A Healthy Dose of Hillary

Respiratory therapist Jerry Rupert listens to Sen. Hillary Clinton talk about how she would reform health care. (By Charlie Neibergall -- Associated Press)

In truth, there are lots of trade-offs implicit in version 2.0 of the Clinton Health Plan, and it would be better for the cause of health reform, and for Clinton's candidacy, if she began to educate the public about them.

Everyone agrees that automated health records are a great idea and will save a ton of money. But someone (the government) has to set the standards and require that doctors, hospitals, and labs invest the upfront money for software and equipment.

And while everyone can rally around paying for performance, shouldn't someone point out that, in practice, that will mean some providers will be paid less while others may be forced out of business?

Mandating that everyone have basic and affordable insurance is the easy part. Less easy is acknowledging that an affordable policy may not cover everything you'd like.

Certainly nobody is opposed to using objective medical evidence to manage the care given by various providers to patients with chronic disease or patients at the end of life. But what that means in practice is that a trained health professional hired by an insurance company is going to have to tell other doctors how to practice medicine and tell patients what drugs and tests and surgical procedures won't be covered by insurance. If that sounds a lot like managed care and rationing, it's only because it is.

The rap on Hillary Clinton -- the reason even Democrats haven't warmed to her -- is that everything she does seems driven by political calculation. Now with a well-crafted proposal on a signature issue, Clinton has the opportunity to prove that she can also be the leader who is willing to tell voters the hard truths they have suspected all along but don't want to confront.

Steven Pearlstein will host a Web discussion at 11 a.m. today at washingtonpost.com. He can be reached atpearlsteins@washpost.com.