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September 16, 2008

HEALTHCARE TAKES CENTER STAGE (OR AT LEAST TRIES TO).... Once in a while, it's probably worth taking a moment to realize that if healthcare policy drove the presidential election, Barack Obama would win the electoral college, 538 to 0.

I mention this because there are some rather devastating items in the news today on the differences between the Obama and McCain healthcare plans, and what the competing approaches would mean to American workers and families.

* David Cutler, J. Bradford DeLong, and Ann Marie Marciarille have a tremendous item in the Wall Street Journal today, explaining the enormous impact healthcare has on the economy, including a direct effect on employment and wages. In some detail, the scholars explain, "Sen. Obama's proposal will modernize our current system of employer- and government-provided health care, keeping what works well, and making the investments now that will lead to a more efficient medical system." McCain's proposal, they go on to explain, raises taxes on workers who receive health benefits, leads to more people without insurance, leaves people with pre-existing conditions behind, and does nothing to address rising healthcare costs.

* The New York Times' Bob Herbert tackles a new study from scholars at Columbia, Harvard, Purdue, and Michigan, and explains that 20 million Americans who have employment-based health insurance would lose it under the McCain plan. The idea is to force people out of an employer-based system, leaving Americans to take meager tax credits out into the treacherous health insurance marketplace.

* TNR's Jonathan Cohn takes a closer look at a recent report from the Commonwealth Fund, and explains that the McCain plan would also screw over an additional 25 million "underinsured" Americans.

* And Ezra Klein explains that once people are forced out of an employment-based system, they're going to be much worse off taking their shiny new tax credit onto the individual market.

Read all of these pieces. The information will be on the final exam.

I'd just add, by the way, that Herbert notes that McCain's radical approach, whether you like it or not, is "a monumental change in the way health coverage would be provided to scores of millions of Americans. Why not more attention?"

Because McCain and his cohorts have spent months trying to convince people that what really matters is lipstick, arugula, tire gauges, celebrities, and sex-ed for kindergarteners. If the campaign shifts to substance, he loses.

That, and healthcare policy is complicated. And news outlets hate complicated.

Steve Benen 12:41 PM Permalink | Trackbacks | Comments (38)
 
Comments

But I thought we already had a plan for the underinsured. Re-classify them as insured and tell them to go to the emergency room on our dime. This is very good for the credit industry, just FYI. And you know the credit industry could use our help.

Posted by: The Answer Is Green on September 16, 2008 at 12:50 PM | PERMALINK

Whaddaya know? There's actually an area where he really is for change.

However, the change he wants really, really, really sucks.

Posted by: N.Wells on September 16, 2008 at 12:52 PM | PERMALINK

I wouldn't be so sure that this is an electoral winner for Obama since most people don't understand what's at stake and won't bother learning. I have been writing to every friend I have in swing states to either make sure they're getting out the vote if they're for Obama or trying to convince them to vote Obama if they're on the fence.

One friend explained that while she was voting for Obama, her husband was voting for McCain. She explained that her husband "has worked his ass off to support his family and provide health insurance and etc. etc. etc. He is 100% against footing the bill for others to have insurance and other benefits that will not apply to us and yet it's coming out of his pocket. Sounds so conservative and ugly, but it is reality."

And that's the bottom line. For some people, insuring that everyone has access to health care isn't a noble, but perhaps unattainable, policy goal. it is an absolute negative. The facts of the case don't matter a whit. The fact that we waste billions by requiring poor people to wait for severe crises and then go to the ER is irrelevant. The fact that our health outcomes are worse than nearly every other industrialized country is irrelevant. Gotta stop those welfare cheats from getting something for nothing.

Don't you know that's just for CEOs on Wall St?

Posted by: Buffalonian on September 16, 2008 at 12:54 PM | PERMALINK

It seems McCain's plan at best combines extreme risk with worse potential benefits. Only a maverick would take those odds.

