might cost them more money to continue seeing the same physician. It includes powerful incentives for Americans to switch from insurance that reimburses any doctor on a fee-for-services basis to HMOs and other so-called managed care plans, which limit but do not eliminate their choices.

For those such as Gominsky who are willing to pay a higher deductible, fee-for-services plans will continue to be available.

Because the average cost of health insurance would vary from state to state, it is impossible for anyone to estimate with certainty what their costs would be. The Administration says the national average would be $1,800 for single people and $4,200 for families.

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