How will Obama, Clinton health care plans impact death by lack of insurance?

Thank you Jill, that was an excellent post.

I believe Clinton's is the far superior plan. Note one MAJOR, and underreported, difference between Clinton and Obama in the FactCheck.org analysis:

Clinton's plan - not Obama's (or McCain's :) - would block insurers from rescinding coverage!

This is a major scandal, I feel. In California, insurers have been criticized (and successfully sued) for their outrageous system of bonuses for staff who find reasons to cut very ill people requiring care from coverage.

Altho I am not a supporter of HRC, this is clearly reason to look twice.

I agree with Marlowcan--this was an excellent post about an under-reported problem.

I also agree that the Clinton plan is best.

Thanks both of you.

But let me ask you this - what do you think about the "forced" nature of Clinton's plan? Is it worth it in the long run? (I am asking - not judging - I have my own opinion which I'm a little hesitant to share - but if you go first...)

The issue is definitely important -- both plans would affect "death by lack of insurance." Not only is recission a problem (Health Net was ordered to pay someone who was a victim of this practice nine million dollars, one reason for which was the hiring by Health Net of people who were rewarded for rescinding insurance policies). Emergency rooms are overloaded because people have neglected routine care and treating problems early, then develop worse problems.

One doesn't have to be a transparently liberal group like "Families USA" [sic] or Kaiser (or Physicians For a National Health Plan, etc.) to understand the current state of health care is far from the best it can be. Make no mistake -- "job lock" due to health health insurance, a campaign issue for Bush the Elder in 1992 and Bill Clinton, remains an issue today (it is no longer surprising or shocking; we are largely numb to it; that doesn't mean we accept or enjoy it).

Clinton's plan may be considered superior, yes. It won't satisfy the true far left, who would accept nothing short of federally provided and financed health care (commonly identified by the weasel language, "single-payer," as if there is any question who the payer may or should be).

Actually, if you are curious, the best known federal health plan is being pushed by two people including JMZ's state's own Dennis Kucinich, the "Medicare For All" plan. (The plan is defective but is the most straightforward as well as the most ambitious approach to federal government provision as well as intervention in health care.) Extending Medicare to everyone actually is the most logical thing to do if the goal is federal intervention into and provision of health care in the USA.

http://kucinich.house.gov/SpotlightIssues/spotl...

Uh I don't understand. I know that Obama has said that insurers would be required to accept people regardless of preconditions....so how could they rescind coverage?

Also I know that Obama originally said he wanted to have a three tiered system. Health coverage similar to the one that government employees get; regulated private health care that people could pick and get subsidies if they couldn't afford it and those companies were required to meet certain conditions (how quickly they could raise premiums is one...he said Clinton didn't have that, and the no rejection of existing conditions); unregulated private health insurance for people that want it.

It looks like this is how Clinton would handle the premium thing: Senator Clinton would limit premium payments to a percentage of income, "This guarantee will be be achieved through a premium affordability tax credit that ensures that health premiums will never rise above a certain percentage of family income."

So the burden wouldn't be on the insurance companies, but the gov't. Am I wrong in any of my info?

"what do you think about the 'forced' nature of Clinton's plan?"

(or in the more weasel-y words of the Health Security [older HillaryCare], being "asked to contribute"?)

It's a tax that's not called a tax but is a step toward eventually calling it a tax or admitting it is a tax.

DLS: thanks for both comments. I agree that Kucinich has been bending people's ears on this for a very long time. I believe that sometime in the last year he tried to analogize what he wanted to the British system (I'm going out on a limb to say that some of his info may come from his British-born wife but I'm just being cute there).

If it's a tax, and I can see why you'd say that, is it more efficient and well-spent to just pay it as a premium or better to have our taxes affected directly? Or does it not matter?

My understanding, which I confess is VERY rudimentary, is that Obama would like to install more cost containment and control measures, or at least that's what he is emphasizing. Theoretically I guess that could include increasing the burden on insurers but again, I am really weak in that area of knowledge. Other folks should jump in.