Posted by: AJB on September 16, 2008 at 12:54 PM | PERMALINK

Much like Clinton did in '92, where he repeatedly and incessantly brought up the fact that his economic plan had been endorsed by a multitude of economists, including Nobel Prize winners, Obama must do the same with this endorsement of his health care plan over McCain's.

Posted by: citizen_pain on September 16, 2008 at 12:56 PM | PERMALINK

Steve Benen wrote: "... healthcare policy is complicated."

Single-payer, nonprofit, Medicare-for-all is not especially complicated.

Of course any candidate who campaigns for it will be asked questions about UFOs during the debates.

Posted by: SecularAnimist on September 16, 2008 at 12:57 PM | PERMALINK

We can easily achieve all these worthy goals and save the economy at the same time. All we need is Victory in Iraq! So who cares what it costs?

Posted by: Capt Kirk on September 16, 2008 at 12:59 PM | PERMALINK

As long as the economy is the subject of the week, let's also point out that more people forced into non-group health insurance means more loan defaults and bankruptcies, thus exasperating the credit crisis even more.

Posted by: Danp on September 16, 2008 at 1:01 PM | PERMALINK

Steve THANK YOU for bringing this message to the light of day. It is about time MSM starts pointing this out to all Americans who are lucky enough to have employer based health insurance. This should make many many people very wary of McCain's plan. All those who read this blog you need to tell people about this since MSM is not up to the task. He wants to give tax breaks to the wealthy and make middle class americans pay more taxes on one benefit we may have. As someone who has a pre-existing condition I had to look far and wide for a job that has this benefit so there would not be a rider attached. McCain having had goverment covered health his WHOLE ENTIRE life is totally clueless on this. Please spread the message.

Posted by: redrover on September 16, 2008 at 1:03 PM | PERMALINK

Medicare for all with improved coverage sounds good to me.

Posted by: freelunch on September 16, 2008 at 1:04 PM | PERMALINK

Isn't it just like a Republican to come up with a grand plan that makes the rich richer, the poor poorer and sticks those in the middle with the bill?

Posted by: Dennis - SGMM on September 16, 2008 at 1:05 PM | PERMALINK

Maybe republicans would understand this issue if it were framed as a tax increase.

Posted by: Danp on September 16, 2008 at 1:05 PM | PERMALINK

There is one thing I am not clear on. Those of us lucky to be covered by our employer would be taxed for the cost of that insurance...so our taxes would increase. Here's the part I'm not clear on. Does everybody get the rebate for healthcare, or just those who elect to buy it "on the free market" themselves? I read somewhere that the rebate would go to the insurance companies, but perhaps I'm mistaken. Either way, the plan stinks. But if it taxes those who have insurance to pay for those who don't...what conservative would like that?

Posted by: McTee on September 16, 2008 at 1:06 PM | PERMALINK

I honestly don't believe for a second that, were (horror upon horrors) McCain to be elected he would spend even a drop of time or political capital to get his health care plan passed. He just had a bunch of red meat written up to appeal to the Romneyites in his party.

I am not saying this because I think his plan shouldn't be criticized (it should, he has it after all), but there's no doubt in my mind McCain would pretty much leave our crappy system as is just like Bush has done (HSAs don't count for shit).

Posted by: Joshua on September 16, 2008 at 1:10 PM | PERMALINK

Ask McCain how much his health insurance would cost him, if he were to go on the "private Insurance market" and try to get insurance. With his 100% disability, history of cancer and age, it would be an interesting question to have him answer. Since he apparently doesn't know what is going on in the private market, this would be a way for him to get educated.
I tried to get health insurance through my employer, and because I have a cataract and may need surgery at some point, they denied my first application, and quoted a monthly fee of at least twice the first estimate. The co-pay and deductible was very high.

I am committed to Oneness through Justice and Transformation.

Posted by: st john on September 16, 2008 at 1:10 PM | PERMALINK

The Rs: the ownership party. I've got mine, too bad for you.

But health care is different; we all pay for those who don't have coverage or don't go to the doctor.

