Editore"s Note
Tilting at Windmills

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May 29, 2007
By: Kevin Drum

OBAMA'S HEALTHCARE PLAN....This is odd. Barack Obama's website is currently featuring an AP story about Obama's healthcare plan. "A copy of his remarks and documents describing the program were obtained by The Associated Press," it tells us.

OK, but since this is actually Obama's own website, couldn't they simply put up a copy of the plan and let us all see it? Why announce it via an AP dispatch?

Whatever. Based on the AP story, though, it sounds like it's a pretty standard take on current conventional healthcare wisdom among Democrats. It relies on private insurance companies, presumably because everyone is convinced that nothing can be passed if we piss off insurance companies. There's some kind of play-or-pay tax on businesses: either provide insurance for your employees or else pay into a central fund. Small businesses will go ballistic over this, but I guess it's OK to piss them off. Oddly, there's apparently no personal mandate, which is everyone's favorite healthcare policy prescription du jour, which in turn makes it a little unclear how the whole insurance company thing is going to work.

I guess I'll wait for more details before saying any more. Overall, it sounds OK but not spectacular, yet another take on the Ron Wyden healthcare plan that I'm sort of lukewarm about. And since I'm in the camp that thinks detailed plans like this don't really have much impact on anything anyway, I'm not going to get too upset one way or the other based on all the wonky details.

Still, I sure wish someone had the guts to take on the insurance industry. Wishful thinking, I know.

UPDATE: I just received a fact sheet with a few more details. It doesn't seem to be available on Obama's website yet, but I've placed a copy on the WM site here. I didn't understand this after reading the AP story, but Obama's proposal creates a new public health insurance plan based on the plan currently available to federal employees. If you don't qualify for anything else, you can buy into this plan. If you can't afford it, you get a reduced premium. Private insurance plans will be highly regulated and will be required to offer benefits at least equal to the public plan.

I'll have more later, but there's not much point in trying to rush out an opinion before I've had time to read more details. So I'm going to hold off for now. Ezra has more over at Tapped, but he's still trying to puzzle his way through it too.

Kevin Drum 1:07 PM Permalink | Trackbacks | Comments (29)

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Comments

No, it's not okay to piss off small business. Because that's what got Reagan into office. (In addition to Anderson's Independent run, and the whole Iran thing).

And, of course, the small businessmen are suckers, because while the Dems tax and regulate them to death, the Repubs subsidize and coddle big business to the point where small business doesn't stand a chance in this rigged marketplace.

Oh well.

Posted by: osama_been_forgotten on May 29, 2007 at 1:12 PM | PERMALINK

Waiting until details of any candidate's health care plan become available is always a good idea. I'm guessing that the people who run Sen. Obama's campaign website agree.

Posted by: Zathras on May 29, 2007 at 1:15 PM | PERMALINK

The Dems CAN flip the insurance industry, if they're willing to get in bed with the devil, incarnate in people like WallyWorld CEO Lee Scott, on this issue.

Fortune 500 CEOs like Scott who are on the record in favor of some sort of national healthcare prolly favor something simpler than Obama/Wyden ideas.

But the devil is in the details as well as in bed; in this case, what's Lee Scott want in return?

Posted by: SocraticGadfly on May 29, 2007 at 1:21 PM | PERMALINK

Time to take your health into your own hands as much as possible. Co enzyme q 10 50 mg, Vitamin C 250 mg 2x a day 500mg acetyl l carnitine 200 mg alpha lipoic acid a multi vitamin (w/out iron for men and post menopausal women)every other day, exercise 20 minutes cardio 3x a week, strength training of some sort 30 minutes 3x a week, flexibility stretching or yoga will do more to insure your future health than anything some politician will be able to do in the next ten years

Posted by: Library on May 29, 2007 at 1:32 PM | PERMALINK

Time to take your health into your own hands as much as possible. Co enzyme q 10 50 mg, Vitamin C 250 mg 2x a day 500mg acetyl l carnitine 200 mg alpha lipoic acid a multi vitamin (w/out iron for men and post menopausal women)every other day, exercise 20 minutes cardio 3x a week, strength training of some sort 30 minutes 3x a week, flexibility stretching or yoga will do more to insure your future health than anything some politician will be able to do in the next ten years

Posted by: Library on May 29, 2007 at 1:32 PM | PERMALINK

I think Edwards' plan *does* take on the insurance companies. He allows them to exist, but they have to compete against Medicare for whoever chooses it. I know who I am betting on.