Jill M. Z.: There is a psychological (and political) tactic behind the mandatory payment of premiums. It disguises a tax and mandatory stuff as something else (just as what goes for health "insurance" is not insurance but pre-paid comprehensive health care). This is a form of taxation disguised as payment of premiums so it looks better and more palatable and is easier to sucker people into believing and doing. (They can be told they're "stakeholders" or "shareholders," something I'm surprised hasn't been done frequently before regarding taxes, though it risks the correct reply that votes then should be weighted by taxes paid just as real shareholders have votes to match their holdings. I'm also surprised by now that the misuse of "investment" when referring to government spending hasn't been extended to payment of taxes as well.)


Note that the so-called "premiums" for Medicare (which the Clinton plan may come to resemble, possibly if not probably as a way to move toward Medicare for everyone -- I'm certain she's thought of this) are bogus. Medicare is financed primarily through general revenue, required by law (so-called "mandatory" spending). The "premiums" finance maybe 25 per cent or so of the total costs.

This is a way to get people to participate in the plan and payment is a form of taxation, even if not called that; it is a way to get more people to participate and as it would include younger, healthier people, should in theory lower per capita costs as well as involve more people in the plan to make it easier to increase the federal government's role and scope in the future.

Cost containment is already a concern, though it will be much greater in about 10-20 years. Also, almost as with the silly expectations of stem cell research as some miracle about to happen tomorrow (same with alternative energy sources), it is silly to expect magical savings from concentration on the object of fixation and obscession currently, namely chronic illnesses and lifestyle decisions. (These things should be addressed, but the effect of these will likely be the same as with conservation measures in energy use. Yes, it can be a significant reduction, but will be nothing like the naive believe and obviously won't be enough by itself to solve any cost or energy-needs problems.)

Social Security is unsustainable, and Medicare is even worse. Beware.

"... About 75 percent of SMI Part B and Part D expenditures are paid from Federal general fund revenues, with most of the remaining costs covered by monthly premiums charged to beneficiaries. Part B and Part D premium amounts are based on methods defined in law and increase as the estimated costs of those programs rise.

In 2007, the Part B standard monthly premium paid by most enrollees is $93.50. During 2007-09, an income-related premium surcharge is being phased in for Part B beneficiaries whose modified adjusted gross income exceeds inflation-indexed thresholds (in 2007, $80,000 for individual tax returns, $160,000 for joint returns).

In 2007, the national average Part D base monthly premium is estimated to be $27.35. (Actual premium amounts charged to Part D beneficiaries depend on the specific plan in which they are enrolled.) Part D also receives payments from States for the Federal assumption of Medicaid responsibilities for prescription drug costs for individuals eligible for both Medicare and Medicaid. In 2007, State payments are estimated to cover 13 percent of Part D costs, but that percentage is projected to decline to 9 percent by 2012 as Part D outlays increase. ..."

http://www.ssa.gov/OACT/TRSUM/trsummary.html


"... HI tax income is estimated to fall short of HI expenditures in 2007
and is projected to do so in all future years. The HI trust fund does
not meet our short-range test of financial adequacy, and fund assets
are projected to be exhausted in 2019. In the long range, projected
expenditures and scheduled tax income are substantially out of
balance, and the trust fund does not meet our test of long-range close
actuarial balance. Currently, this imbalance is relatively small, with
tax income is estimated to cover 99 percent of costs in 2007, but will
grow rapidly in the absence of changes to current law: taxes would
cover 79 percent of estimated costs in 2019, and only 29 percent at
the end of the long-range period. Closing deficits of this magnitude
will require very substantial increases in tax revenues and/or
reductions in expenditures.

The Part B and Part D accounts in the SMI trust fund are adequately
financed under current law, since premium and general revenue
income are reset each year to match expected costs. Such financing,
however, would have to increase rapidly to match expected
expenditure growth under current law and to finish rebuilding Part B
assets to an appropriate level. ...

