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Tilting at Windmills

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February 4, 2008
By: Kevin Drum

GEARING UP....Jon Cohn has some good news on the universal healthcare front:

Today the Service Employees International Union (SEIU) announced it would be launching a $75 million election-year campaign on behalf of universal coverage....But it's not just a bunch of television and magazine spots the union has in mind. They're also planning to finance what sounds like a pretty substantial ground effort, including a rolling publicity tour to stage events across the country.

....As veterans of the 1993-94 Clinton health care fight know, [one reason] that effort failed was the fact that the political pressure came overwhelmingly from one side....This time, fortunately, it looks like the interest groups in favor of reform are getting an early start....At a time when all of the fighting over universal coverage has many people (myself included) worried that its prospects are suddenly diminishing, this is a reminder the political pressure for it is only going to get stronger in the coming months.

There's more at the link.

Kevin Drum 1:44 PM Permalink | Trackbacks | Comments (40)

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Comments

Oh, goody. Lucky us.

Posted by: Brian on February 4, 2008 at 1:48 PM | PERMALINK

This ad campaign, coupled with Sen. Obama's charisma and overall change-ness will means its only a matter of time before we have universal healthcare! How can Senate Republicans resist Obama when they hear him speak? I can see Mitch McConnell gushing over Senator Dreamy right now.

Posted by: Pat on February 4, 2008 at 1:57 PM | PERMALINK

Jon Cohn. Of The New Republic.

I know TNR is generally center-left on domestic/economic issues, but on foreign policy, a.k.a. war with Muslims, they are consistently bloodthirsty hawks. (Along with smug, smarmy, dismissive jerks).

So which is more important - a couple percentage points in progressive taxation, healthcare for the (relatively) well-off US poor, or advocating wars killing hundreds of thousands of innocent Muslims?

It's like saying, "oh, I'm a liberal, I recycle and everything, but we really need to turn the Arab world into a parking lot." I don't see how liberals could give a pass on neo-con foreign policy just because it comes from the reasonable, serious and sensible schmucks at TNR instead of the Weekly Standard.

So I don't care what Jon Cohn of TNR says about healthcare.

Posted by: luci on February 4, 2008 at 2:06 PM | PERMALINK

Will Barack the Messiah bring us universal health care?

Posted by: Bob on February 4, 2008 at 2:25 PM | PERMALINK

Thankfully, it looks like Obama, whose plan isn't universal, will be the nominee. Because even when domestic politics swings towards the democrats, we still have to compromise with Republicans. That's what UNITY is all about.

And, yes, I'm bitter. The MSM is picking my candidate AGAIN. That's worked out so well the past two elections, I can hardly wait to see how it works this year. Oh, wait, I already know. Hillary in 2012! She'll take back the White House from John McCain.

Posted by: SoCal Dem on February 4, 2008 at 2:43 PM | PERMALINK

Yeah, Kevin, act as if you really give a shit about universal health care.

Kinda funny how happy you are to throw mandates out the window as a potential solution to UHC by voting for Obama, given your supposed concern about UHC.

I'm sure we'll get a river of crocodile tears from you when Obama's plan comes to grief because it can't cover millions and millions of people. Sniff, sniff.

Because you're so concerned for their welfare, don't you know.

Posted by: frankly0 on February 4, 2008 at 2:45 PM | PERMALINK

Well, that's some good news. And what's with all the bitter trollz?

I guess it suxx to be you, eh?

Posted by: fourlegsgood on February 4, 2008 at 2:49 PM | PERMALINK
Kinda funny how happy you are to throw mandates out the window as a potential solution to UHC by voting for Obama, given your supposed concern about UHC.

Since individual purchase mandates are not a potential solution for UHC, and are likely, when they fail, to poison the whole idea of UHC more than a plan without them would, that's kind of what I'd expect of anyone who cares about UHC.

I'm sure we'll get a river of crocodile tears from you when Obama's plan comes to grief because it can't cover millions and millions of people.

Whether any subsidy-and-choice plan on the model of either the Clinton or Obama plan can cover people is a matter of calibrating the available subsidies to the needs, mandates are just a threat to punish those who are failed by the virtually inevitable failure to keep the subsidies properly calibrated to the needs. Mandates don't make health-care more accessible, they simply punish the people for whom healthcare is not accessible despite the other components of the plan.

Posted by: cmdicely on February 4, 2008 at 2:57 PM | PERMALINK

Under President McCain, it's gonna suck to be all of us.

Posted by: Pat on February 4, 2008 at 3:01 PM | PERMALINK

Yeah, cmdicely, you know better than any health care economist what the viable solutions are.

Maybe the rest of us can ask ourselves a simple question: given that a great number of health care economists have proposed plans with mandates, and given that a good number of them see that as an essential feature for plans to work, why should we want to remove that possible solution from the toolbox?

