"We've got to find a way to share the risks and lower the administrative costs." So said former President Bill Clinton Monday night, and no, he wasn't talking about Social Security--though he might have been. He was talking about health care. Clinton was the star attraction at ex-Gov. Jim Hunt's 20th annual Emerging Issues Forum, now institutionalized on N.C. State University's Centennial Campus as the Institute for Emerging Issues. Someday soon, it was announced, the institute will have a new home on the campus in the James B. Hunt Leadership Center, which will go up just as soon as Bob Ingram, who recently retired as chair of pharmaceutical giant GlaxoSmithKline, can raise the money to build it.
Ingram's fund-raising role doubtless explains why Clinton, after mentioning the 40 percent increase in the (U.S.) cost of pharmaceuticals over the last two years as a major health care problem, hastened to add that "there's no easy answer to that, because we get a lot out of it."
Also noteworthy: Ingram announced that the architects who designed the William J. Clinton Presidential Library in Little Rock, Ark. --with its signature "bridge to the 21st century"--will do the Hunt building at NCSU.
Clinton on health care, however, was like taking the bridge back to the 20th century, to a time when Democrats could fashion programs like Social Security that did socialize risks and benefits for mass populations, largely eradicating poverty for senior citizens.
Contrast that with George W. Bush's push in the direction of "owning" your retirement risk--with Wall Street ready to help run your own personal Social Security portfolio at only modestly higher administrative costs. (Promise.)
The Bush approach, as Clinton said politely without ever mentioning Social Security, Wall Street or--in this connection, Bush himself--is exactly how we run our health care system. It's privately managed, services are based on how much you can pay, and it's by far and away the most expensive health care in the Western world--the last the result, in large part, of the approximately 25 cents out of every health care dollar that's spent on administrative overhead.
Insurance companies pay a lot of money to avoid covering people, especially people with chronic illnesses, Clinton said. Consequently, 43 million Americans have no health insurance. "No other country finances health care the way we do, in this crazy-quilt pattern." And no other country pays 15 percent of GDP--gross domestic product--for health care. Switzerland and Canada, the next-most expensive, pay about 10 percent. The difference, if we did too, would put $500 billion back in our collective pockets--"that's still real money to most people," Clinton said.
Unfortunately, Clinton's 1994 reform effort did not move in the direction of a national health care system like Canada's or Switzerland's. Instead, it took the private insurance companies as a given and tried to change the way they did business. The industry promptly dubbed it "a radical government takeover," and he got a whippin' for his troubles, he recalled.
Lesson? Well, he really didn't seem to have one, beyond a fond wish that the world were different and people of different political views would work things out instead of "gutting each other every election." After his '94 bomb-out, Clinton tried "chipping away" at our health care problems with small changes aimed at kids, seniors, diabetics, AIDS patients, people who change jobs, and so on. Yet in '05, more people are uninsured and the cost of the system just keeps on going up and up and up.
The history of humanity is greater and greater interdependence (globalization in its best senses), a philosophizing Clinton said, interrupted by outbursts of clan behavior, selfishness and war. To the extent that the world adopts "shared benefits," it can forestall and minimize the carnage. To the extent that some are selfish and don't share, resentments grow and the potential for disaster increases. "My test is, if it builds on our shared values, it's good. If it undermines shared values, it's bad."