Editore"s Note
Tilting at Windmills

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September 17, 2007
By: Kevin Drum

HILLARY'S HEALTHCARE PLAN....Ezra Klein looks at Hillary Clinton's new plan for universal healthcare and finds himself impressed:

The Clinton plan opens the Federal Employee Health Benefits Program to everybody, ensuring that anyone can access the same menu of regulated private options that federal employees get.

The plan also creates a new public option, modeled off (but distinct from) Medicare. That's a big deal: The public insurer offers full coverage and is open to all Americans without restriction. Public insurance is what I feared her plan would avoid, and instead, she embraced it wholeheartedly.

[Various other good points, including an individual mandate, community rating for insurance companies, subsidies for low-income consumers, and limitations on employer tax deductions for healthcare.]

So the policy is very, very sound. The rhetoric is interesting too, being entirely about "choice." It's called the "American Health Choices Plan." The first section, on the opening of FEHBP and the creation of a new public insurer, is titled, "Providing a Choice of Insurance Plans." The first bullet point assures readers that every American will be able to keep their current coverage if they so desire. Etc, etc.

I'm not a big fan of individual mandates and private insurance companies, but in the spirit of Atrios's advice to "stop wanking," I also understand that my preferences just aren't on the table right now. And I have to say that I agree with Ezra: although the three leading Democratic presidential candidates have proposed healthcare plans that are similar in a lot of ways, Hillary's strikes me as not just substantively as good as any of them (and better in some ways), but also the politically savviest and most practical of the lot. Given her experience in 1994 (she knows what won't work) combined with the legislative canniness she seems to have developed in the Senate (she know what will work), that's not too surprising.

In any case, it's a good plan. Edwards and Obama are going to have a very hard time making criticisms that stick. Obama, in particular, suffers because his plan is, if anything, a bit less ambitious than Hillary's even though he's supposed to be the candidate with fresh new ideas. For now, anyway, I think Hillary has outflanked him.

Outflanked him on healthcare, anyway. Now, about the war in Iraq.....

POSTSCRIPT: I should add that I don't actually agree with Atrios's advice to "stop wanking." Policy discussions are useful regardless of whether they have any short-term prospect of being implemented, and pundits and analysts absolutely should bitch and complain about shortcomings even in policies they favor. Maybe especially in policies they favor. Still, sometimes you have to choose between options on the table, and that's where we are with healthcare right now. On that score, Hillary's plan looks pretty good.

UPDATE: Maggie Mahar has more details on HRC's plan here.

Kevin Drum 4:11 PM Permalink | Trackbacks | Comments (73)

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Comments

Hmm, one doesn't notice anything about patients NOT being able t "deal directly with their doctors" in this plan.

And as to who is going to "take their money and deny them care," it looks like it would in most cases still be INSURANCE COMPANY bureaucrats, not federal ones.

But hey, two wrong points, no right ones, could be worse...

PS, re "stop wanking," I thought Atrios' point was not that one shouldn't suggest alternatives and/or bitch about other alternatives or about the current situation, I thought the point was, once a political decision has been taken, don't waste your breath complaining that it wasn't EXACTLY your plan. When groups make decisions, it's NEVER exactly any one participant's plan.

Posted by: bleh on September 17, 2007 at 4:22 PM | PERMALINK

Al, under the current system you DON'T deal with your doctors, you deal with insurance reps sitting in a cubicle hundreds of miles away. The health system should be a part of the public sector. Making profits off the denial of coverage is inefficient and immoral.

Posted by: ppp on September 17, 2007 at 4:23 PM | PERMALINK

Any plan that does not eliminate private insurance companies is wanking.

Posted by: osama_been_forgotten on September 17, 2007 at 4:25 PM | PERMALINK

Hillary/Obama 2008

She won't take a second seat; and we usually give our VP to an up and coming politico... Edwards and Kucinich are good guys, but they've tried and failed already. And the rest don't have the name or the consistency to be on the ticket.

Honestly, this crew of candidates is so good that I really wish we could elect them all.

Posted by: Crissa on September 17, 2007 at 4:26 PM | PERMALINK

"the current system where patients can deal directly with their doctors."

Holy crap! The best Al line EVAH!!

Posted by: Gore/Edwards 08 on September 17, 2007 at 4:26 PM | PERMALINK

Another point about Atrios's admonition: wanking is especially bad when it is done in retrospect, as in, "I didn't speak up at the time, but everything turned to sh*& because they didn't do it the way I wanted it done."

In terms of prospective dialogue, there has to be some more push in terms of framing the debate. It's pathetic that no legitimate conteder for the Presidency is coming close to a simple and effective health plan; instead we get a privatized system that was never given the chance to become public.

Posted by: ppp on September 17, 2007 at 4:28 PM | PERMALINK

I took Atrios' point to also be along the lines of "hey, don't kinda support Bush in something but when it goes sour, say, "Oh, it is just because Bush didn't follow my way of doing it!"

And yes, Obama got totally outflanked here. I think this plan will shore up Clinton a lot.

Posted by: Gore/Edwards 08 on September 17, 2007 at 4:29 PM | PERMALINK

Importantly, though few commentators are addressing this, is that Hillary's plan, more than anybody else's, addresses the QUALITY of American healthcare, with the recognition that quality improvement is both necessary and very possible, and will probably conserve resources.

I'm an Obama man, but I must say I'm impressed with this proposal.

Oh, and OBF, c'mon, get real, OK?