And the corrollary is, why should we vote for a candidate who has chosen to turn that possible solution into political poison purely for narrow, personal political gain?

Posted by: frankly0 on February 4, 2008 at 3:09 PM | PERMALINK

cmdicely's comment above reminds me of a contortionist having a hard time removing his head from between his legs.

Posted by: Bob on February 4, 2008 at 3:17 PM | PERMALINK

If outfits like GM weren't run by dinosaurs they'd be behind single-payer since they're currently paying more for health care than steel on a U.S. made car.

The current system penalizes employers who provide health care and advantages the jerks.

Posted by: john sherman on February 4, 2008 at 3:18 PM | PERMALINK

Too bad the Democratic Party is on its way to nominating someone who's ferociously opposed to universal health care. That might make it a little harder, no?

Posted by: Steve on February 4, 2008 at 3:21 PM | PERMALINK

Any affordable UHC plan (you know like they have in virtually every other advanced country) will have to tackle the excess costs(profits) in the healthcare/insurance/ambulance-chaser industries. These folks are gonna fight like hell to maintain their increasingly large piece of the pie. Any plan (including just letting the current system continue) which doesn't will bankrupt the country.

Posted by: bigTom on February 4, 2008 at 3:27 PM | PERMALINK

john sherman: If outfits like GM weren't run by dinosaurs they'd be behind single-payer since they're currently paying more for health care than steel on a U.S. made car.

Walter Reuther, head of the UAW, was saying that in the 1940's! And he was right. It seems like Mr. Reuther, an avowed socialist, knew more about business than the management of the Big 3.

Posted by: alex on February 4, 2008 at 3:30 PM | PERMALINK

"You know those trey stupid socialistic European countries that provide health care and other safety nets for their citizens? They're kicking our butts."

Our hallowed currency is so hammered that a vacation in Ireland takes a ton of green not to speak of France which is now frankly out of my league. Ah truffles, I knew thee well. Craig Johnson

Posted by: cognitorex on February 4, 2008 at 3:36 PM | PERMALINK

Too bad the Democratic Party is on its way to nominating someone who's ferociously opposed to universal health care.

Gosh, we're about to nominate Joe Lieberman? How did this happen?

Oh, wait, you're probably talking about Barack Obama, therefore you're a hack liar.

Posted by: AJL on February 4, 2008 at 3:45 PM | PERMALINK

"And the corrollary is, why should we vote for a candidate who has chosen to turn that possible solution into political poison purely for narrow, personal political gain?"

I dunno, Frank, given that I'm watching the same race you've been watching and I haven't seen any actual "demagoguery" or any evidence of the issue being turned into "political poison," you've lost me.

Granted, I recall Hillary Clinton almost single-handedly turning the entire concept of universal health care into political poison for nearly 15 years. But that, I suppose, was selfless leadership and counts as "experience."

Posted by: AJL on February 4, 2008 at 3:50 PM | PERMALINK

Consumer Reports just had an article about where the excesses in health care cost are. By far the biggest costs come from hospitals and Doctors. Good luck getting those groups to lower their fees. The AMA has monopoly control restricting the number of MDs in the Us and they won't give that up without a fight.

Third place was prescription drugs, but that's nearly top on everybody's list because those are the bills people see the most often.

Malpractice suits were responsible for only 2% of the health care budget.

Posted by: Tripp on February 4, 2008 at 3:53 PM | PERMALINK

From ABC News. Feb 3, 2008,

"Sen. Hillary Clinton, D-N.Y., this morning left open the possibility that, if elected, her government would garnish the wages of people who didn't comply with her health care plan. "We will have an enforcement mechanism, whether it's that or it's some other mechanism through the tax system or automatic enrollments," Clinton said in an appearance on "This Week with George Stephanopoulos".

Clinton went on to say, though, that such mechanisms would not include penalties. "They don't have to pay fines … We want them to have insurance. We want it to be affordable. And what I have said is that there are a number of ways of doing that. Now, there's not just one way of getting to that."

One way of getting to that? Garnishing wages sounds insane to me. Is this supposed to be a 'liberal' position?

Posted by: nepeta on February 4, 2008 at 4:07 PM | PERMALINK
And the corrollary is, why should we vote for a candidate who has chosen to turn that possible solution into political poison purely for narrow, personal political gain?

Obama didn't turn individual purchase mandates into political poison. They are inherently political poison for a subsidy-and-choice system, because they guarantee that if the subsidies are ever miscalibrated, the system will be required to punish the people that the miscalibration causes it to fail. That inherent flaw can be recognized before such a foolish plan is implemented, preventing it from tarnishing the idea of publicly-subsidized, personally-selected health care, or it can be ignored and a plan featuring it implemented, and the cause of universal healthcare set back decades when it implodes.