Posted by: EmmaAnne on May 29, 2007 at 1:36 PM | PERMALINK

If you change health insurance in a way that takes away 10% of the industries profits, they will fight toot and nail. If you take none of their profits, the game is not worth the candle.

Posted by: Jörgen in Germany on May 29, 2007 at 1:50 PM | PERMALINK

Sadly, Clinton has pledged to take on the insurance industry...

It's really the only way to do this.. the insurance industry is going to fight just as hard against an Obama plan as it would for a single-payer plan, so why not go for the better plan?

I agree with the first poster that pissing off small businesses is a good way to lose as well.

Of course, it talks about nothing for the people who are chronically ill and in most need of subsidy. The poor always get subsidized, but the sick always pay through out the nose. No changes here...

I was supporting Obama for president.. now, I'm afraid that I really can't... this "plan" is very, very weak. It is a compromise plan... a plan you reach AFTER negotiating and fighting... not before.

Thanks,

Mike

Posted by: lord_mike on May 29, 2007 at 1:52 PM | PERMALINK

More stupid bullshit. Look, we already have the solution - Medicare for everyone.

If we cannot have Medicare for everyone then reduce the age for eligibilty to 55 from 65. This would relieve the private health care system of most of the costs they currently pay and would lead to lower premiums for the rest of the population. Of course to pay for the increased medicare coverage we could take the conservative approach and just borrow the money or we could spread the cost out through fair progressive taxes.

Posted by: ken on May 29, 2007 at 2:01 PM | PERMALINK

It's Kerry's (very underrated) plan. Why am I not surprised to see it resurface?

Posted by: cazart on May 29, 2007 at 2:25 PM | PERMALINK

Ken's plan is mine as well ... progressively lower the age of eligibility for Medicare over, say, 5-10 years. This would have several benefits, not the least of which would be making older employees more attractive for businesses.

Since we know that the bulk of health care costs are at the end of the age curve Medicare already covers, lowering the eligibility age doesn't (or shouldn't) cause a linear increase in costs.

Posted by: rick on May 29, 2007 at 3:20 PM | PERMALINK

I don't see why we'd want to perpetuate health insurance as an aspect of worker compensation. That coupling seems more harmful than helpful, and if we're going to fix health care, we might as well just eliminate that.

Posted by: Royko on May 29, 2007 at 3:51 PM | PERMALINK

VA for everyone is the new Medicare for everyone.

Posted by: Gary Sugar on May 29, 2007 at 4:01 PM | PERMALINK

"Why don't Liberals put their money where their mouth is instead of using other people's money?"

Ummm.... isn't that how the insurance companies that you support work?

I'd love to do something like you suggested, unfortunately, current federal law prohibits such action--laws that your republicans failed to change while they were in office.

Thanks,

Mike

Posted by: lord_mike on May 29, 2007 at 6:06 PM | PERMALINK

Earth to Democrats:

Insurance companies don't vote. People do.

Come up with a health care plan that makes actual people happy, and you'll get all the votes you need to get or stay in office.

You can then tell insurance companies to stick it. (Yes, you really, really can!)

Posted by: frankly0 on May 29, 2007 at 6:07 PM | PERMALINK

Mark,

One of the major problems with the current system is administrative duplication, which is very, very expensive (as well as inefficient). Creating a new insurance company while not eliminating any of the others does nothing to solve that problem. A single-payer system should reduce overhead as well as make it the system more accessible.

btw- Medicare for all sounds like a good start.

