During the last four years, my colleagues at The Heritage Foundation and I have been criss-crossing America talking about health care and the Heritage Consumer Choice Health Plan. Under the Heritage proposal, Americans would receive tax credits or vouchers to help them buy the health plan of their choice, and they would be able to keep the same plan no matter how often they changed jobs. We have discussed this proposal in hundreds of forums, from business conferences to "town hall" community meetings, and we have received comments from tens of thousands of Americans from all walks of life.
One of the most common questions we hear goes something like this: "I like your proposal, but I'm confused about how health care coverage would change for my family under your plan, and that worries me. How would the Heritage plan affect me and my family?" The question reflects a seeming paradox in public opinion about health care. Most Americans want major reforms in the country's health care system -- but not in the way they receive care themselves. The consumers we have spoken with are generally satisfied with the quality of their families' current care, but they are terrified that for some reason -- because they change jobs, perhaps, or because insurance rates skyrocket -- they won't at some time in the future be able to afford or otherwise obtain access to the quality of care they count on today.
To be sure, a minority of Americans today already face life without protection against crippling medical costs, or are dependent on charity care or third-rate public hospitals. Most of these individuals do get care, but their finances are constantly at risk. At any point in time during the year, as many as 30 million Americans may fall into this category. What is really driving the politics of health reform today, however, is the growing fear of insured middle-class Americans that one day they may join the minority who cannot afford -- or because of poor health or other reasons, cannot obtain at any price -- adequate health insurance. Telling these Americans that uninsurance is an overstated problem, as some conservatives do, misses the political point. Every middle- class person knows a relative or neighbor who has faced financial disaster because they lacked adequate insurance. No one wants to be next.
Anxiety About Choice
Hillary Clinton understands this fear and is shrewdly exploiting it. She talks about "security" and conjures up the idea of a national health card that will wipe away the fear of bankruptcy. She knows how to touch raw middle-class nerves.
Polls also indicate the special vulnerability of some conservative solutions to the health care problem. Americans do want choice in health care. But they also have deep anxieties about choice if it means they are somehow on their own, having to bargain with doctors, hospitals and insurance companies. They see the health industry as too big and powerful for ordinary people to cope with. The idea of consumers using the yellow pages and a telephone to negotiate prices with surgeons may seem like nirvana to libertarian scholars, but to the average American that prospect is nothing short of a nightmare.
It doesn't matter whether people are right or wrong in how a consumer choice system actually would work: The simple fact is that the prospect of such a system alarms them. Thus one thing Americans want in a reformed system is a powerful institution on their side, an 800-pound gorilla, to represent their interests against the insurance companies and the hospitals. That's why so many people are drawn to a Canadian-type system, and to Mrs. Clinton's plan, in which the government plays the gorilla. It is why Mrs. Clinton gets cheered by people who should know better when she grouses about price gouging and profiteering in health care and proposes price controls. And it is why the Heritage proposal concentrates on how Americans could turn to a labor union, a church, or some other powerful organization working on their behalf, to bargain with health care providers and to construct a family plan. …