All in all, I'm very positive on the plan. But there's a substantial distance between Clinton's proposal and my perfect plan. If I wore the crown, I wouldn't allow the fragmentation it leaves in place: Medicare, Medicaid, and S-CHIP would be dissolved. Private and public insurance would be offered from within a single, coherent structure -- like FEHBP. The Clinton plan, in contrast, goes to great lengths to preserve every existent program and insurance option so as to minimize disruption for those currently pleased by their coverage choices.
This is, sadly, the smarter way to go. One of the lessons Clinton clearly took from 1994 is that you don't touch the care that millions of Americans already rely on and trust -- not in a country where 80-some percent profess satisfaction with their personal coverage. So though I'd prefer something more integrated, I wouldn't advise any politician to cater to my instincts. That's why I'm positive on Clinton's plan: I think this is damn close to the best policy you can get while retaining something politically sellable.
But since I'm not a politician, the reason I'd fight for such system-wide integration is simple: Costs. It's very hard to impose any sort of coherent cost control -- either on the supply or the demand side -- when you're simultaneously trying to change the behavior of Medicare, Aetna, Blue Cross, the VA, Metlife, the VA, the Indian Health Service, etc, etc. Put it in one place, and you can try out a lot of cost control mechanisms, from smart cost-sharing (wherein more cost-effective treatments have no copay, while less proven therapies require a substantial out-of-pocket contribution) to HMO-style care reviews to government bargaining. You can do much more to popularize better treatments, best practices, preventive care, and healthy living incentives.
Indeed, a plan that detonates and then reintegrates the healthcare system is better in every way save the most important one: You can't pass the damn thing. That is one of the lessons of 1994, in which the Clintons' sought to reconstruct the entire health care system and got mauled for it. For a really good explanation of the political difficulties inherent in healthcare reform, read this post of Mark Schmitt's. I don't agree with all of it, but I think everyone interested in the debate should be required to commit it to heart.