For HI, the primary source of financing is the payroll tax on covered
earnings. Employers and employees each pay 1.45 percent of wages,
while self-employed workers pay 2.9 percent of their net income.
Other HI revenue sources include a portion of the Federal income
taxes that people pay on their Social Security benefits, and interest
paid on the U. S. Treasury securities held in the HI trust fund.

For SMI, transfers from the general fund of the Treasury represent
the largest source of income, currently covering about 79 percent of
program costs. Also, beneficiaries pay monthly premiums for Parts B
and D that finance a portion of the total cost. As with HI, interest is
paid on the U. S. Treasury securities held in the SMI trust fund. ...

... HI and SMI are financed in very different ways. Within SMI, Part B
and Part D premiums and general revenue financing are
reestablished annually to match expected costs for the following year.
In contrast, HI is subject to substantially greater variation in asset
growth, since financing is established through statutory tax rates
that cannot be adjusted to match expenditures except by enactment
of new legislation.
Despite the significant differences in benefit provisions and financing,
the two components of Medicare are closely related. Most
beneficiaries are enrolled in both HI and SMI Part B, and a majority
have enrolled in SMI Part D. Many receive health care services from
both HI and SMI in a given year. Thus, efforts to improve and reform
either component must necessarily involve the other component as
well. In view of the anticipated growth in Medicare expenditures, it is
also important to consider the distribution among the various sources
of revenues for financing Medicare and the manner in which this
distribution will change over time under current law. ..."

http://www.cms.hhs.gov/ReportsTrustFunds/downlo...

"[I]s it more efficient and well-spent to just pay it as a premium or better to have our taxes affected directly?"

Better to have it directly financed by taxes rather than paid as premiums, if these premiums will be like Medicare and only pay for a small fraction of the total costs.

I don't advocate POOF! going to mandatory financing 100% through general revenue of Medicare For All or any other program (which no doubt some liberal activists would like to see with many programs, typically while not bothering to address how the revenues will be acquired to pay for them), because it is reckless. However, it is more efficient as well as simpler and more logical to have it all done through taxes and paid out of general revenue as a single, complete financing source rather than to have two separate, incomplete financing sources.

Thanks for all this, DLS - this last paragraph in particular - that's really what i've wanted to hear opinions about.

I recently convinced a soon to be president of an organization that the constitutional change he wanted me to push in a committee I'm working with would not SOUND palatable. I urged him to accept a slightly different change, that wouldn't get him exactly what he wanted but would be FAR more likely to be approved by the board. Ultimately, the amendment was approved by the committee the way I suggested it and approved unanimously by the board. After the meeting, he came up to me and said, simply, "You were right."

Because sometimes, the difference between 99 cents and 1.00 is way more than a penny.

I guess we'll just have to see who gets elected and the mood of the government when they get there re: how this health care stuff will go down.

Yep -- to me the question isn't whether there will be a greater role, if not right away than eventually, for the federal government in health care but when and to what extent; huge numbers of people want federal intervention and provision. From what I have learned, this includes a number of health care providers, not just the lay public or activists. Other than lawsuits (which are crazy) the other huge issue the providers face is the mulitiplicity of insurers with various paperwork needs and various amounts of misconduct ("lost" claims, denied claims, etc.).

I'll leave you with this money-and-bureaucracy-related gem (it's others' turn now to post). It's the latest variation on an old theme.

Most desireable residency -- $$$ cosmetic surgery $$$

http://www.nytimes.com/2008/03/19/fashion/19bea...

I like this proposal best.

http://www.pbs.org/now/news/315.html

I will expand on it, it should include disability insurance, unemployment insurance as well as retirement insurance.

A basic package, if you want more than you can add to it.

That would shift social services into private insurance and eliminate a large part of federal income tax.

Would that give your insurance company a vested interest in you being healthy and employed?

Taxes shifted to consumption is wise, taxing on labor is self defeating. It also makes people more cost conscious, less you have the money then the tax will not hurt you, it will take the excess.

Is Obamas expert an Emanual?