.~.- I

The Michigan Daily - Friday, October 15, 1993 - 3


By Lauren Dermer
Layout by Lesley Feldman
and Kathy McShare
Illustrations by David Gulisano

'4
The entrepreneurial Instinct
(Self-employed)
NA
All of your own health insurance
premium, estimated at $1,800 for
individuals.
100 percent of health premium is
tax deductible. Currently, only 25
percent is deductible.

Small or mid-sized company
(50-5,000 employees)
80 percent of health insurance
premium
The rest
Small bdsinesses with an average
wage of $24,000 or less are
subsidized by the government.

,,
Big Cmpanis &Crporion
(5,00+ empoyees

Low-wage jobs
80 percent of health insurance
premium.
The rest. But subsidies would
limit contribution for coverage to
1.9 percent of wages.

Stay In school
NA
If college is far from home,
students would join a local health
alliance. Otherwise, family policies.
e c

Employer Pays:
You pay:
Other info:

80 percent of healthi
premium.

insurance

The rest
Company has option ofsetting up
it's own health alliances with all
three basic plans.

How his plan would affect you

A brief glance at the 239-page proposal Presi-
dent Clinton calls the "Health SecurityAct" is bound
to induce confusion, if not pain.
The plan to revamp the nation's $900 billion
health care system is among the boldest, most
complex social-policy initiatives crafted since the
New Deal.
It is also among the hardest to
decipher.
As the debate over reform moves
front and center on the national stage,
big battles loom for Clinton's plan.
Experts scramble to illustrate how
the plan might affect everyone - the
elderly, big business, small corpora-
tions, disabled workers, doctors,
nurses, hospitals, the pharmaceuti-
cal industry, early retirees.
Everyone, that is, except us.
The Twenty-Somethings.
Health Alliances

In his nationally televised pre-
sentation of the plan, Clinton
singled out 20 year-olds as a
group that will have to pay more
now, in exchange forgreater cov-
erage later.
Pay more now. Greater cover-
age later. What, exactly, does he
mean?
It impossible to say for sure
how young adults would be af-
fected. Clearly, there could be
disadvantages. Jobs maybecome
less attainable, and health care
costs may continue to rise.
But experts in health policy
and management say if the plan
works as intended - no doubt a
big IF - young adults would be
better off than they are now.

FIRST, THE GOOD
'*NEWS
"If the plan were fully implemented
as it stands, those in their 20s would
be greatly advantaged."
University economist Leon
Wyszewianski's view, echoes other
experts. When examining Clinton's
health initiative through the eyes of
college students, experts agree the
good outweighs the bad.
Here's a glance at why the plan
looks attractive to Twenty-Some-
things on the brink of entering the real
world:
Look Ma, I'm insured!
Pregnancy tests. Flu shots. Physi-
cal exams. Emergency treatment. For
everyone - anytime, under any cir-
umstance.
For people in their late teens and
early 20s, universal coverage - the
crux of the Clinton proposal - may
be a lifesaver.
Young adults represent a group
with one of the highest numbers of
uninsured individuals. Nationally, 16
percent to 19 percent of students are
estimated as being uninsured.
And while most students are cov-
*red by their parents' plans while in
school, the freedom of graduation
brings the harsh reality: health care is
no longer free.
For young people not in school,
many do not have jobs, and those who
do often don't get health benefits.
But Clinton's plan would cover us
all - and subsidize those of us with
salaries too low to talk about.
Under his plan, most of us would
sleep easy with what is called "health
security" - the faith that when at-
tacked with a case of mono or hepati-
tis, Uncle Sam will help pay the bill
- job or no job.

Singin' the entry-level blues
Scenario: After countless visits to
Career Planning &Placement and way
too many hours spent making the mar-
gins line up on your resume, you finally
land the job of your dreams.
Or so you thought.
Now, a few months into your first
real job, you want out. But your em-
ployer is paying for a large percent-
age of your health care. If you quit, a
visit to the gynecologist may mean a
week without lunch.
No need to fret.
Clinton's plan ensures that even if
you're fired or quit to look for a new
job, government subsidies will help
pay the bill. Also, a new employer
would be required to offer health care
at comparable prices.
"For young people, this would get
rid of what is called 'job lock' -
feeling locked into a job just for the
benefits," said Wyszewianski, a pro-
fessor in the School of Public Health.
"You would only be tied to employ-
ers to the extent that they pay premi-
ums for you."
Under the current system, people
who leave their jobs opt for the lesser
of two evils - keep current health
insurance at an inflated rate, or pay
cash for all medical treatments.
School of Public Health Prof. Dean
Smith added that the plan would al-
low young people more flexibility in
job selection.
"Instead of taking the 'safer' job,
such as one in manufacturing, that
may not have as nice a career path,
they could take more risks without
the fear of not having insurance," said
Smith, who specializes in health in-
surance.
So for the not-quite-sure-what-I-
want-to-do-with-my-life generation,
'portable health insurance" may be
the key to job mobility.

