Federman emphasizes the importance ofpreserving preventative medicine in the plan,citing the country's "very bad record inimmunization."

The dean is concerned that two of the plan'skey aspects remain uncertain: the costprojections, including the tax impact, and theapproach to managed competition.

Federman says he is unsure whether managedcompetition, which has never been tried, would beas promising as proponents hope. "The plan isterrific on access, very hard to interpret forcosts, and not explicit about quality," he says.

O Canada?

Criticisms by other public health experts,however, went more to the basic tenets of theproposal, such as its heavy reliance on employersto provide benefits.

Peter Hiam, former commissioner of insurance ofMassachusetts and now a professor at the BostonUniversity School of Public Health, said heopposes Clinton's employment-based system.

According to Hiam, it was a historical accidentthat employers provide insurance. During World WarII, there were price controls and employers gaveout health benefits. Ever since, employers havesimply continued to provide benefits.

Hiam is opposed to the employment-based systembecause it requires that each employer have anindividual insurance company, creating a "needlesscomplication."

"The system we have is a nightmare [because itis so] complex," says Hiam. "I'm not belittlingthe potential for improvement. What's a shame isthat [Clinton's] not being so bold to simplify andmake the system more fair."

But more specifically, Dr. Ezekiel J. Emanuel,assistant professor of medicine and of socialmedicine at Harvard Medical School, says hedoubted a simplified form for patients wouldimprove quality.

"Everyone who knows anything about improvingquality knows you will have to have more forms,[not fewer], in assessing patient outcomes," hesays.

Hiam says he thinks Clinton endorses anemployment based system because of state politics:it is the easiest method by which to please asmany people as possible, he says.

And Rashi Fein, professor of economics ofmedicine at the Medical School, while callingClinton's speech an excellent "call to arms," saysa single payer system, similar to Canada's, wouldhave been a better choice. Universal insurancewould not be paid by employers, but by abroad-based tax based on ability to pay, in aversion of Canada's much-touted health caresystem.

"Think of it as free public education. Everyonegets it, but we don't base it on who you workfor," he says. "The plan would have been simpler,and we wouldn't have had to compress evolutionarychanges into a revolutionary time period."

Fein also says that the plan's financing,largely based on expected savings, would not comequickly enough. "Clinton will be under pressure tolet the deadline slip a bit."