Clinton Team Defends Costs of Health Plan

A recent Gallup poll shows growing public skepticism about the administration's agenda for reform.

OVER the weekend, the Clinton administration's health-care ``war room'' went on the defensive. Top-ranking administration officials blanketed the airwaves trying to ease concerns generated by reports that 40 percent of Americans will pay more under the Clinton health-care plan.

``There was a fair amount of confusion,'' admits Marla Romash, the White House's health-care spokeswoman.

That confusion fueled criticism on Capitol Hill, where some supportive lawmakers took a measured step away from the proposal.

In the news media, the talk was of plummeting public support and calls to put the faltering proposal out of its misery.

``The mistake they got into was the 40 percent number was carried as a headline in many major newspapers. It implied people were going to pay more for less,'' says Robert Blendon, a health-policy analyst at the Harvard School of Public Health.

Since then, the White House has been working urgently to clarify the issue. Here is the administration's breakdown of which Americans who are currently insured will pay more and why:

* Fifteen percent of insured Americans will pay an average of $6 more per month. They are young, healthy people who now have low-cost plans because insurance companies group them with other young, healthy people who don't use their insurance policies often.

``The problem in [the current] system is these people can lose their insurance if they have a car accident or marry someone with a pre-existing condition,'' Ms. Romash says.

The Clinton proposal implements a community rating, in which all people are insured at the same cost, no matter their age or how often they use their policies. That means that the young people will pay more now, and older people will pay less.

The trade-off in the Clinton plan for this young, healthy 15 percent: Pay more now for a policy that can never be canceled and for a future with lower health-care costs.

* Another 25 percent of insured Americans will pay ``slightly more'' in premiums, but for a better benefits package. These are the people who now have bare-bones insurance coverage with high deductibles.

The White House contends in exchange for ``slightly more'' in premiums, most people in this group will actually pay less in out-of-pocket expenses, bringing down their overall health-care costs.

* The other 60 percent of insured Americans will pay the same or less for a benefits package that is the same or better, according to the administration.

A Gallup poll done for CNN and USA Today from Oct. 28-30, the days following the release the the President Clinton's legislative package, shows a growing skepticism about the Clinton proposal on the part of the American public.

Only 34 percent said they believed that the Clinton plan will solve the nation's health-care problems, compared with 61 percent who believed this last February.

Dr. Blendon says one cause for much of the confusion and uncertainty is the Clinton administration's failure to explain its benefits package, which is key if the public is going to be asked to pay more.

``There appears to be willingness [on the part of the American people] to pay a modest tax or premium to get everybody covered. The next level is how much they'd be willing to pay for a better benefits package,'' Blendon says. ``But they don't know what those benefits are, so it's hard to survey.''

There is one group that will end up paying substantially more under the Clinton plan, which requires that everyone have insurance.

They are the estimated 10 million to 12 million young Americans who now choose not to buy insurance at all. They're known as the ``free riders.'' When they need medical care now, they go to hospital emergency rooms, and their bills end up in the ``bad debt'' and ``free care'' columns of hospital balance sheets.

``Will they be worse off under the Clinton plan? Yeah, because this current system is unfair, and they are taking advantage of it,'' says Marc Roberts, a health-policy analyst at the Harvard School of Public Health. ``I mean, if we arrest a criminal, he loses his capacity to steal. Is that a terrible thing? Not every advantage is an entitlement worth respecting.''