Ezera Klien has a full discussion of Hilary Clinton’s health care proposal, this I think summarizes it well:
Let me try and give a quick sketch of the Clinton proposal before I have to run for a meeting. Here’s the thumbnail: Clinton’s plan is of the “individual mandate” variety, in which universal coverage is achieved by mandating that every American purchase health care. In order to ensure that that’s both possible and affordable, the Clinton plan creates a few new coverage options, reform the insurance industry, limits coverage costs to a percentage of income, and washes your car.
Okay, it doesn’t wash your car. It does open the Federal Employee Health Benefits Program to everybody, ensuring that anyone can access the same menu of regulated private options that federal employees get. FEHBP is the program that already insures millions of current government employees, including the members of Congress, by offering a variety of regulated private options to choose from. Throwing the doors to that program wide open is the most basic and ubiquitous of coverage solutions.
This seems like a the mandatory insurance that I am required to carry on my car, but this may be a very workable plan and would make it much easier for people to get coverage, while at te same time making it possible for people who want a different plan to continue with whatever plan they like. This proposal seems like something that serious presidential candidate would think up to fix a problem. See the whole article here
Doing what Romney and the Democrats did here in Massachusetts. Splitting the baby in half ala King Solomon.
I’m definitely leaning towards the candidate who can put the words ‘universal coverage’ into their stump speech.
Squeezing private insurance out of the deal has to be the goal. Especially after what the industry has done to thousands of people who lost everything in Katrina, it’s high time that lobby in particular got frozen out of a few policy discussions.
I say we should pick a few models, take what works, improve on what is already in place across the world, and put this issue in the rearview mirror for a generation. Get government back on its feet with the type of budget management its been lacking for too many years now…empower the auditors once more, set them loose on the beurocracy and get this health care thing done right.
We could land on the fucking moon in the 60s, so we have to be able to pull this off.
Al:
We all know the moon landing was faked 🙂
A perfect health care system would eliminate big pharma and get rid of big insuarnace as well.
What I do like about Hilary’s plan is that at least it would increase competition among insurance companies, if employees could switch to a non employer affiliated companies at any time at least the insurance company would not have a monopoly. At least in my case, the companies that I have worked for only offered one insurance company and it was a take it or leave it proposition. What that does, is it forces people who don’t go to the doctor a lot, like me, to subsidize people who do go to the doctor a lot, where if I had choices for a company that either offered a high deductible or limited doctor visits it would have fit my sitation better.
It is interesting to me that the “free market” seems to limit choices where at least Hilary Clinton’s proposal should increase choices.
Hillary says that this will cost $110 billion to provide insurance for 47 million. I think the $2,500 per head cost is a bit high for this–but I think it might be a good start at maybe half that level.
Vouchers would probably keep things most competitive. And issuing these in the tax filing cycle would probably keep the corruption down to a minimum.
The whole idea of competition in health insurance is, to me, a ridiculous concept. Insurance, 401K funds, etc…aren’t exactly things you go to the store and pick up every week. Truth is, most people sign up and forget what it is.
Basing a health policy around the promise of competition solving things in the marketplace is naive. The big players will collude, buy out whoever isn’t playing by the rules and otherwise work to get a better deal than they already have now.
Also, with people potentially switching plans on the fly, the number of denials for pre-existing conditions will rise. ALSO, the issue in regards to hospitals and doctors actually getting paid on time won’t be solved, only exacerbated, as new names arrive, and new hoops for their administrative staffs to jump through…
I view health insurance as a racket, because it is.
Al:
Good point about mutual funds, I always thought part of the reason some people wanted to privatize social security was that it would put a lot of improperly managed money into the stock market.
Seems like their are two sides to the equation in health care, on one side you have doctors and pharmacutical companies that may be trying to overtreat illness, and on the other side you have insurance companies that are trying not to pay for any treatment. The end result seems to be a lot of money spent on unneeded procedures and no money spent on people who are really sick.
I read somewhere that our current health care system combines the compassion of capitalism with the efficiency of communism, that seems like a pretty apt description.
So the example you provided of car insurance is limited to the government coercion, and not to the marketplace for insurance? I’ll miss those Geico and AllState commercials, and it’s only going to be more Peyton Manning taking their place.
Vouchers will address the racketeering of which you speak. Food stamps haven’t seemed to create monopolistic trends in the food services industry nor problems in getting paid, so I’m not really worried about vouchers for the impoverished, either.
Car insurance is not tied to an employer the way health insurance typicaly is, and I think that is the benefit of Hilary’s plan, you would be able to get a non employer based group rate.
