I didn’t even realize that the text of H.R. 3600 of 1993, the original Clinton health system change proposal bill, was online until I thought to look it up over the weekend.
H.R. 3600 came out before I paid any attention to health policy, or knew what a bill number was. I didn’t really know what it contained. All I knew was that it was complicated.
Now that the Patient Protection and Affordable Care Act (PPACA) is law, reading H.R. 3600 is a little like going through PPACA’s baby pictures.
See how PPACA could have been called the “Health Security Act”! See how the first name on the list of sponsors is Richard Gephardt, from Missouri. How’s that for a blast from the past?
See how “individual responsibility” and “employer responsibility” were a thing even back in 1993, and that “state responsibility” and “federal responsibility” were also a thing? How adorable.
One thing that surprised me was finding long-term care insurance (LTCI) in the text. The H.R. 3600 drafters wanted to set up an advisory council that would develop national standards for LTCI benefits, issuer solvency, rates and rate increases.
Of course, it’s easy to look at that section and think, “If only…”
But a section like that also shows how complicated and difficult health policy is. The people who developed the AARP and CalPERS long-term care (LTC) benefits programs must have started out with Health Security Act-like dreams in their heads. They sincerely wanted to create premium-supported LTC benefits programs that would be strong, fair and wonderful.
But their programs ran into the same problems everyone else’s programs have run into.
To some extent, the dreamers behind those programs helped create everybody’s LTC finance problems by giving people unrealistic ideas about how easy it is to offer consumers “promises” about defined LTC benefits to be delivered in the distant future.
Maybe the H.R. 3600 LTCI council could have imposed much-needed discipline on the original LTCI coverage prices, but it could also have imposed benefits requirements that would have seemed fine then and might look absurd today.
So, maybe one of the most important lessons of H.R. 3600 is that, when you’re developing LTC policy proposals, or other health policy proposals, you can’t assume that you’re smart enough to know what the world will be like in 20 to 30 years. Chances are that you really have no idea. A good system needs to have enough “give” in it to accommodate changes in circumstances.
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