And what about contagious diseases? Those microbes don't care who you are. Is it not in everyone's self interest to make sure people with contagious diseases are treated to make sure they don't pass them along? As a mom, I know that my kids got almost everything from their schoolmates, and that my hubby and I sometimes caught them as well. Sure, most are pretty harmless, but what if there's an outbreak of something more serious?

O/T: Richard Cohen, formerly "guilty" of "being in the tank for McCain", is no longer in that tank.
http://www.washingtonpost.com/wp-dyn/content/article/2008/09/15/AR2008091502406.html?hpid=opinionsbox1

Posted by: Hannah on September 16, 2008 at 1:12 PM | PERMALINK

Stop wasting our time with this junk, Steve. Don't you know that this election isn't about "issues?" It's about personality!

Posted by: Jurgan on September 16, 2008 at 1:12 PM | PERMALINK

Buffaonian has touched upon the salient fact of American politics.

There are, at any given time, enough people to elect a president who would also volunteer to live with their family in a cardboard box under a bridge, and eat sparrows toasted on an old curtain rod, if you only promise them that the black-gay-foreign-liberal-Mexican in the next box over doesn't even get the sparrow.

Posted by: Davis X. Machina on September 16, 2008 at 1:14 PM | PERMALINK

OOPS, slap lip stick on me and call me a pig. I said in a earlier post that McCain has had goverment covered health insurance his whole life. I forgot that he did not have any health insurance for 5 1/2 yaers when he was a POW. Oh No now no one should have this benefit. How else we will understand what he went through. We don't understand anything I guess. Like his daughter said the other day on the Today Show "Only my family understands war, PERIOD".

Posted by: redrover on September 16, 2008 at 1:21 PM | PERMALINK

Americans can no longer afford health care. The candidates should tell Americans the market has determined their labor inputs are no longer sufficient to earn enough to pay for any health care services.

Posted by: Brojo on September 16, 2008 at 1:22 PM | PERMALINK

The New York Times' Bob Herbert tackles a new study from scholars at Columbia, Harvard, Purdue, and Michigan, and explains that 20 million Americans who have employment-based health insurance would lose it under the McCain plan.

If this turns out to be true, it blows a big hole in the budget calculation for McCain's plan.

If I get health insurance through my employer and it's taxed as regular income, I pay an additional $X in taxes and get it back in the form of a tax credit.

If 20 million people are shoved into the private market, then the feds lose $20X million in revenue, but we're still on the hook for all those tax credits.

Posted by: Quaker in a Basement on September 16, 2008 at 1:22 PM | PERMALINK

I think you're all forgetting that John McCain is an expert on healthcare because he spent 5 and a half years on the Hanoi Hilton health plan where the only pre-existing conditions were Maverickitis an enlarged honor gland.

Posted by: syl on September 16, 2008 at 1:22 PM | PERMALINK

Does everybody get the rebate for healthcare McTee (1:06)

This is what McCain's website says:

While still having the option of employer-based coverage, every family will receive a direct refundable tax credit.

I'm not sure what that means, and the rest of his health care plan sounds like he will form a commission.

Posted by: Danp on September 16, 2008 at 1:29 PM | PERMALINK

Substance is important--but it MUST be tied in on a personal gut, felt and imagined level wherein folks REALLY get it -- not on a cerebral/intellectual/factual/logical level.

And it has to be brief! As in one or two minutes, three or four sentences at a time repeated over and over...No more than that!

Time to elicit the voters 'choice and voice'-- to time to ask the voters substantive questions though--such as:

Is your life better now than it was four or eight years ago? This is about values.

What does country first really mean? I'll tell you--it means strength and security of our country begins right here at home: Tou can't walk very far without legs. You can't fight very hard when your internal system is malnourished. And you can't win if you keep ignoring others and keep cutting off communications both here and abroad.

Without internal strength, things unravel and fall apart (entropy). It all comes tumbling down--like a house of cards. It all collapses.

Ask yourself if McCain's talk about Country First is just a house of cards.

What does Country First really mean?

Ask yourself:

What legacy do you want for your children, your nieces, your nephews, your grandchildren?

What about your health care costs, your mortgage payments?