The other side of the equation is all of the overtreatment that takes place, especially in the form of unneeded drugs that are prescribed, I agree with Al that health insurance is a racket, but right now it seems that pharmacutical might be a bigger racket. Without controlling costs any kind of health care program will run into trouble.
Controlling costs only leads to service degradation–fewer options, more wait, more pain, more death. This happens in Canada, Britain, and pretty much all the other countries, who put cost distortions ahead of supplying competitive care.
I also agree that health insurance is a racket, like any other business. But government is a racket, too, otherwise Bush could not provide all this fodder for us. I’d prefer competitive businesses to a monopolistic government. I choose how to participate on my own terms, opting in and opting out. I don’t have some out-of-touch bureaucrats taking that freedom away from me.
Vouchers, baby, vouchers. You guys aren’t kicking the tires of the proposed solution, just big pharma and insurance interests.
I just finished a book called selling sickness, the main point of the book was that big pharma creates sickness. One example that sticks out in my mind was high “high choestrol” which the medical industry keeps redefining to the point that everyone has high cholestrol. Here is the kicker, people don’t die from high cholestral and all those meds that purport to lower cholesteral are not only expensive but they have nasty side effects.
But as long as restless leg syndrom is under control who cares about the cost.
There’s a great essay out of Harpers from earlier this year. I’ve got it in PDF form, and will try to post it here. The premise is, the writer voluteers for a drug trial, and the way they determine whether someone is clinicaly depressed is examined in real time, as the guy is going through the test.
I’ve felt that restless leg syndrome while I’ve been trying to sleep, once this year I had to get up and walk around. No way in hell would I take a pill for it.
My whole life I’ve had psoriasus on my legs, elbows, head, and growing up I used every kind of cream they came out with, light treatments, ointments, special shampoo, etc. The reality is, when I apply a steroid cream, it works like a miracle for a while, but then the psoriasus starts eating it up like its nothing. What to do? Put on more cream, one more time a day…around age 20 I just said fuck it and haven’t treated it since.
They’ve got injections you can get twice a year that will clear it up. A cousin does this, and my mom mentions it all the time. I won’t do it. I don’t trust the market for these things, but most important, it doesn’t even bother me anymore. I’ve got patches of it in the normal places, they get worse in times of stress and during the winter, but in the grand scheme, it’s not really important.
The importance of clearing it up would be entirely a cosmetic concern. Since that’s the case, is it worth the risk to get these injections over a number of years? I don’t think so.
Karl – I’ll swap you something for that book if its yours to lend. I’ve got Frank Rich’s ‘The Greatest Story Ever Sold’ I can send out to you.
We, the People, deserve better than this:
As she unveils HillaryCare II, Mrs. Clinton likes to joke that it’s “deja vu all over again” — and it is, unfortunately. Her new plan is called “Health Choices” and mentions “choice” so many times that it sounds like a Freudian slip. And sure enough, “choice” for Mrs. Clinton means using different means that will arrive at the same end: an expensive, bureaucratic, government-run system that restricts choice.
Begin with the “individual mandate.” The latest fad after Mitt Romney’s Massachusetts miracle, it compels everyone to have insurance, either through their employers or the government. Not only would this element of HillaryCare require a huge new enforcement bureaucracy, it is twinned with a “pay or play” tax on businesses that don’t, or can’t afford to, provide health insurance to their employees.
The plan also creates a new public insurance option, modeled after Medicare, and open to everyone, regardless of income. To keep insurance “affordable,” HillaryCare II offers a refundable tax credit that limits cost to a certain percentage of income. Yet the program works at cross-purposes, because coverage mandates always drive up the price of insurance. And if the “pay or play” tax is lower than a company’s current health insurance costs, a company will have every incentive to dump its employee plan and pay the tax.
Meanwhile, the private insurance industry would be restructured with far more stringent regulations. Mrs. Clinton would require nationally “guaranteed issue,” which means insurers have to offer policies to all applicants. She would also command “community rating,” which prohibits premium differences based on health status.
Both of these have raised costs enormously in the states that require them (such as New York), but Mrs. Clinton says they are necessary nationwide to prevent “discrimination” that infringes “on the central purposes of insurance, which is to share risk.” Not quite. The central purpose of insurance is to price, and hedge against, reasonably predictable risks. It does not require socializing every last expense and redistributing wealth.