Posted by: Chocolate Thunder on September 17, 2007 at 4:30 PM | PERMALINK

Question for Hillary:

"If we had a single-payer universal health system in the same way we have a single-payer retirement system in Social Security, would you be in favor of privatizing it?"

Follow up:

"How can you be against the privatization of Social Security and yet in favor of a system that continues the privatization of our nation's health care?"

Posted by: ppp on September 17, 2007 at 4:33 PM | PERMALINK

Damn.

*sigh*

I suppose now I'll have to actually take the time to read through HRC's plan before I dismiss it.

You bastards!

;)

Posted by: Disputo on September 17, 2007 at 4:48 PM | PERMALINK

Oh, and OBF, c'mon, get real, OK?
Posted by: Chocolate Thunder on September 17, 2007 at 4:30 PM | PERMALINK

YOU get real.

If you think that we can leave private insurance companies intact, and solve any part of this health care crisis, it is YOU who are living in a fantasy world.

We're better off just leaving shit alone, than to pass a law REQUIRING everyone to buy a particular product (health insurance). I mean, holy mother of fuck, do you have any idea how insane that is?

The insurance companies already can charge whatever the fuck they want. With Hillary's plan, they're going to charge whatever the fuck they want, and if anyone can't pay, they're just going to make the rest of us pay. That's really fucking great!

Posted by: osama_been_forgotten on September 17, 2007 at 4:52 PM | PERMALINK

Shorter Hillary:

"The corporate healthcare industry has veto power over our Congress. Let's pay them their blood money, and cover everyone in a way that locks in their profits forever and ever. Okay, it's wasteful and inefficient and opens up a million new possibilities for corruption, but hey, at least we'll cover everyone. We're rich enough to pay this ransom."

Posted by: ppp on September 17, 2007 at 4:55 PM | PERMALINK

Meanwhile, over at Redstate, they're flummoxed by Ms. Clinton's crazy talk that there are Americans who die sooner than they should because they can't afford to see a doctor.

Posted by: Quaker in a Basement on September 17, 2007 at 4:55 PM | PERMALINK

I'm just shocked at what a handout it is to insurance companies. I know she feels beaten by them, but yeesh.

Posted by: Gore/Edwards 08 on September 17, 2007 at 4:55 PM | PERMALINK

OK, I've mentioned this problem before with "individual mandates".

You've been living from paycheck to paycheck, but you just lost your job. You have a mortgage, which has to be paid. You have kids in college, and tuition has to be paid. You have to eat, and that costs money.

Problem is, you don't actually have enough money for all of this, because, remember, you don't have a job.

Your former employer had paid for your health insurance in large measure. Now they don't, because, remember, you don't have a job.

So who pays for your health insurance now, given that you have far less money than before, but you presumably must pay the entire premium yourself? If you can't pay for it, is the great "solution" that you'll be further punished by the government, because it's mandated that you have that insurance?

Could someone tell me how this is supposed to work under Hillary's plan, or any other plan with "individual mandates"?

Posted by: frankly0 on September 17, 2007 at 4:57 PM | PERMALINK

The real question with Hillary is, does she mean it? She has seemed very gun shy about healthcare since 1994. I suspect this is just a sop for the primaries to be quickly forgetten thereafter, which is not the case with Edwards.

Posted by: AJ on September 17, 2007 at 4:59 PM | PERMALINK

fyi: Here is a quickie analysis of Hillary's plan from Don McCanne's at Physicians for a National Health Program:

http://pnhp.org/news/quote_of_the_day.php

Hillary Clinton’s proposal “preserves existing health insurance,” and includes the responsibility of individuals “to get and keep insurance” through the current private insurance market, or through a “Health Choices Menu” of private FEHBP-type plans, or through a Medicare-type public program.

Thus her proposal is an individual mandate to purchase private insurance that is no longer affordable for average-income individuals, or to purchase a public plan that will be even more expensive because of adverse selection.

To make the plans affordable for individuals, she would use a combination of refundable tax credits and a cap on premiums at a percentage of income. Assuming that the plans would provide adequate benefits and adequate protection against financial hardship, the increased spending through the tax system would be exponentially more than the estimates in her plan. And most of the proposed savings to pay for these increases are largely nebulous, and some of those measures would actually increase costs.

Further, the administrative complexities of refundable tax credits and means-tested premium caps would still leave many without coverage. Coverage will never be universal unless it is truly automatic for everyone.

If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.

Many will try to contrast the differences in the Clinton, Obama and Edwards proposals, but they are all basically the same. In spite of their rhetoric, they have each made the protection and enhancement of the private insurance plans a higher priority than patients."

I would only disagree with Don insofar as saying that Obama's plan is significantly even less than this, and Edwards a bit less bad. A pleasant surprise that Hillary's is offering something this "bold" and not a surprise that it is more subsidy and support for the private for profit insurers that have given so much to her campaign.

Once again, time to point out that Medicare overhead of 3-4% versus the private for profits overhead of 15-20% is $350 billion not going to health care, but going to an unneeded middleman. Plus further savings by not having the paperwork involved in determining and rejecting eligibility if everyone is eligible, and all the many other reasons single payer is the way to go to provide Universality & Comprhensive coverage & Cost-control.

Posted by: DrSteveB on September 17, 2007 at 5:02 PM | PERMALINK

One of the important counterarguments, as I explained earlier, to right-wing propaganda against national health care such as Hillary's plan/s is this: they will talk about "how much it costs" as if the program cost was an *additional* expenditure by the public. Of course, the true effective cost is how much her program costs minus what we already pay now. You might be surprised how often they actually try to generate confusion over this issue, and how many duhds actually fall for it.