Posted by: cmdicely on February 4, 2008 at 4:08 PM | PERMALINK

Or neither could happen and you tweak it as you go, as will happen with the Medicare prescription drug benefit.

Posted by: PaulB on February 4, 2008 at 4:11 PM | PERMALINK
Or neither could happen and you tweak it as you go, as will happen with the Medicare prescription drug benefit.

Sure. As I argued in the last thread where this is discussed, the reason I see mandates as problematic is that they don't help, they are bad policy that adds pain to anyone the system already fails (due to miscalibrated subsidies), and that by doing so they increase the political risk to the whole structure when a miscalibration occurs. I don't think they necessarily doom it out of the gate, but they don't help it acheive universality and they make it more likely that its failures lead to collapse rather than the right kind of tweaks that would acheive universality.

My point was that the "poison", such as it is, in mandates is an inherent feature, not something that Obama created. frankly0 is obsessed with the idea that mandates are an essential component for a subsidy-and-choice plan to acheive universality, and is eager to berate and insult anyone who disagrees with that assessment, or suggests voting in a way which does not take that assessment as both true and the deciding factor in voting. But so far, he hasn't present an argument for that assessment besides saying that Krugman argued for it, and so have unspecified other people.

Posted by: cmdicely on February 4, 2008 at 4:20 PM | PERMALINK

nepeta: Garnishing wages sounds insane to me. Is this supposed to be a 'liberal' position?

The government garnishing wages is essentially a tax. The "garnish" scare word is one that Stephanopoulos decided to use, and merely mentioned that she "left open the possibility".

The devil is in the details - how much would the premium (sounds better that garnish, doesn't it?) be for what level of income?

Of course it's quickly become obvious how the Right is going to attack Hillary's plan. And one of our own has led the charge on this. It brings new meaning to "circular firing squad".

Of course the irony is that mandates were the pet project of a certain R, and touted as the "compassionate, free market" approach to UHC. The R's and the MSM never let a little hypocrisy get in the way of their attack poodles though - these are the same people who attacked Kerry for his Vietnam service, while their guy deserted from his obligation to defend the skies of Alabama.

Posted by: alex on February 4, 2008 at 4:38 PM | PERMALINK

Any UHC plan that doesnt explicitly target single payer via increments is just a subsidy for a broken system and a validation of the insurance companies assertion that they have god-given, perpetual charter to take our money for nothing.

Posted by: Michael7843853 G-O/F in 08! on February 4, 2008 at 4:45 PM | PERMALINK

Garnishment is the correct word in this particular context, though unsavory to Mrs. Clinton it may be. In essence, what she was describing was the collection of a debt- a debt that arises because the wage earner has not paid the premium for his/her insurance.

Posted by: Yancey Ward on February 4, 2008 at 4:49 PM | PERMALINK

$75M is a lot of money. The insurance companies will spend much more. The repetition of a theme greatly influences people. We need a president who will be a relentless UHC advocate able to counter the insurance companies' media machine. Sen. Obama has the oratory skills, but does he have the courage and stamina to fight the insurance companies? President Clinton did not and it is questionable if Sen. Clinton does.

Posted by: Brojo on February 4, 2008 at 4:58 PM | PERMALINK

I know what 'garnish' means, although I'm not clear on exactly how it's done through one's employer. I see it as being more than an owed 'tax' and certainly different from 'paying a premium.' I agree with cmdicely, that a mandate is an inherent weakness in a UHC plan. It doesn't seem so long ago that I was hearing discussion of a UHC plan which would 'compete' with private or employer sponsored plans, and if it was seen by the public at large as being the cheapest, best bang for the buck insurance available, then more and more people would sign up for it. (Is this the free market approach??)
Subsidies, for those who couldn't afford the full premium would also be available. Can someone tell me why this approach wouldn't work?

Posted by: nepeta on February 4, 2008 at 5:14 PM | PERMALINK

Yancey Ward: Garnishment is the correct word in this particular context, though unsavory to Mrs. Clinton it may be.

If you want to be a stickler about it, it's only garnishment if the deadline for payment has passed and they automatically take it from your pay. Otherwise tax withholding would be garnishment, which it's not.

Whether or not it's garnishment in the strictest sense, depends on how it's structured. If they tack the bill onto your taxes at the end of the year, but don't automatically take it from your paycheck, then it's not garnishment anymore than it is when you calculate your income taxes at the end of the year and find that you owe money. If you don't pay the additional amount then they can, with additional proceedings, choose to garnish your pay.

What counts in the real world though is not whether it meets the strict definition, but whether garnish is used as a scare term in the political debate. It's already started. It's like using the inaccurate but scary "death tax" instead of "estate tax". Maybe Stephanopoulos got an early copy of the Talking Points Memo, or is trying to help author it.

