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Clinton's wiser health plan

HILLARY CLINTON has learned from her gravest political mistake. The health plan she unveiled this week contained the best of her 1993 initiative - health insurance for all - while avoiding the government expansion that doomed the earlier plan. Along with proposals by Barack Obama and John Edwards, her main rivals for the Democratic presidential nomination, her proposal offers a framework for progress.

Republican candidates generally favor market-based solutions. If the market alone could supply the answer, 47 million Americans would not lack health insurance. Clinton wouldn't upset the market, as she tried to do in 1993, but she would regulate it to control costs, expand coverage, and make sure companies couldn't drop people if they became ill.

Clinton, like Edwards but unlike Obama, would mandate that everyone buy insurance and would offer tax credits to those who can't afford it. In exchange for being compelled to cover everyone, companies would get millions of new, healthy customers, who in turn would get coverage at reasonable rates. Despite Obama's reluctance to endorse a mandate, such a requirement is the most politically viable way to spread the burden of paying for coverage among all Americans.

Clinton's proposal is much like the Massachusetts plan approved last year, but the state makes do with limited revenue sources. Clinton would use the clout of the federal government to keep costs down, and would add tens of billions of dollars to healthcare by repealing tax cuts for people making more than $250,000 a year.

Under her plan, people would keep their existing insurance, but they could also buy into the Federal Employee Health Benefit Program or a Medicare-like plan. In some respects, she doesn't go into quite as much detail as her rivals. Edwards would establish regional Health Care Markets, and Obama a National Health Insurance Exchange, to help people buy coverage. They are closer than Clinton to the Massachusetts model, with its Commonwealth Health Insurance Connector.

But Clinton knows Congress will fill in the details, and a national connector could be added then. Notwithstanding the fine points of any candidate's health plan, the key ingredients of reform are a presidential commitment to universal coverage, a Congress that is amenable to a new approach, and money to cover the costs of new coverage.

With so much of Massachusetts in Clinton's plan, one would think former governor Mitt Romney would offer a kind word, since he signed the 2006 law with fanfare. Instead, he dismissed her proposal as "Washington-managed healthcare." He wasn't so antigovernment at the State House.

People in the rest of the country need coverage as much as those in this state. As Clinton's plan recognizes, Massachusetts is a model for the country as a whole.

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