What about the roads and bridges and levies in your neighborhood?

What about your gas prices, the cost of eggs and milk at your grocery store?

What about the overcrowded classrooms and the low pay our school teachers get?

What about the cost of putting your children through college, and owning a home?

How safe is your job? How many pay raises have passed you by, how many more hours do you work now just to make ends meet?

Our planet is in peril, and yet we have a VP candidate who seriously believes that global warming is a man-made and the Polar Bear doesn't belong on the endangered species list.

This is not a game. This is not funny. Our time is now, and time is running out.

The time is now to reach into your SOUL and look for the right choice for real strength.

Something like that..sigh...I just don't know.

Posted by: on September 16, 2008 at 1:32 PM | PERMALINK

"And that's the bottom line. For some people, insuring that everyone has access to health care isn't a noble, but perhaps unattainable, policy goal. it is an absolute negative."

Yea. It is weird. The banality of evil I guess.

I was discussing this with my father and explaining to him how Obama and McCain differed. He seemed to agree that Obama's plan was far better, and generally with how that kind of universal coverage (which goes beyond what Obama is currently suggesting) would work and the very first thing he did was try to think up a way to make it worse for the people who's insurance is paid for by the government. He suggested giving them no choice of doctor's, etc. It struck me as very odd that seemingly the most immediate thought he had was how he could make the system worse for the poor. His biggest worry was that somebody somewhere might manage to get care for free even if they could afford it, and the system being worse for a whole swath of the population apparently was not even a consideration.

Posted by: JeffF on September 16, 2008 at 1:34 PM | PERMALINK

"I wouldn't be so sure that this is an electoral winner for Obama since most people don't understand what's at stake and won't bother learning."

Oh please! Anyone who has to reregister for their healthcare plan every year at work, or has their carrier change is depressed for weeks dreading the thought of actually needed to use it. I have healthcare at work. We also have AFLAC for additional coverage and the supplimental healthcare savings account plan. If you enrolled in all of it your paycheck wouldn't buy a book of stamps.

People might not understand the workings of the insurance plans and industry, but they sure know they're fucked if they get sick.

Posted by: Saint Zak on September 16, 2008 at 1:34 PM | PERMALINK

McCrazy's "plan" is a political time bomb- if people only knew about it. For the life of me I can't understand why Obama isn't hammering him on it.

Posted by: Steve LaBonne on September 16, 2008 at 1:36 PM | PERMALINK

Buffalonian at 12:54 p.m. - You might explain to your friend's husband that he actually has it in reverse. It's the uninsured who get nothing, yet pay for the health insurance of everyone else. Why? Because we are still largely an employer based system. So the cost of the employer health insurance is included in the price we pay for goods and services. So, if you aren't covered by a plan yourself, you are still paying for the health insurance of others every time you buy a product or service. And similarly, for those covered by government plans, the uninsured are paying for theirs, too, through taxes.

Is this fair? Of course not.

Posted by: hark on September 16, 2008 at 1:41 PM | PERMALINK

Buffalonian, simply tell your friend that he might lose his health insurance if trends continue unabated, and that McCain's "plan" will make it even likelier that his company will stop offering group health insurance.

It's OK for your friend to be self-interested; indeed, it's in the self-interest of everyone who can't afford to pay out-of-pocket for every conceivable health catastrophe (i.e., everyone but the super-rich) for the structural problems of our nation's health-care system to be addressed.

Posted by: kth on September 16, 2008 at 1:52 PM | PERMALINK

Buffalonian has touched upon the salient fact of American politics.

Well actually yes. But quite that way Davis X. Machina! Buffalonian's friend doesn't understand the concept of insurance. No one has ever explained the idea to him in broad strokes. Nor did anyone ever explain it to me.

One day I was just reflecting and came to the conclusion that of all the inventions of humanity, insurance is almost certainly the greatest. The broad idea of everyone sharing a small cost to guard against the inevitable large costs that strike individuals is the killer application of humanity. If you think about it, that really is the definition of government itself and the formation of militias.

What am I getting at here?

