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BMJ. 2007 September 29; 335(7621): 637.
PMCID: PMC1995512

Hillary Clinton unveils plan for healthcare reform

Hillary Clinton, nominee for the Democratic party's presidential candidate and New York senator, last week announced her plan to reform health care. She would require insurers to provide coverage for anyone who applied and would bar companies from charging people who have greater healthcare costs more for their premiums.

Speaking to the annual convention of the American Association of Retired Persons, in Boston, she said, “Health care should not be a privilege for a few, but a right for every single person. There are 47 million uninsured in this country, and covering them is a moral imperative.”

Mrs Clinton told a story about a constituent who came to her after her son was diagnosed as having leukaemia. The insurance company had agreed to pay for a stem cell transplant but refused to pay for the search to find a suitable donor. But after Mrs Clinton took up the cause the insurer complied.

“It should not take a US senator for a parent to get the health care [that] their son or daughter needs,” she said.

If elected, she vowed to accomplish her goal in her first term. The estimated cost would be $111bn (£55bn; €80bn). She has replaced the complexities of her last effort 14 years ago during her husband's administration in favour of simplicity, cost control, and individual consumer choice, calling it “the American health choices plan.” She emphasised the plan was not designed to be operated by the federal government.

The plan depended upon every US resident having health insurance, just as most states require drivers to buy car insurance. Her plan, she says, is the only way to achieve affordable health care for everyone, with a federal tax subsidy the key to help individual people pay for coverage.

Mrs Clinton's plan builds on the existing system of coverage through employers. People who receive insurance through the workplace could continue to do so. Businesses, in turn, would be required to offer insurance to employees or to contribute to a government operated pool that would help pay for people who were not covered. A tax subsidy would be offered to small businesses to help them afford the cost of providing coverage to their employees.

For individual people and families who are not covered by employers or whose coverage is inadequate, Mrs Clinton would offer expanded versions of either of two existing government programmes—Medicare and the health insurance plan offered to federal employees. No new federal bureaucracy would be created by the plan, she said.

The costs of the plan would be met by ending George Bush's tax cuts for people earning more than $250 000 a year.


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