No liberal reform would be complete without repealing the Bush tax cuts of 2001 and 2003; Mrs. Clinton would foot the bill for her plan with this tax increase. The rest of the estimated $110 billion per year in new government spending would be achieved by “modernizing” health-care delivery and “promoting wellness,” though this $35 billion in savings is speculative, if not fanciful. Further tax hikes would be required: That $110 billion is a back-of-the-envelope calculation, and Team Hillary is keeping the specifics in its pocket.
Given how poorly “universal” policies fared the last time around, who can blame them? Mrs. Clinton and Ira Magaziner headed a health-care task force with more than 500 members that eventually produced 1,342 numbing pages of proposals. It’s hardly surprising this boondoggle died without so much as a Congressional vote.
Yet Mrs. Clinton insisted that the public had been spooked by Rush Limbaugh, an article in a marginal political journal and advertising campaigns such as “Harry and Louise.” In other words, the lessons she learned were political, not substantive. She thought she had overreached with too-sweeping changes. So she and her husband began to slice their universal health-care ambitions into smaller initiatives like the 1997 State Children’s Health Insurance Program (Schip).
This is her strategy now. HillaryCare II is designed to cause minimal disruptions to current private insurance coverage in the short run, while dressing up the old agenda with slightly different mechanisms and rhetoric. Rather than fight small business, this time she is trying to seduce it with tax credits for small companies that provide insurance. Only later when costs rise will the credits shrink or other taxes rise. To court large manufacturers, like the auto and steel industries, she’ll offer another, “temporary” tax credit to subsidize their health-care liabilities. Her plan, in short, is HillaryCare I in better clothes — a transitional platform to shift people to the default option, which is government insurance.
What’s striking about all this is how little new thinking there is. Like the other Democratic proposals, HillaryCare II would mark another major government intrusion into health care. It would keep all of the system’s current problems, most of them created by government policies, and entrench and expand them. The creativity is all in the political repackaging.
http://online.wsj.com/article/SB119016971585932036.html?mod=hps_us_at_glance_opinion
This is a sweeping statement. Doesn’t controlling costs also reduce overpayment, improve effeciency?
Al, were you around during the Nixon, Ford and/or Carter price controls for gasoline? When the government tries to freeze prices, they are going into denial over the laws of supply and demand.
Soviet breadlines, here we come.
I’m no fan of Mitt, but I think his healthcare plan makes tons more sense than Hill’s:
I like the plan I put forward in Massachusetts. But even so, I wouldn’t do what Sen. Clinton does — impose my way on every other state. Other states may borrow from what we did. Some will surely improve on it. But let’s keep faith in federalism, in private markets and in individual responsibility.
I have announced my health-care plan for the nation. It follows the principles I pursued in Massachusetts. Reform state insurance markets first, to lower the cost of policies. Give states financial flexibility with Medicaid funds and with existing “free care” payments so that states can craft their own programs to expand private insurance. End the tax discrimination against individual purchasers of health insurance who currently must buy their coverage with post-tax dollars.
These, among other features of my plan, will lower the cost of health insurance, get all of our citizens insured, remove the threat of losing insurance when you lose or change jobs, improve the health of our citizens, and reduce the growth in health-care spending. It’s the free market way, the private sector way, the individual responsibility way — the American way.
http://online.wsj.com/article/SB119025374664933444.html?mod=opinion_main_commentaries
The free market has had considerable time to fix the health care system, and if anything it seems to be getting worse. Maybe it is time to try a new approach. The system we have now seems very good at creating problems i.e RLS, Osteoporosis, high cholestral etc, ect, and then devoloping expensive ‘cures” that generally have worse side effects than the “disease” that they are hoping to cure. The worst part about many of these cures devoloped by the pharmacutical companies is that they interfer with things that would really help, like getting more excercise and eating better.
For a market to work everyone has to have equal access to information, medicine is very complex and not everyone can go to med school so it is almost impossible for the average person to get a enough knowledge to make the right decision regardng their health. In theory you should be able to get good unbiased advice from a doctor, but that is unlikely when your doctor receives thousands of dollars worth “gifts and training” from pharmacutical companies. At the same time we are expecting insurance companies to pay for these treatments, the end result is a complete mess that is not making people healthier.
The free market does not work in this situation. It is time for a new solution, and while Hillary care may not be perfect it seems to be a step in the right direction and at least it is politicaly possible to implement what she wants to do, so at this point I would say it is better than what we have. And it is certainly better than a free market approach that seems to focus on erectile dysfunction.
Our medical system does suck. But we also have the best healthcare in the world. The problem is, we are spending way too much for it, precisely because of the government programs which impede the market, not to mention the politicians taking health care money for their campaigns.