Also, you hear complaints about "choice" being taken away. But we always have choice from among whatever options exist. The real question is: how desirable to most of us are the options and their consequences?

Posted by: Neil B. on September 17, 2007 at 5:15 PM | PERMALINK

To explain my previous post a little further, I think that the proposals that include "individual mandates" -- and isn't that all of the proposals for the major Democratic candidates? -- only address a portion of the health care access problem, and, I suspect, the smaller part of the problem.

The part of the problem they do address is the difficulty some people have getting health care insurance because health care insurers don't want to have them because they are poor risks, etc.

What they DON'T seem to address is how people can lose their health care coverage because their current financial circumstances don't allow them to afford it. Given the now well documented vicissitudes in financial well being of many Americans -- who nowadays often lose jobs at the drop of a hat -- how can they retain access to health care when bad times strike?

In my view, if a health care plan can't address that sort of concern -- and in fact may aggravate it by penalizing people who can't really afford health care -- then it is close to worthless.

Maybe there's something here I'm not aware of that really addresses these issues, but I've never seen anything like a satisfactory answer to my questions on this point.

Posted by: frankly0 on September 17, 2007 at 5:17 PM | PERMALINK

Maggie Mahar: ... the plan guarantees that working families will receive a refundable tax credit designed to prevent premiums from exceeding a percentage of family income.

WILL. NEVER. HAPPEN.

Posted by: Econobuzz on September 17, 2007 at 5:18 PM | PERMALINK

Meanwhile, over at Redstate, they're flummoxed by Ms. Clinton's crazy talk that there are Americans who die sooner than they should because they can't afford to see a doctor.

I think it's probably best that I don't go over there.

Posted by: shortstop, ready to start swinging at the people still in denial over this on September 17, 2007 at 5:24 PM | PERMALINK

Just to explain myself even further, I suspect that the number of people who can't get insurance because, say, they are poor risks is actually quite small compared to the number of people who will, at some point in their lives, lose their jobs and income, and may be unable to pay for health insurance. (Even those who can manage to cough up the premiums may be financially greatly damaged by the further burden imposed in that time of hardship).

How can a program that really addresses only the poor risk problem possibly be considered an adequate solution to access to health care?

Posted by: frankly0 on September 17, 2007 at 5:29 PM | PERMALINK

Obama, in particular, suffers because his plan is, if anything, a bit less ambitious than Hillary's even though he's supposed to be the candidate with fresh new ideas. For now, anyway, I think Hillary has outflanked him.

—Kevin Drum

And, unfortunately, that is all this is about. For both of them.

Posted by: Econobuzz on September 17, 2007 at 5:35 PM | PERMALINK

I think it's probably best that I don't go over there.

You and me both, Sister.

Posted by: Blue Girl, Red State (aka G.C.) on September 17, 2007 at 5:36 PM | PERMALINK

