Obama administration using Clinton-era health care reform as 'reverse playbook' - MedCity morning read, May 14, 2009

The Clinton administration’s ill-fated stab at health care reform in 1993 finally has become a model — of how not to do it, writesÂ Jonathan OberlanderÂ in an opinion piece in the current issue of the New England Journal of Medicine.

Oberlander, an associate professor of social medicine, and health policy and management at the University of North Carolina, Chapel Hill, says the Obama administration is using the Clinton-era plan as a “reverse playbook” for running its own reform plan.

During his presidential campaign, Barack Obama talked about offering universal access to health care by creating new private and public insurance options for the uninsured, along with offering subsidies for lower-income people so they could buy insurance, Oberlander wrote.

The cost of such a plan was pegged at between $1 trillion and $2 trillion over 10 years. That works out to between $100 million and $200 million of new spending a year, a modest increase for a health care system that already spends $2 trillion a year, he said.

But even if universal health care coverage saves money in the long run, it would require a lot of up-front cash to expandÂ insurance, given congressional pay-as-you-go budget rules and the administration’s commitment to health care reform that pays for itself, Oberlander wrote.

Some money-raising options that might work: Increasing “sin taxes” on tobacco and alcohol; taxing employer-paid health care insurance (employers currently get a tax exemption for these payments); and employer and individual mandates to buy health insurance.

The Wall Street Journal Health blog outlines pros and cons of each option.