The reason Bill Clinton could win where Barack is not, is that Bill knew how to educate voters so they would act in their best interests and not act as Davis X Machina has outlined.

Along another similar arc:

You can not win by just calling McCain a liar. Or even proving him to be one. You have to point out why lying matters. So too with every issue. EVERY ISSUE requires education.

One more arc to ponder:

If I was Barack, I'd get Bill Clinton in Ohio right now. I'd promise him practically anything.
Ohioans needs some serious educating. They are about ready to flush themselves down the McToilet. And the rest of the country too...

Posted by: koreyel on September 16, 2008 at 1:59 PM | PERMALINK

I think the American people will understand very well if you hammer the point the McCain plan will tax your employer-provided healthcare as income. That is a tax increase.

My employer, bless their little pea-picken' hearts (as my Mom used to say), have jacked up deductibles so high ($1500 for single employee, $2000 for employee+1) that employees can't afford to use the plan. An Admn Asst. I work with making less than $40K a year can't afford to take her daughter for twice yearly testing that needs to be done for a degenerative disease she has. HSAs? Please . . . don't get me started.

Posted by: Lori on September 16, 2008 at 2:13 PM | PERMALINK

For some people, insuring that everyone has access to health care isn't a noble, but perhaps unattainable, policy goal. it is an absolute negative.

These people should be relentlessly mocked until they are too ashamed to show their faces in public.

Posted by: Pee Cee on September 16, 2008 at 2:25 PM | PERMALINK

My individual health care insurance just went up to over $300 per month. This is an 80% pay plan with a $1750 deductible. Lot of good a %2500 tax credit would do me.

Posted by: ringrid on September 16, 2008 at 3:08 PM | PERMALINK

Personally, I'm very much *for* abolishing employer-provided health insurance. It really does hobble the employers -- especially small and medium-sized ones -- limiting their competitiveness.

But, and it's a big BUT... It needs to be replaced not with individually purchased insurance but with a single-payer, not-for-profit (ie government provided) healthcare.. Not so much an "insurance", as a *right* to healthcare, same as you have to kindergarten through highschool education or police and fire protection.

Maybe it could be administered by communities/localities, same as education, police and fire protection are. Maybe it should be ran top down, the way VA is. I don't know. But I do know that the proliferation of health insurance "plans" are an abomination, which produces nothing but paperwork and profits for shareholders.

Posted by: exlibra on September 16, 2008 at 4:56 PM | PERMALINK

The plan says that if you have employer health insurance you will now be taxed on it and receive the credit to offset the tax. If you don't have employer coverage you can buy private insurance and direct the govt to send your credit to the insurance company on your behalf. Bottom line is everybody would be in the private sector because of an overlooked fact - if the employees' coverage are taxable they will pay income tax and FICA (i.e. Social Security and Medicare) tax on them. Employers have to match FICA taxes out of their own pockets. So this plan also imposes a massive payroll tax increase on employers, many of which will just scrap their plans because they can't afford the added costs of more payroll taxes on top of annual double digit premium increases.

Posted by: marindenver on September 16, 2008 at 6:17 PM | PERMALINK

marindenver @ 6:17 PM posted - "...many of which will scrap their plans because they can't afford the added costs of more payroll taxes..."
And why do I think THAT is the whole idea?

Posted by: Doug on September 16, 2008 at 6:38 PM | PERMALINK

John McCain wants to privatize Social Security which could wipe out the system as we know it and leave seniors without an income.

John McCain wants to change the health care system to ensure working people lose their health care or have to pay much more for it. In fact he wants to tax your health care benefits!

John McCain isn't the person Americans can afford to have as President in 2009.

Posted by: MarkH on September 16, 2008 at 7:59 PM | PERMALINK

Add this to the list of things I want to see in ads running around the clock this fall: "Under John McCain's healthcare proposal, 20 million Americans will lose the health insurance they get from their employers. Can you afford to pay for your medical insurance out of pocket?"

Posted by: Dylan on September 16, 2008 at 11:05 PM | PERMALINK




 

 
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