Dueling D Health Plans
A few weeks ago, a TMV reader suggested we evaluate and post on the health care reform strategies of the leading Democratic candidates.
By now, those strategies are semi-old news and others having already chimed in. But I was reminded of the request after reading an analysis of the Clinton, Obama, and Edwards plans in a recent edition of The Economist. The article offers a number of useful insights and summaries for those who have not yet had an opportunity to do their own analysis of these plans or read others’ analyses.
Leading off, the article notes that …
All three have eschewed radical change. Instead, they are jostling over the centre ground: how to tweak America’s predominantly private health-care system.
As a moderate, that strikes me as both smart and necessary. They’ve apparently learned from Hillary’s experience in 1993: radical proposals on a subject as emotionally charged as health care can quickly go down in flames. But don’t be fooled: With the exception of Hillary’s new plan, the other two are not shy about major reform.
With respect to Edwards’ plan, The Economist article notes that …
Mr. Edwards has long set the pace with an ambitious plan that nods at cost control but concentrates on insuring every American by 2012 … Mr. Edwards’s scheme promises an overhaul of insurance markets, subsidies to help poorer people pay their premiums and a legal requirement that everyone should buy health insurance.
In a sop to the party’s left, a government health scheme, such as Medicare, would compete with private insurers. Employers would have to provide their workers with health insurance or pay a tax. But the Edwards plan would still cost the federal government some $120 billion a year, money that would be raised by rolling back Mr. Bush’s tax cuts for the rich.
My take, which is obviously colored by my right-leaning perspective: Not only is Edwards’ plan perhaps the most ambitious, it smacks of big government getting bigger, of that old “tax and spend†label associated (fairly or not) with Democratic programs. Rather than pay for his program by eliminating tax cuts (for anyone, the rich or otherwise), I’d like to see proposals for cutting government spending elsewhere, and re-applying those funds to health care priorities.
The one nod I will give to Edwards’ plan: mandatory coverage, purchased or otherwise secured.
While conducting the annual review of a younger employee in the mid-1990’s, I reminded him that the company not only offered good pay but a very solid benefits program. He said he didn’t care about benefits, especially health benefits. He was young, ailment-free, and thus paid for rare medical expenses out of his own pocket. What about emergency care, I asked; wouldn’t he feel better having coverage, just in case? He shrugged it off, blinded by a young person’s stubborn sense of immortality.
What I now realize is that not only was that employee doing himself a disservice, he was affecting the rest of us, as well, especially people like me with a family at home, whose annual healthcare costs could be astronomical. Without the premiums of the younger employees, we “elders with families†were picking up more of the burden. You can label that “selfish,†if you like, but the reality is pretty simple: Eventually, this younger employee would become an older employee, possibly with a family of his own, and at that point, he would covet a good health plan as much as I did. But without spreading the cost among those younger than him, the burden would be even greater on his family.
Many states have moved to mandatory automotive insurance; the precedent is a smart one and Edwards is headed in the right direction with this proposal for health care. (Some might argue that mandatory health coverage is better left to the states, but as federalist as I am on many issues, I think healthcare is enough of a national/interstate commerce issue, that it warrants a heavier-than-normal dose of D.C. jurisdiction.)
Moving on to Hillary’s plan, The Economist article offers this synopsis:
Her preferred step-by-step approach has started with cost control; ideas for boosting coverage are promised in the coming weeks.
Mrs. Clinton offers a litany of well-known, but sensible, savings, such as shifting to electronic records, concentrating more on preventitive medicine, improving the management of chronic diseases, and creating a “best practices institute†to set guidelines for optimal care. In all, she claims, $120 billion a year could be wrung out of the health system, money that could be used to pay for broader coverage.
You go, girl. In my book, that’s a much better approach than Edwards’ tax-and-spend concept, although I find it remarkable that electronic records aren’t already standard procedure. My one concern with Hillary’s plan, as it’s summarized by The Economist, is the “best practices institute†which would “set guidelines for optimal care.†Again, that idea smacks of big-government intrusion into private choices, and would seem to run counter to Democrats’ historic insistence on keeping government out of doctor-patient relationships on issues like abortion and end-of-life matters.
Regarding Mr. Obama’s plan, The Economist article notes that it “borrows from both his rivals’.â€
Obama focuses on cost-control measures similar to Clinton’s. And like Edwards, he would tax companies that don’t provide coverage; infuse federal funds through a roll-back of the Bush tax cuts; and reform the insurance market, “including the creation of a National Health Insurance Exchange, to act as a clearing-house for people to buy coverage, as well as an industry watchdog.†Unlike Edwards, Obama would not force people to buy health insurance. Additionally, he thinks “the federal government should reimburse private insurers for a share of any catastrophic health costs.â€
I don’t think the federal government has any business reimbursing private sector companies, and the exclusion of mandatory coverage is baffling. As The Economist article concludes, that exclusion “makes [Obama’s] plan both less efficient and less effective†than Edwards’ plan.
13 Responses to “Dueling D Health Plans”
“…and the exclusion of mandatory coverage is baffling.”