You've been living from paycheck to paycheck, but you just lost your job. You have a mortgage, which has to be paid. You have kids in college, and tuition has to be paid. You have to eat, and that costs money.
~~~~~~~~~~~~
Sounds alot like before the fall of Rome.

Posted by: Ya Know.... on September 17, 2007 at 5:39 PM | PERMALINK

I suspect that the number of people who can't get insurance because, say, they are poor risks is actually quite small compared to the number of people who will, at some point in their lives, lose their jobs and income, and may be unable to pay for health insurance.

Given that insurance companies more or less have carte blanche over what they term a "poor risk," and are increasingly using those moving goalposts to deny or drop coverage, I would like to see some numbers before I gave your comparison more than "I suspect" status.

You are absolutely correct, however, that the sudden loss of health insurance, having everything to do with job insecurity and nothing to do with preexisting conditions or health risks, is a mushrooming problem that no one is considering. And you are also right that a solution cannot address the former and ignore the latter.

Posted by: shortstop on September 17, 2007 at 5:41 PM | PERMALINK

Why change a system that has produced more medical advances than any other system in the world over the past century?

Were talking healthcare, you know D O C T O R S?

Not medical research which is done at many Collegs and drug companies such as Merck.

How many times have you been to Merck al to see a doctor?

Posted by: Ya Know.... on September 17, 2007 at 5:43 PM | PERMALINK

I find myself so depressed by the possibility that Hillary Clinton is likely to be our next President and so depressed by the ravages caused by our current President that I find myself tuning out completely. HC has a plan for health care?? Why should I care? Why does that matter? If she had a totally abysmal plan would it change anything? Hillary Clinton is being stuffed down my throat, and I will vote for her because the Republicans are evil bastards, but does it really matter? People think it matters what her policies are???

I predict that when people look closely at HC's plan it will turn out to be a boondoggle for the insurance companies and not really address the underlying problems of health care in the US today. franklyo is asking exactly the right question. What problem is solved by taking something that is too expensive and complicated for many people now and making it mandatory?

In terms of wanking, I would vote for Dr SteveB!

Posted by: PTate in FR on September 17, 2007 at 5:55 PM | PERMALINK

I dunno...after spendng a couple of hours at the DMV recently, I am hesitant to turn over anything to the government. Particularly healthcare. Anyone out there enjoy going to the post office?

Posted by: nikkolai on September 17, 2007 at 5:55 PM | PERMALINK

Cross Posted from TPM Cafe

Hillary has "Balls" on Health Care-2007 Version

See Maggie Mahar's good piece on TPM Cafe home page today

Hillary triangulated Obama and Edwards!

Considering how wounded she was in 93-94 her announcement today was a good comeback!

The good Senator from New York has got "balls" in the best sense of the word.

I am most interested in cost control through both individual AND institutional prevention as you all know by now:). This will free up $ for those who need treatment for non-preventable diseases.

Dr. Rick Lippin
http://medicalcrises.blogspot.com

Posted by: Dr.Rick Lippin on September 17, 2007 at 6:04 PM | PERMALINK

I predict that when people look closely at HC's plan it will turn out to be a boondoggle for the insurance companies and not really address the underlying problems of health care in the US today.

Everyone else has been saying the same thing all day in this and other threads, on this and other blogs. We agree.

HC has a plan for health care?? Why should I care?

PTate, come on, now. You know why. Because, unlike the French system you're enjoying right now, a whole lot of people are suffering mightily and dying early under this one. You've told us many, many times how much you can't stand Hillary, and frankly, I don't like her, either, but for somewhat different reasons than yours. However, none of us is in a position to just "tune out" what is certainly among the top three concerns, and certainly the chief domestic issue, in this country because we're going to be stuck with a president we don't like. It matters.

Posted by: shortstop on September 17, 2007 at 6:09 PM | PERMALINK

Anyone out there enjoy going to the post office?

Hate it. Enjoy it considerably more, however, than listening to someone glibly equate people's health and lives with having to stand in line to mail a freaking package.

Aaaaaaaaaaaaaargh.

Posted by: shortstop on September 17, 2007 at 6:11 PM | PERMALINK

Learning a little more about it, this sounds somewhat like California's auto insurance system. Everybody's required to have insurance, and if you can't get it at an affordable rate from a private carrier, you're put in the "Assigned Risk Pool," which has rates fixed by the state. Importantly, in this case, the ARP is COVERED BY THE INSURANCE COMPANIES. In other words, the adverse-selection problem is solved by dividing up the "uninsurables" and handing them back to the inscos as a condition of being licensed to do business in the state.

Something like this could work with Hillary-Care too...

Posted by: bleh on September 17, 2007 at 6:14 PM | PERMALINK

Kevin,

I remember you posting a story comparing satisfaction of Americans with their health care and which system they use private, Medicare or Medicaid.

But I'm having trouble finding the entry on Political Animal. Can you help me?

Posted by: Carl Nyberg on September 17, 2007 at 6:21 PM | PERMALINK

"If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone."
::
"Many will try to contrast the differences in the Clinton, Obama and Edwards proposals, but they are all basically the same. In spite of their rhetoric, they have each made the protection and enhancement of the private insurance plans a higher priority than patients."
---

Once again, time to point out that Medicare overhead of 3-4% versus the private for profits overhead of 15-20% is $350 billion not going to health care, but going to an unneeded middleman. Plus further savings by not having the paperwork involved in determining and rejecting eligibility if everyone is eligible, and all the many other reasons single payer is the way to go to provide Universality & Comprhensive coverage & Cost-control.
Posted by: DrSteveB on September 17, 2007 at 5:02 PM

------

Thanks DrSteveB for posting that. I'm an Edwards supporter, but this issue is so important to me that any one of the top Dem candidates who offers single-payer will get my vote in the primary. It is totally fucking retarded to just hand over all our cash to private insurers. I know their lobby is powerful, but Good God that is so stupid leaving them in the middle. At least come up with something that will phase their asses out quickly or something... I would even (gasp!) vote for Hillary if she could see the light about this and change the program. Reason: I figure Iraq is pretty much on AutoPilot into the crapper at this point anyhow, and the differences between the Dems on that probably isn't going to change the eventual outcome much.