Posted by: getWellsoon on May 29, 2007 at 6:10 PM | PERMALINK

Let's be patient and not pass judgment too early as the dems present their plans.
My experience is that the best laid plans have a way of evolving

Posted by: consider wisely always on May 29, 2007 at 7:02 PM | PERMALINK

If the government offers its own health insurance plan and makes it affordable and effective, then there is no need to require anything from the private companies. Unless the private companies meet or beat the government's deal, they will lose their customers to the government. In practice it becomes pretty much a single payer plan, but without the official nastiness that would go into banning private insurers.

Posted by: Bob G on May 29, 2007 at 9:00 PM | PERMALINK

the insurance industry is going to fight just as hard against an Obama plan as it would for a single-payer plan,

No it's not. Single payer would destroy the private health insurance industry, or at least reduce it to bit player status, like it is in Britain and Canada. Obama's plan, in contrast, still gives private insurance the lion's share of the business. So of course they'd fight harder against single payer. Duh!

More stupid bullshit. Look, we already have the solution - Medicare for everyone.

Yeah, what a wonderful solution. Government-funded health care isn't bankrupt enough, so let's make it even more bankrupt. Let's create a new $2 trillion federal entitlement program, because we're just soooo disciplined about paying for our entitlements, aren't we? Just how much bigger do you want the deficit to grow? How much more debt do you propose to saddle our children with?

Posted by: The Hotness on May 29, 2007 at 9:54 PM | PERMALINK

Medicare is not bankrupt. It has a dedicated income stream to pay benefits. It takes in plenty of money and as the economy grows it will take in more. Now the Defense Department, on the other hand, is bankrupt. They have no independent income stream as does Medicare and it is funded almost entirely out of money borrowed from the communist Chinese.

Posted by: ken on May 29, 2007 at 11:16 PM | PERMALINK

No it's not. Single payer would destroy the private health insurance industry, or at least reduce it to bit player status, like it is in Britain and Canada. Obama's plan, in contrast, still gives private insurance the lion's share of the business. So of course they'd fight harder against single payer. Duh!

You'd think, but the insurance industry fought Romney's plan in MA and the Governator's plan in CA as well as Hillary's plan int he 90's. All these plans gave big $$$ to the insurance industry, and yet they fought tooth and nail against reform.

The poster is right... since any health care reform package is going to be smeared as "single payer socialism", might as well propose single payer socialism.

Thanks,

Mike

Posted by: lord_mike on May 29, 2007 at 11:47 PM | PERMALINK

"If we cannot have Medicare for everyone then reduce the age for eligibilty to 55 from 65. This would relieve the private health care system of most of the costs they currently pay and would lead to lower premiums for the rest of the population. Of course to pay for the increased medicare coverage we could take the conservative approach and just borrow the money or we could spread the cost out through fair progressive taxes."
Posted by: ken on May 29, 2007 at 2:01 PM

YEP. That's the best and simplest "duct-tape" big fix that's substantive and doable. Increase Medicare tax on employers and employees AND add a cap gains/corporate profits medicare tax surcharge. Leave taxes on dividends alone (maybe reduce somewhat?) to encourage longer-term investment. That will halt the bigger companies from offloading their older/sicker workers onto the ice floes. Then, just push down the minimum age to opt-in to medicare from 55 down to X over the next 20 years. That way the private insurors are *incrementally* phased out.

Posted by: Doc at the Radar Station on May 30, 2007 at 12:52 AM | PERMALINK

The way to get rid of insurance parasites is to allow citizens to buy into a government insurance program. If insurance companies cannot do it cheaper (compete) they would lose out. Competition is the basis of capitalism.

Posted by: bakho on May 30, 2007 at 9:07 AM | PERMALINK

Medicare is not bankrupt. It has a dedicated income stream to pay benefits. It takes in plenty of money and as the economy grows it will take in more.