New career opportunities
Kirsten Covell is feeling pretty
optimistic as she begins to look for a
job for next year. The School of Nurs-
ing senior senses that Clinton's plan
would work to her advantage.
"If it works out that everybody is
really going to get health care, that
care has got to be given, and nurses
are qualified to give that care," she
said.
The Twenty-Something genera-
tion can expect an array of new job
opportunities in fields other than nurs-
ing as the health care bureaucracy is
reshaped into new networks of doc-
tors, hospitals and insurance
companies.
"We're going to see creative ca-
reer options in allied health and other
areas that don't even currently exist,"
said Simone Taylor, director of Ca-
reer Planning & Placement.
The current number of health man-
agers will increase 43 percent by 2005,
according to the U.S. Bureau of La-
bor. University School of Public
Health students, enrolled in the
nation's top-ranked health manage-
ment program, can expect to fill some
of these spots.
AND, THE NOT-SO-
GOOD NEWS
With all of this additional security
under Clinton's plan, young people
would have nothing to worry about,
right?
Well, not quite.
In simple terms, President
Clinton's prescription would make
insurance more costly for the young
and healthy and less expensive for the
old and sick.
This is where "pay more now" fits
into the picture. As they say, every
rose has its thorns.
Here's a look at some of the trade-
offs Twenty-Somethings will face in
return for more secure health care:
The Young and the Healthy
In today's health insurance mar-
ket, people who need health care the
most - like the elderly and those
diagnosed with diseases - pay the
highest premiums. So the typically
healthy young adult has it easy.
Premiums are substantially lower
for Twenty-Somethings who pose less
of a risk because they are terminally
healthy, or at least living that illusion.



Everybody would be grouped into huge buying groups called alliances. The alliances would negotiate
with health-care providers for services at the lowest prices.
Pick a plan
All health alliances would be required to offer at least three basic coverage plans. Out-of-pocket costs
would vary, according the-type of plan you choose.

Health Maintenance
Organization (HMO):
You get: All care, either under
one roof or from an approved
network of doctors for $10-15
per visit.
You lose: Some freedom to
choose doctors.
But Clinton's plan calls for a shift
to "community rating." Premiums
would not vary according to sickness,
occupation or - you guessed it -
age.
"It's the same premium for every-
body, averaging out the low premiums
of 20 year-olds with the high premi-
ums of 50 year-olds," Wyszewianski
said.
Shirley Lockery, professor of so-
cial work, translated it into plain En-
glish: "The young, healthy person is
going to have to pay more initially in
order to spread the costs out."
Squeezing small businesses
Health care reform, we've seen,
will open some doors to new job op-
portunities for post-graduation
enjoyment.
But other doors - like doors to
small businesses---may be slammed
in our faces.
Small businesses that now pay
nothing toward their workers' health
insurance would be required under
Clinton's plan to pitch in-no matter
how short their shoestring.
The money they would be forced
to forsake has to come from some-
where.
And the first place to cut back
would likely be hiring.
For many small businesses, health
reform could mean shedding workers
or decreasing salaries, two prospects
that make a graduating senior cringe.
The government would subsidize

Fee-for-service:
You get: Traditional pick your
own doctor and pay-as-you-go
plan
You lose: Cash. This would be
the most expensive option.
companies with fewer than 50 work-
ers and an average wage of $24,000 or
less.
But subsidies are only expected to
avert some of the overall job losses.
Small business lobbying groups
claim that companies that don't offer
insurance cannot afford to, even with
Clinton's promised subsidies.
Working the night shift
By day, a paralegal. By night, a
magazine copy assistant. On week-
ends, a waitress.
Juggling three jobs today is noth-
ing out of the ordinary for Twenty-
Somethings trying to pay their rent.
But part-time work may be in
jeopardy.
Under Clinton's plan, employers
would be required to contribute to
health care costs of part-time workers
by paying prorated shares of
premiums.
Many might be tempted to cut out
part-time offers altogether. Or worse,
businesses may limit hours to just
below the number that makes em-
ployees eligible for benefits.
"The devil is in the details," Smith
said. "It will all be decided in the
details of what constitutes part-time
to determine whether you get
insurance."
The devil is in the details.
Under Clinton's plan, all Ameri-
cans would have access to health cov-
erage, regardless of income, age or

3
Hybrid Plan:.
You get: A combination of HMO
and fee-for service. A little more
control over physicians choice
and treatments, yet a little more
expensive than an HMO.
preexisting medical conditions.
But that is all we know for sure.
The details -who will pay, where'
the money will come from and how
reform will change our everyday care
- are foggy at best.
Clinton's plan rests on the con-
cept of "managed competition."
He says health insurance will be
affordable if people band together in
large "alliances" to bargain with com-
peting networks of providers for the
best service at the best price.
Critics argue cost controls will
result in fewer new drugs and ration-
ing of care. Some argue the cherished
doctor-patient relationship will get
lost in the process. Some argue for
more government control. Many ar-
gue for less.
No doubt, the debate will rever-
berate not only through Congress, but
also through countless dining rooms
and university lecture halls.
But even so, after the nuances are
untangled, policy experts say Con-
gress will pass a health care plan
somewhat similar to Clinton's.
Jason Levien, campus coordina-
tor of the National Health Care Cam-
paign, says the best part of health care
reform for Twenty-Somethings is how
it affects us politically.
"It's the first step in getting people
who witnessed a stage of very cynical
attitudes toward government attached
to politics," he said. "The big picture
is just great for our generation be-
cause it's binding us to politics."

' nThe devil is in
the details.'
_- Dean Smith, Public Health professor

'U' medical students prepare for changes in the health care future