Posted by: Doc at the Radar Station on September 17, 2007 at 6:22 PM | PERMALINK

insurance companies are here to stay. Won't you pay insurance for your house or your cars? it is idiotic to exclude insurance companies b/c you can't and nobody can't. all this talk about single payer system is stupid b/c it will never happen.

Posted by: bob on September 17, 2007 at 6:30 PM | PERMALINK

bob, Sure private medical insurers can still have a role: They can sell "Cadillac gap" plans to the super wealthy and build hospitals in Bermuda for all I fucking care.

Posted by: Doc at the Radar Station on September 17, 2007 at 6:31 PM | PERMALINK

There seem to be two basic problems with health care these days: 1) insurance companies do everything in their power to prevent you from getting treatments that cost them money; the result is nightmarish bureaucracy every time you get sick. 2) Many people can't afford health insurance at all.

I don't see how this plan helps with #1 at all. And I don't see how forcing people to buy insurance helps with #2. Am I missing something?

Posted by: JD on September 17, 2007 at 6:38 PM | PERMALINK

Doc at the Radar Station:

All I am trying to say is be realistic when we talk about health care coverage. We never had it before so the first plan will be difficult to get passed and probably won't please everyone but we have to start somewhere. so instead of arguing abou this system vs that system, we need to implement the very first plan first then tweak it if needed. we never know if Hillary's plan or Edwards plan will work b/c it is all speculation at this point.

There is an existing system and NO it's not perfect but we need to work within that system initially then from there we can tweak it or see if a new plan is needed. We are capitalist country so all companies want to get rich.

Posted by: bob on September 17, 2007 at 6:38 PM | PERMALINK

Actually, it's going to be absurdly easy to discredit her plan, considering the possibility that even the name of the plan contains a very big lie.

[Note: WM edits and deletes comments without notice, and this comment will likely be edited or deleted as have many previous comments.]

Posted by: The annoying LonewackoDotCom on September 17, 2007 at 6:42 PM | PERMALINK

...We are capitalist country so all companies want to get rich.
Posted by: bob on September 17, 2007 at 6:38 PM | PERMALINK

Just because they WANT to get rich does not mean they have a RIGHT to get rich.

Their corporate charters are a legal fiction, granted by the state. They can easily be revoked (by any politician with a spine; note distinct, and tragic lack of said politicians). The fact that nobody's charters are getting revoked when these companies, who are PARASITES, and are clearly doing more harm than good, speaks volumes to how much money these corporations are giving to the politicians.

We need to work within the system?
The first thing you do when you find yourself in a hole is to STOP DIGGING.

Posted by: osama_been_forgotten on September 17, 2007 at 6:54 PM | PERMALINK

bob, I understand what you are talking about. The insurance lobby and the current system *does* have a tremendous amount of inertia that would have to be overcome. I DO think that Hillary's plan is a BIG improvement over just leaving things alone-the refundable tax credits over a certain % of income and the ability to opt-in to Medicare addresses most of my concerns. But I've got two big concerns: 1) I'm wondering if it will get watered down from what she is currently proposing when the test comes, and 2) It is really disturbing that we have "to save a place for insurance companies just because their lobby is too powerful to mess with". What's happened to our democracy?

Posted by: Doc at the Radar Station on September 17, 2007 at 6:59 PM | PERMALINK

osama_been_forgotten:

Are you paying insurance for your cars and house? If you do, Why ? why do you want to make insurance companies rich? Please answer.

Posted by: bob on September 17, 2007 at 6:59 PM | PERMALINK

The Far-Right Al-Bot: "Why change a system that has produced more medical advances than any other system in the world over the past century?"

Especially when that system accidentally cut off your oxygen at your birth, thus providing a ready explanation for your obvious lack of cerebral matter.

Posted by: Donald from Hawaii on September 17, 2007 at 7:15 PM | PERMALINK

PTate in FR: "I find myself so depressed by the possibility that Hillary Clinton is likely to be our next President and so depressed by the ravages caused by our current President that I find myself tuning out completely."

Oh, you poor thing!

Posted by: Donald from Hawaii on September 17, 2007 at 7:47 PM | PERMALINK

Anyone out there enjoy going to the post office?

I have lived in two different cities this past year,
in Texas. I enjoyed dealing with the Post Office which was stocked with courteous people who did their jobs professionally and forthwith.

Now trying to get Comcast to do their frikin jobs was a nightmare. So I decided to use Directway instead. The sales staff were all hard-charging serious people, the technical side, not so much. Unrestrained not-free markets at work.

FOAD you authoritarian loving weasel. We've seen your bullshit in action and found it wanting.

Posted by: SnarkyShark on September 17, 2007 at 7:54 PM | PERMALINK

Are you paying insurance for your cars and house? If you do, Why ? why do you want to make insurance companies rich? Please answer.

The best car insurance system I ever lived under was the government run one in British Columbia. Relatively efficient and cheap. What's true of health care is true here if considerably less pressing. bob, you don't need to recreate the wheel. Just look over your border in, oh, any direction. Insurance is a system where you have people collectively pool money in case of disaster. Private insurance means having one individual whose job is to direct as much of that pooled money as possible towards himself (and ideally to increase the amount of that pooled money). The incentives in any such system are antithecal to the task. So yeah, the insurance companies have got to be out of any solution. Let them paddle around in fringe areas where they can't do any great harm.

Posted by: snicker-snack on September 17, 2007 at 8:35 PM | PERMALINK

I am not in favor of any plan that makes healthcare "affordable" by implementing a set of tax credits which may (or may not) result in a refund check once a year.

That does not meet the needs of the average household, where making ends meet is a function of what can be paid for out of your monthly take-home pay.

Posted by: lux on September 17, 2007 at 8:37 PM | PERMALINK

Did I miss something? Where do unemployed people fit into this scheme? Tax credits for those who pay no taxes?

Posted by: nepeta on September 17, 2007 at 8:53 PM | PERMALINK

Tax credits for those who pay no taxes?

Posted by: nepeta

That's the REFUNDABLE part of the plan. Pure bullshit.