Er, the latest report from the Medicare Board of Trustees projects that Medicare will run out of money by 2018, a mere 11 years from now. By 2030, the ratio of workers to beneficiaries will drop to 2.4 (it's currently 3.9). Medicare spending is projected to increase by 7% per year for the next 10 years. It's a fiscal train wreck in progress. The idea that we could create a new $2 trillion federal entitlement program to provide "Medicare for all" without creating a huge risk of a massive increase in the federal deficit is pie-in-the-sky wishful thinking. In addition to all its other problems, single-payer health care would be a fiscal catastrophe.

Posted by: The Hotness on May 30, 2007 at 12:57 PM | PERMALINK

Medicare will NEVER 'run out of money'. Medicare has a dedicated income stream provided by Medicare taxes. As long as we have an economy, as long as we have businesses, as long as we have jobs, Medicare will have incoming funds.

Please stop using false right wing talking points regarding Medicare.

Whatever the 'cost' of providing medical care in in 2018 is, it will be 'paid'. If it cannot be 'paid' the cost will drop until the cost meets the ability of someone to pay.

The best to pay for medical care is though Medicare. Medicare has proven that it is the cheapest and most effective way to pay for medical care today. And Medicare will also be the best way to provide for medical care in 2018.

The demographics in 2030 hold whether we have a single payor plan or whether we have private insurance. We are STILL only going to have the same number of WORKERS to pay either private insurance or medicare premiums. It is just that Medicare delivers more medical care for each dollar paid in premiums. So the demographic argument strengthens the case for Medicare for all.

Posted by: ken on May 30, 2007 at 1:22 PM | PERMALINK

Medicare will NEVER 'run out of money'. Medicare has a dedicated income stream provided by Medicare taxes. As long as we have an economy, as long as we have businesses, as long as we have jobs, Medicare will have incoming funds.

Please stop using false right wing talking points regarding Medicare.

Whatever the 'cost' of providing medical care in in 2018 is, it will be 'paid'. If it cannot be 'paid' the cost will drop until the cost meets the ability of someone to pay.

The best to pay for medical care is though Medicare. Medicare has proven that it is the cheapest and most effective way to pay for medical care today. And Medicare will also be the best way to provide for medical care in 2018.

The demographics in 2030 hold whether we have a single payor plan or whether we have private insurance. We are STILL only going to have the same number of WORKERS to pay either private insurance or medicare premiums. It is just that Medicare delivers more medical care for each dollar paid in premiums. So the demographic argument strengthens the case for Medicare for all.

Posted by: ken on May 30, 2007 at 1:22 PM | PERMALINK

Do you understand basic arithmetic? It's not enough merely to have "a dedicated income stream." Your income must equal or exceed your spending in order for you to remain fiscally solvent. Under current income and spending, Medicare will run out of money in a decade. There are only three possible ways out of this--raise taxes, cut benefits, or go into debt. You can see what would happen under "Medicare for all" by looking at countries that already have it. They either have massive rationing of health care (Britain, Canada) or run massive deficits (France). If you think you can sell that to the voters, good luck to you. I won't be voting for it.

Posted by: The Hotness on May 30, 2007 at 2:45 PM | PERMALINK

Whatever the 'costs' of providing medical care people in 2018 are, the most cost effective way to 'pay' those costs will be Medicare. It is the best most effecient health care delivery system in America today and there is no reason to think it will not be the best in 2018 as well.

But just like a private insurance company, if the 'costs' go up, the premiums must go up as well.

What is so controversial about that? Either way the costs go up. It is just that the best way to pay those costs, whatever they amount to, will be a single payor plan like Medicare.

Posted by: ken on May 30, 2007 at 5:34 PM | PERMALINK

Whatever the 'costs' of providing medical care people in 2018 are, the most cost effective way to 'pay' those costs will be Medicare. It is the best most effecient health care delivery system in America today and there is no reason to think it will not be the best in 2018 as well.

But just like a private insurance company, if the 'costs' go up, the premiums must go up as well.

What is so controversial about that? Either way the costs go up. It is just that the best way to pay those costs, whatever they amount to, will be a single payor plan like Medicare.

Posted by: ken on May 30, 2007 at 5:34 PM | PERMALINK




 

 

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