I found this interesting coming from someone reviewing the plans from a moderate perspective. Just as Obama is avoiding mandates this year, Kerry decided against them in 2004.
Putting aside the arguments pro and con mandates, I saw mandates as being a possibly more controversial aspect of the plans which might reduce support from moderate, making passage more difficult. If your view is typical of other moderates I’ll need to reconsider that.
I’m really not sure my view is “typical of other moderates.” But like you, I’d be interested to know if it is.
Hillary Clinton’s history of speeches on health care can be found at: Hillary Clinton’s Record of Speeches
Barack Obama’s history of speeches on health care can be found at: Barack Obama’s Record of Speeches
John Edwards’s history of speeches on health care can be found at: John Edwards’s Record of Speeches
Thank you for calling it “mandatory” coverage, because no matter what the media calls it, it’s *not* universal coverage.
As nearly as I can tell, all 3 plans still suffer from a few critical flaws: they still depend on employer-purchased insurance plans (which short-circuits any possible role of market forces), they don’t address the fact that individuals pay more money than companies and with “after tax” dollars for health insurance, only one guarantees coverage for children (Edwards), and they barely address the problems that those without employers face getting insured (particularly those with chronic health conditions).
And there is already a private program that would fill Obama’s idea of reimbursing insurance companies for catastrophic loss; it is called reinsurance. Warren Buffet’s company makes a lot of money selling such policies.
When all is said and done, all 3 candidates, by “eschew[ing] radical change”, are merely putting bandages on serious wounds.
Short[ ]Woman said:
When all is said and done, all 3 candidates, by “eschew[ing] radical changeâ€, are merely putting bandages on serious wounds.
I would disagree; they’re seeking substantial change. But certainly there is plenty of demand out there for more, something like the Conyers “Medicare for All” concept (but with proper compensation to the private industry if it is made no longer for-profit).
Now if you want to speak of radicalism, Michael Moore’s movie on health care is being released, and at least one on the Left likes the movie.
I can envision the Dems having Moore appear at their convention next year as the keynote speaker not only on health care but as the principal Bush-basher at that circus. Why not? Conyers already has appeared with Moore. (note source and earlier movie review)
What I now realize is that not only was that employee doing himself a disservice, he was affecting the rest of us, as well, especially people like me with a family at home, whose annual healthcare costs could be astronomical. Without the premiums of the younger employees, we “elders with families†were picking up more of the burden.
He wasn’t doing himself a disservice at all. He was doing YOU a “disservice” by not picking up some of YOUR cost.
But for himself, he was making a completely rational decision. Namely, not paying for what he didn’t need. And by the odds, he was 100% correct. Had he not been, he would have been doing you a “disservice” by accepting coverage. No?
You can call that selfish if you like–but it’s no more nor less selfish than you wanting the subsidy from his premiums to reduce your premiums.
But for himself, he was making a completely rational decision. Namely, not paying for what he didn’t need.
Or what he thinks he didn’t need.
This kind of person (young, no health problems, doesn’t foresee any large medical expenses) is the real face of the “uninsured.” I’m fully aware of the problems faced by those with pre-existing conditions — I’m one of them — but the young person who doesn’t want elaborate health coverage, especially pre-paid full coverage rather than true insurance (which only addresses rare, catastrophic events people try to avoid, which is the opposite of everyone’s current re-run dream, regular preventive care and chronic-illness care), is the true face of the “uninsured” in this country. Look for him or her particularly on a college campus near you.
The logic behind “community rating” and even more so, universal health care provision (ideally with an identical “contribution” by each taxpaying individual) is certainly there in front of us all and appeals to many, but Marx beat all of us to it already. (To avoid the taint, refer instead to “utility.”)
Tully is a perfect example of why I don’t have any respect for libertarians. He says
Of course the comment that he is referring to doesn’t affect only one person. It affects thousands. Yet somehow it is equivalent to those prescient people who just know that they are never going to need insurance…until their psychic powers fail when they have a car accident, skiing accident or unforeseen illness.
Jim, please. There is no reason to make it personal. Just engage the argument.
He seems a little too ready to be reactionary, the way many older lefties and partisan Democrats have been since 1980.
It’s as if it’s a crime to question, let alone criticise, anything collectivist and coerced rather than the more-American individualistic and voluntary. *sigh*
To solve national problems effectively, we would need a sense of common purpose, a common vision of where we want to go. I don’t see that today
We invest only in our own separate nest eggs, there is no will to invest in the future of the country.
To truly address this issue would require radical change, but In a nation as politically polarized as it is, no radical change is possible. The best we can hope for is some patchwork of fixes that will leave behind as many problems as it solves.
It’s a shame that health care is treated like an isolated issue, when, in reality, it ties in with so many other problems we are confronting.
Reports show that poor health care contributes to poor peformance at school, whilch leads to poor achievement in adult life, which leads to further income disparity and the alienation of large segments of society. In calculating the costs today, we fail to calculate the costs tomorrow that we will be paying, in one form or another, if we fail to come to grips with this.
I can’t endorse any of these plans. All of them lack a sense of vision. They are politially timid, but then, maybe timidiy is what it takes these days to crawl forward a few inches.
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