Posted by: Econobuzz on September 17, 2007 at 8:59 PM | PERMALINK

The problem with the FEHBP is that it is still expensive, if you are paying both the employer and employee share. I have Anthem and it would likely cost $800 a month for it if I paid the full freight. How many people without insurance can afford this kind of health insurance?

Posted by: Mark on September 17, 2007 at 9:47 PM | PERMALINK

Econobuzz,

Refundable tax credits mean that you still recover the allowable costs (in a tax refund, i.e.) even if your total tax is less than the amount you are claiming for the tax credit. Check this out:
http://www.irs.gov/pub/irs-utl/program_kit_rev_1-2007.pdf

Posted by: Doc at the Radar Station on September 17, 2007 at 10:57 PM | PERMALINK

I lived in Tokyo for many years. Every morning people commute from the suburb to work by train. Train is their only choice because the city is too crowded to have any real highway system.

In theory, the train company can charge as high price as they wish and people would still have to use the train. Fortunately, the train ticket price is controlled by government.

The broken health care system in US is similar to the case in Tokyo when the train ticket price is not under government regulation.

Health care simply does not work by free-market, because the demand curve in a quantity-price chart will go straight up in price because it cannot go below a certain quantity. The health insurance companies, pharmacies, doctors naturally try to maximize profit by charging very high price, because the demand cannot drop no matter how high the price is (actually when the price is so high that the demand starts to drop is when people starts to die and is the equilibrium today in US)

Suppose Hilary Clinton gives everybody $10000 to buy health insurance. The health provider will simply raise the price by $10000 and pocket every penny, and the same health care problem stays. It's only natural for Hilary Clinton to do so since she receive massive donation from health care companies. Probably the wise choice for us now is to start buying health care stocks.

In Japan and many other countries, the government sets the price paid to doctors for each type of operation they perform, and price for each type of medicine, the same way as they regulate the price of train tickets. It of course comes at the cost of doctors and drug companies. But that's the only choice when free-market principle does not work unless you want people to die in exchange for high stock price. It amazes me that I have never once heard anybody mentioning this on TV, it's just so telling how "un-democratic" america really is.

Posted by: middleclassman on September 18, 2007 at 12:08 AM | PERMALINK

"Anyone out there enjoy going to the post office?"

I'll add my voice to others who have responded to this question...Yes, I do actually enjoy going to the post office in the US. I always find the people behind the counter to be helpful, courteous and knowledgeable. The cost for mailing something is reasonable. I am astonished at the volume of mail that the US Post office delivers speedily and without error. And they deliver it to my door in a timely fashion. If I need to visit the PO in person for some reason, I have a number of branches I can go to within a reasonable distance of my house, they are open at reasonable times, and parking is easy.

I think the USPS is doing a fantastic job.

I am now in a position to compare the French postal service and the US postal service, and I would say, in this case, the US and France systems are comparable. The US system may even be a little better.

If I could make the same statement about health care in the US, we would all be so thrilled.

Posted by: PTate in FR on September 18, 2007 at 5:27 AM | PERMALINK

shortstop: "...none of us is in a position to just "tune out" what is certainly among the top three concerns, and certainly the chief domestic issue, in this country because we're going to be stuck with a president we don't like. It matters."

Yes, healthcare is one of the top domestic priorities, but what is happening here is confirmation bias or tail-wagging-dog bias, or satisfising, not evaluation of policy. The polls suggest that HC will be the next Democratic nominee, and we all agree that the USA desperately needs a functioning health care system. She has finally suggested her health care plan. Therefore, whatever she has proposed is good enough. The pundits are saying, shut up, Hillary's the one, her plan is The Plan. Don't wank. It's like 2004, when we all fell into step to find an "electable" candidate. It's a plan, it's a good plan, it's politically feasible.

So why spend the mental energy? What outcome might make it matter? The only outcome that would matter is if the people who are going to vote in the primaries would switch to Obama or Edwards. But that isn't going to happen, is it? If HC's trackrecord on Iraq and domestic leadership doesn't make a difference, if her status as a legacy candidate doesn't matter, her healthcare plan won't make a difference either. But KD says it's substantively good and practical. She's outflanked Obama on this one.

Don't wank. I have no voice in the selection of the specific Democratic nominee, and come Nov, 2008, I will vote for HC whether her healthcare plan is brilliant or doomed for disaster. However much I don't want to see the Clinton's returned to the WH, I expect her to be an improvement over the current batch of psychopaths. That is my simple but efficient heuristic.

Posted by: PTate in FR on September 18, 2007 at 8:02 AM | PERMALINK

"I dunno...after spendng a couple of hours at the DMV recently, I am hesitant to turn over anything to the government. Particularly healthcare. Anyone out there enjoy going to the post office?"

It's all about who runs it. The DMV here in NJ is fine.

And there's nothing wrong with the post office, either. I put my mail in a box, it goes, I get my mail in my box, its fine. Every time I have to go its usually no more than a few minutes, service is prompt and courteous, and several POs around here extended their hours to accomodate working folks. There are screw-ups once in a while, but considering the volume of product they are dealing with, its perfectly fine. When I moved they didn't switch out the locks on my box for a few days, I called them up and it was done the next day.

I'd rather deal with the PO than, say, Verizon or the cable company.

Posted by: Joshua on September 18, 2007 at 10:25 AM | PERMALINK

I think a lot of people seem to be missing the long-term effects of having a Medicare-like "public" not-for-profit plan. I'd love universal, single-payer health care, but it would be nearly impossible to pass a plan that cut out the insurance companies completely. Just look at the ideological opposition to expanding the S-CHIP program, and that has the PR value of being for children.

But a public plan "buy-in" with lower costs and equivalent coverage will achieve virtually the same thing in the long run. In order to match the price of the public not-for-profit plan, insurance companies would have to sacrifice their exorbitant profits, and they wouldn't be able to just keep ratcheting up their premiums with a public "not-for-profit" option to keep them... er... honest. (Not to mention, if they have to give up their obscene profits, I suspect they'd just as soon find another business to be in.)

