I finished reading and making an outline of the Clinton plan enroute from Raleigh,NC to Dallas, TX today. It was a journey that started in front of the airport doors at 545 AM and ended in Dallas at noon. I asked those around me as I traveled what they thought of any candidates proposals and got a variation of, “I have been way too busy but when such and such happens, I will settle down and find out what they think.” I think most of us will think about these issues when pigs fly because for most of us what we think doesn’t matter that much. Now as they say in the cartoons lets get on with the show.

The Clinton plan is 3 parts and was a 30 page download. The message of the Clinton Plan is Choice. She calls it The American Health Choices Plan. No matter what anyone says, its about making voters happy but that isn’t different from any other candidates plan except Dennis Kucinich.

The five points of Hillary’s plan are:

1. Choice. Keep the insurance you have now, join the plan that is similar to (but not exactly like) your congressman’s or senator’s plan, or be covered by medicare, medicaid or SCHIP.

2. Reduce costs, reduce premiums and get to keep your insurance job to job, employed or not.

3. Share Responsibility - She is going to regulate the insurance industry and throw them some perks.

4. Ensure “affordable” coverage for all

5. Fiscally responsible - savings on the current plan are to pay for future benefits. Everyone within the industry shares the responsibility of reining in costs.

I have applied 6 questions to the previous plans. So here they are for Hillary’s plan.

1. Is is comprehensive. Yes, the plan addresses costs, prevention, improvement in treating people and streamlining the system while covering everyone that will accept coverage. It is the most well thought out health plan of all the candidates and it is documented with references for the ideas presented.

2. What are the specifics? Choice of plans, Insurance regulation to make companies insure you, and prevent them from over-charging or dumping you, Electronic Medical Records and a “best-practices” think tank of some sort to create information about what works and what doesn’t in treating chronic disease.

She will still provide various “tax credits” but not for “heinous rich people” (those in her own income bracket), they will have to pay more out-of-pocket. Stop loss coverage, but not for insurance companies but for companies that pay their retirees health coverage, to keep the problem from being catastrophic for them. Like everyone else the only money saved now would be from negotiating the price of medicare part-D drugs. The rest are potential savings after this or that is done. Like all plans, it gets the ball rolling in a different direction.

3. Does the plan cost money - yes. The governments share looks to be another $500 billion - roughly 45 million are uninsured and mostly that is because of cost not choice. Costs for health care now are $1,560 billions. About 1/6 th of the country needs insurance or better insurance. Everyone would have the chance to switch to the government program and many insured and probably all uninsured would.

The employer would pay an insurance tax or part of the price of premiums but “small” businesses (less than 100 employees?) would get a tax credit. Over all the 46% to 58% Federal share of expenses is going up. Perhaps it will level off if we are really successful with treatment and prevention.

I did not see any proposals to limit advertising of junk food to kids or to fund programs that are proven effective to get kids moving and better fed to stop obesity. Maybe its in the fine print somewhere. Hillary knows no one is going to vote for her if she advocates “fat” police that raid your house if you order too many takeout pizzas in a certain period of time.

4. Does the plan include some pain for everyone? Yes, but disguised pain. Insurance companies and drug companies are going to take it on the nose at least rhetorically. The tax payer is the one who will be taking the pain. At least if everyone is insured, then the uninsured won’t be paying for the premiums of the insured.

5./6. Have parts of the plan been tried elsewhere? Can the candidate answer complex questions with complex answers. To her credit, Hillary Clinton has been down this road before and has learned from it. She is versed in her program and she isn’t touting any foreign models but what has worked here in various places.

It is best to remember that most examples were from small samples, one institution or one program’s effect within one state. There needs to be flexibility and accountability if this things is going to work in any form.

Only John Edwards thus far has anything in writing as comprehensive and well documented as Hillary Clinton. Politics aside, she and her staff have done the best job so far but still are lacking. The lack is for honesty.

How much does the Federal Government really pay? Some estimates are 58% of current expenditures. Joe Biden is good at touting this but not at planning what is to be done about it. Thirty percent is a figure I have seen many places as the administrative costs currently. In her documents Hillary credits Medicare with 1.5% and Medicaid with 3% admin costs as opposed to private insurance at 11%. Where does the 30% figure come from - Office of Management and Budget? I will have to look for that.

My opinion is that we must have fewer sick people and we must treat them according to proven protocols or we are not going to be able to afford universal treatment for everyone. It all boils down to personal responsibility. Self restraint is the basis for a democratic form of government. But, choices have to be in place and we generally have few with little flexibility.

We have built a physical nation that must have cars to get places. We are a nation of riders, not walkers and bike-riders. I would raise the Federal tax on gasoline to make it $5 per gallon and ear mark the federal income for universal coverage and programs to promote wellness.

It is a fact that a small percentage of the patients use most of the resources. I have heard the figure 75% of resources. It is the Pareto principle, the 80/20 rule in action. We have to help people arrive in older age with no more than one chronic disease. We have to help them get to advanced age leaner, with more endurance and muscular strength. It requires self restraint and self discipline and a collective effort to secure the opportunity.

Doctors and treatment are not the key, they are the stopgap. Plans and programs and money well spent on prevention - nutrition, exercise, treating depression and correcting misinformation/wrong thinking that lead to wrong behaviors - is what is needed. What good is a screening colonoscopy if the person is obese, smokes and can not change any habits. Most of our nation will soon have two of three of those problems.

The Doctor treats problems, not prevents them. Public Health should be getting the money for research and implementation. Biden refers to that in his plan. As much money should be spent on public education as is spent on advertising treatment solutions like drugs. They amount could be divided into credits and those credits could be bought to be used as advertising opportunities. No credits, no advertising at least in the mainstream - Internet and other electronic means (TV, Radio).

The Clinton plan won’t ever look like it does here. It is comprehensive but it does not really address the issues. It does provide a frame work that a Democratic congress might vote for.

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