Posted by: alex on February 4, 2008 at 5:18 PM | PERMALINK

nepeta: Can someone tell me why this approach wouldn't work?

We don't know whether or not it will work - a point I made (ok, conceded) on Friday, and which is made by Dean Baker.

P.S. Since I wrote on Friday, and Dean's post appeared today, it's obvious that he got the idea from me and failed to give credit. Dean's a good guy though, so I won't take legal action (this time).

Posted by: alex on February 4, 2008 at 5:25 PM | PERMALINK

After reading my above comment I see that it wouldn't be a 'universal' plan at the outset. But it could be the beginning of one. Another thing that would happen is that if the public plan was competitive, as it would have to be in any case, then insurance companies would have to either lower their premiums or increase benefits to compete, another good effect. Businesses, still stuck with increasing healthcare costs, would more and more have to put more of the load on their employees, causing more to switch to the public plan. I dunno... If we can't have a UHC plan without the middle man of insurance companies and mandates, I'd rather have a publicly subsidized UHC plan that is available with an ability to attract a very large portion of the population.

Posted by: nepeta on February 4, 2008 at 5:26 PM | PERMALINK

Thanks, Alex. So why are neither of the Dem candidates suggesting such a model? Oh, yeah, the insurance company problem. So what? Let the blood-suckers try to compete.

Posted by: nepeta on February 4, 2008 at 5:40 PM | PERMALINK

alex,

It was understood from the context of the discussion that the deadline had passed for paying the premium- that is why the wages are then garnisheed.

If it is tacked on to the bill for taxes due April 15, then, technically is it not garnishment.

Posted by: Yancey Ward on February 4, 2008 at 5:44 PM | PERMALINK

Anything - any solution (ha!)- that does not take on the insurance,MD/AMA and Big Pharma industries is destined to fail.
The targeted legislation,supply of 'official' medical practitoners and access to drugs is the "supply" problem that has driven up costs.
Without addressing these problems, there is no 'Cure', the rampant inflation of medical services all stem from these things.
"Universal insurance coverage" is a sick joke!

Posted by: jay boilswater on February 4, 2008 at 6:38 PM | PERMALINK

I was curious about just how much insurance company profits are. Here's the answer for 2007:

By TheStreet.com Ratings Staff
TheStreet.com
January 16, 2008

Health insurers continued to boost profits in the second quarter, even as they struggled to raise premiums in line with health care costs. TheStreet.com Ratings’ review of the financial performance of the 648 health insurers it tracks found that total net income rose by 27.5% during the first six months of 2007 to $8.8 billion, up from $6.9 billion the prior year.

Investment gains helped bridge the gap. They comprised 43.4% of industry profits, up from 35.7% the prior year, growing 55% to $3.8 billion through June 30, 2007 — up from $2.5 billion a year earlier. By comparison, profits from insurer’s core underwriting business increased just 9.1% to $5.8 billion through June 30, 2007, up from $5.3 billion the prior year.

(The study is based on the latest available statutory filings with the National Association of Insurance Commisssioners.)

Posted by: nepeta on February 4, 2008 at 7:02 PM | PERMALINK

Eliminating the profits on health insurance companies doesn't net you much, does it? Would have been, what, $16.6 billion last year, if the two halves were the same?

Posted by: Yancey Ward on February 4, 2008 at 8:46 PM | PERMALINK

Make that 17.6.

Posted by: Yancey Ward on February 4, 2008 at 8:47 PM | PERMALINK

"frankly0 is obsessed with the idea that mandates are an essential component for a subsidy-and-choice plan to acheive universality, and is eager to berate and insult anyone who disagrees with that assessment"

Perhaps. I'm more inclined to think that he's obsessed with Obama and is using everything he can think of as a bludgeon against him. His posts of the past few months certainly support that conjecture.

It's also worth noting that neither Clinton's nor Obama's plan is likely to remain unaltered once it hits Congress. And nobody knows what that means with respect to mandates, or the lack thereof.

Posted by: PaulB on February 4, 2008 at 9:19 PM | PERMALINK

Obama didn't turn individual purchase mandates into political poison. They are inherently political poison for a subsidy-and-choice system, because they guarantee that if the subsidies are ever miscalibrated, the system will be required to punish the people that the miscalibration causes it to fail.

Precisely, cmdicely. And you know who these folks will be? Middle-class people who just lost their job (and their house/car/last years tax return causes them to flunk the means test. Or self-employed people who are having a bad year.

In other words, the people we really need to be on board to ever make UHC a reality.

Posted by: Brautigan on February 4, 2008 at 9:51 PM | PERMALINK

Maybe the Health INS. biz should have thought out there plan a little better.This raising rates 30-50% is just dumb on there part.

Posted by: john john on February 5, 2008 at 2:18 PM | PERMALINK




 

 

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