As far as the self-selected "high risk" pool being the only ones that join it, I doubt that. On top of the unemployed, and the large pool of employees that don't get health benefits at work, insurance companies have to stop cherry-picking, so they're bound to get some of the high-risk people too. And all it would take would be for one major employer, say, an auto company, to switch to the "public" plan for their employes, and presto! huge risk diversity comes in to the public 'pool."

Add to that the "retiree legacy costs" provision, and, while it's not everthing I've ever dreamed of, I think it's a good first step towards it.

IMHO, of course. YMMV

Posted by: KarenJG on September 18, 2007 at 11:38 AM | PERMALINK

**

Posted by: mhr on September 18, 2007 at 12:23 PM | PERMALINK

"I should add that I don't actually agree with Atrios's advice to "stop wanking.""

So, we should put you down in the pro-wanking column?

Posted by: nemo on September 18, 2007 at 1:19 PM | PERMALINK

"when people look closely at HC's plan it will turn out to be a boondoggle for the insurance companies . . . "

I've been hearing this in comments over on tpmcafe too. But they seem to be coming from people who haven't read the plan.

If you read it, and see that insurers can't cherry-pick, must offer comprehensive coverage equal to what Congressmen have, and must compete with a Medicare-like public-sector program that will have lower administrative costs (advertising, executive pay, etc.) and won't need to generate a profit for investors -- I don't see the boondoggle.

Also, while the plan doesn't explicitly put a cap on how high premiums can go, if premiums (or premium minus tax credit) can't go higher than a certain percentage of income, that would seem an implicit cap on premiums.

Please tell me what I'm missing . . .

Posted by: Maggie Mahar on September 18, 2007 at 2:35 PM | PERMALINK

First, how exactly are we supposed to pay for this health care coverage the government is going require us to have? I am having a hard enough time buying groceries as it is. Now I am going to be forced by the government to pay insurance premiums! And how exactly is the government planning to enforce this plan if it becomes law? Garnish your wages? Make companies refuse employment to those who cannot comply? Throw you in jail if you don't have health insurance?

I am having a hard time seeing how this plan will actually help anyone.


Posted by: tw on September 18, 2007 at 4:03 PM | PERMALINK

My god, do you people even read? There is a public component which will be structured like Medicare - which is why it will be dramatically less expensive than private insurance. There is no need for profit. There are no shareholders. Insurance companies will not be allowed to reject you based on pre-existing conditions, nor will they be allowed to discontinue your coverage if you get ill, or if you leave a job. And the government will mandate what they must provide - no more "swiss cheese" coverage. Any person can leave the private system at any time and join the public component which is required by law to provide the same services that the private companies are required to provide. Small employers will be more likely to use the public component for their employees. That forces private insurers to compete more for your health care dollar. If they raise their premiums too high, they lose customers to the public component. They skimp on actual services, they lose out to another insurance company that will promise to not skimp. The government mandates and the public component provide checks and balances on the system. And as the public component becomes more successful, it tilts the playing field towards single payer health care, and circumvents the ad campaign the health insurance industry will undoubtedly unleash.

As for the underprivileged, they will still be covered by county healthcare. We don't yet know the details of how premiums will be handled when people lose jobs. Maybe it means we could rethink our unemployment system as well.

Posted by: basement angel on September 18, 2007 at 4:17 PM | PERMALINK

Shhhhhh, Maggie, you're harshing their buzz.

Posted by: basement angel on September 18, 2007 at 4:20 PM | PERMALINK

"Insurance companies will not be allowed to reject you based on pre-existing conditions, nor will they be allowed to discontinue your coverage if you get ill, or if you leave a job. And the government will mandate what they must provide - no more "swiss cheese" coverage."

---

I must admit that this alone (heavy-duty insurance regulation/reform) would be a big step forward all by itself. Her plan does require Community Rating to determine premiums, does it not? I'm getting mixed signals on that. If it does, this really is significant. Once it's implemented, most health insurance plans will probably gradually move to the public plan through attrition, so it could end up being a "de-facto" single-payer system given enough time. If the pubic plan(s), don't satisfy you, you can always stick with the private ones. There *are* choices. She has cleverly named the program.

Posted by: Doc at the Radar Station on September 18, 2007 at 4:38 PM | PERMALINK
It's like 2004, when we all fell into step to find an "electable" candidate.

And look how well that worked.

Posted by: cmdicely on September 18, 2007 at 4:52 PM | PERMALINK

Will Hillary's plan cover you if you're sick and can't work and don't have money?

Posted by: mike on September 18, 2007 at 5:31 PM | PERMALINK

"I don't actually agree with Atrios's advice to "stop wanking."

Kevin Drum -- now expressly, not just objectively, pro-wanking anymore

Posted by: The Fool on September 18, 2007 at 5:32 PM | PERMALINK

HRC's plan leaves the Insurance Companies intact... politically astute but absofuckinlutely wrong for America's standard of living.

On this issue Edwards got way ahead of the curve when he proposed two systems a) keep what you have now aka private-25%-off-the top OR move to b)single-payer Medicare PLUS. Bring real competition to the market (which we'll never see under HRC's plan). You choose and after some period of time as more people move to one system or the other it will become apparent which system is working the best.

This is just primary posturing by a has-been with nothing to add and it'll never ever see the light of day if she wins.

Posted by: bigsky in Iowa on September 18, 2007 at 8:52 PM | PERMALINK

Bigsky - you're a real dumbass. Just wanted to say it for the record in case nobody else had pointed it out to you recently.

Primary posturing for a has-been? This is a woman who has been working on heath care issues for 25+ years, and SCHIP, one of her most well known efforts, is perhaps the best received public program in decades. She's introduced a bill to extend health insurance to families of four who make up to $82k a year. How do her historically affirmed actions jive with your dumbass assesssments? How does the front runner for the president of the United States become a has-been? Her lead's increasing, dude. She's not going away. Of course, if her plan offers mental health parity, you might. Geez.

Posted by: bigsky's mom on September 18, 2007 at 9:06 PM | PERMALINK

The pros with HRC's plan seem to be that politicians will probably find it easier to sell to the public than a single-payer model, and that it has a potential for universal coverage.

Like others have pointed out though, there seems to be no method for cost containment. Since healthcare is going up at 6 % per year, simply offering tax credits to lower the cost will not solve much. Eventually, the healthcare tax credits will come to look like the government's current giveaways to the oil companies.

Another very serious con about HRC's plan is the "mandatory" part. Herein lies the chief difference between the status-quo mentality and forward thinkers -- persons who support mandatory payment make persons who still can't afford it feel not only very guilty, but also criminal. Contrast that to European or Canadian plans which put the sick at lease with at least one thing they don't have to worry about.

A real solution would involve choice between a private plan with a tax credit OR a government plan with flexible cost based on income. Persons who can't afford coverage (unemployed, homeless, students) would get the government plan for free. (Sorry I don't know what to do with illegal immigrants HC either...)

I agree with earlier posts about the importance of having competition between private and public plans. Competition should breed improvement of both sectors -- bringing down price of private plans and bringing up quality of public plans. If people prefer the bureaucracy and "innovation" of a private insurance company, its their choice. If the government plan is unpalatable, a person can switch to private. Both free market supporters and non-profiters could (theoretically) support such a proposal.

Sounds like Edwards' plan is closest to this model, so he has everyone beat in the realm of ideas. I think either Edwards or Obama's plan would ultimately result in the greatest degree of reform and improvement in the healthcare system.

Ultimately, the politicians need to grow a pair and do what's best for ALL the people. When that will be is anyone's guess. Oddly, it occasionally does happen, but it sure seems to take a major disaster for it to occur. It's sad to know that the bunch that is in office now cannot and will not do anything substantial about the crisis.

Posted by: shamanbart on September 19, 2007 at 1:27 AM | PERMALINK

Maggie Mahar: "I've been hearing this in comments over on tpmcafe too. But they seem to be coming from people who haven't read the plan."

Your response was to my comment, and yes, you're right, I haven't read the plan. Nor do I intend to. Making that point is a sly way to discount everything I might have to say. Use me as a proxy for the uninformed, responding-from-the-gut average citizen out there.

First, my logic about insurance companies and boondoggle...right now some people have health insurance and some people don't. After this plan gets enacted, 100% of people will pay for health care. The difference between, say, revenues based on 75% of the population and 100% adds up to a boondoggle, at least the way I define boondoggle. Even if the insurance companies will have to accept everyone and have their profit margins capped. Do you really believe insurance companies will not get a windfall from this?

As someone else upthread has said, what does it say about America that insurance companies MUST be involved in any health care solution because that is the only way obtaining healthcare in the USA is politically expedient?

My second point is based on my experience with other insurance policies...car, house, life. Yes, they are competitve with one another. And, wow, it drives me totally crazy trying to compare options, figure out which one is right for me.

The problem of this program is its emphasis on choice, competition and financing. The more options, the more craziness, the more room for corporate shenanigans and shell games even if they are competing with public sector programs. (Drawing an analogy from other free-market domains, have you tried to buy cough medicine recently? How about a cell phone?) The more choices, the more complicated the system will be. The more complicated the financing (low income families will get refunds, etc.) the more difficult to administer.

We need a healthcare plan that is simple for citizens to understand, afford and access, something fair yet simple for the government to manage, something that will not drive up healthcare costs and something that provides coverage for every one. Does this plan hit more than one of these four criteria?

And how can I be such a bad, bad liberal and not read all the details about it? Not Wonk??? Because it isn't worth my time. There is nothing that Hilary Clinton can do or say that will make me think it is right that she is running for President. Since she has a good shot at being the next POTUS, I am glad she has offered a healthcare plan, and I'm glad that it seems to be as good as America is likely to get. America desperately needs one. But I stick by "boondoggle."

Posted by: PTate in FR on September 19, 2007 at 11:54 AM | PERMALINK

Apparently Hillary hasn't learned a thing from her first go-around with "Hillary Care Part One" in '93/'94. We all know how well that was received. "Hillary Care Part Two" is just more of the same...another expensive, bureaucratic, government-run system that will fail.

According to Hillary we're supposed to help pay for this with "tax credits"? Hmm...I thought a "tax credit" meant that it reduced your overall tax liability or that you may even receive a refund from the government for overpayment. And since "the poor" will not pay a dime under her program, will the average working slob get "extra tax credits" to pay for Hillary Care for "the poor"... as well as their own? I wouldn't bet on it.

Posted by: Loki on September 19, 2007 at 4:28 PM | PERMALINK

There are so many things wrong with this proposal, I don't know where to begin. Here are only two of the many issues that has to be considered in any social healthcare plan to avoid becoming the social demise of itself and of this country.
1. The plan has to be only for American Citizens. Not illegal aliens regardless of how long they have been living in this country evading paying taxes and not complying with our laws.
2. Everyone has to pay into the plan, EVEN and especially our Politicians! Have we forgotten about our broke social security that our politicians created excluding them selves from paying into? Oh, the reason they don't pay into it because they are not eligible to receive any money from it. Oh, but wait, instead they get a minimum of $15,000 a month put into their separate retirement plan.

I think our politicians should be working on fixing their existing broken tax burdens before they create another tax burden on the rest of us real "Americans".

Posted by: GC on September 22, 2007 at 12:28 PM | PERMALINK




 

 

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