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Hillary, Obama and Healthcare
With Iowa one month away, the almost obsessive horserace coverage is in full swing and, as it has for much of campaign, it shortchanges the substance of the serious and urgent issues in dispute.
Take the fight between Hillary Clinton and Barack Obama over whose healthcare plan would cover more people or cost less. The substance of that battle received about two sentences in today's Washington Post front page story out of Iowa. But here's the real problem (because we all know horserace coverage is what we're going to get at this stage in this endless campaign)....Even if the Post or the Times devoted a full story analyzing the leading candidates' healthcare proposals, how much attention would the two papers give to alternatives offered by someone like Congressman Dennis Kucinich--the only candidate supporting a truly universal, Medicare for all, healthcare plan that, according to recent polls, has majority support? I suspect very little. In our downsized politics of excluded alternatives, media polices the parameters of what's considered "realistic" when it comes to many choices, including healthcare reform.
That's why a recent analysis of the mainstream candidates' healthcare proposals is so valuable. Released by Healthcare-NOW, an organization committed to universal single payer reform, it's a useful guide for voters who want to understand the full range of choices they should be seeking in this campaign. It's not that all of the leading candidates' proposals aren't advances over what we have now, but as voters and citizens we could demand more. And it will require an independent progressive movement to push truly universal healthcare reform onto the next president's agenda.
Check out the analysis below, prepared by Len Rodberg, Research Director, New York Metro Chapter, Physicians for a National Health Program, September 25, 2007. Presented to the New York Chapter of Healthcare-NOW on November 6, 2007.
* * *
The Mainstream Democratic Candidate' Proposals for Universal Healthcare The mainstream Democratic candidates for President -- John Edwards, Barack Obama, Hillary Clinton -- have each put forward their proposals for "affordable quality health coverage for all." The three Democrats' proposals, while purporting to provide "universal health care", will not actually achieve this goal:
None of these plans offers a realistic way of containing the rising cost of health care. All will add additional funds to an already too-costly system. None will truly provide universal access to care.
Only a single payer national health insurance program can actually achieve affordable, workable universal access to health care.
The three proposals share a set of common elements:
The private insurance system would remain in place, with no fundamental change in the way it operates. Those who currently have insurance would not experience any change in how they are insured or the coverage they have.
Large employers would be required to provide insurance for their employees or (in the case of Edwards and Obama) pay into a fund to subsidize insurance for their employees. Everyone (for Edwards and Clinton) or children (for Obama) would be required to have insurance, either through their employer or purchased on their own (an "individual mandate"). Income-related subsidies would be provided through the tax system.
Insurers would be required to offer coverage to everyone ("guaranteed issue") without limits on pre-existing conditions, and without "large premium differences based on age, gender, or occupation" (from Clinton's plan).
All would make available a "choice" of private insurance plans, as well as a public insurance option modeled on Medicare. (They use the language of the insurance industry -- and Hillary Clinton uses it in the name of her plan itself, the "American Health Choices Plan" -- suggesting that what consumers want is a choice of plan.)
All claim to achieve cost savings through expanded use of information technology, an emphasis on prevention, and better chronic care management.
What is missing from these plans?
Since multiple payers would remain (even if one of them might be a public payer), few of the savings and simplifications that are possible with a singe payer can be achieved.
Consumers must purchase insurance, but no limits are proposed on what insurers can charge them.
No regulations are proposed that would assure the adequacy of benefits or that would affect either the restrictions that insurers now impose on the choice of doctor and hospital or the way they handle, and deny, claims.
There is no simplification of the complex and wasteful private insurance system with its copays, deductibles, exclusions, and claim denials.
There is no assurance of a "level playing field" between the public insurance plan and the private ones. Insurance company advertising and targeted marketing will still be used to promote private plans over public and to avoid the poor and the sick. At the same time, the private insurers will surely insist on the additional subsidies they already enjoy in the Medicare Advantage program.
Nothing is proposed that would control the rising cost of health care. (The measures they suggest to achieve savings may well increase costs rather than reduce them. In any case, the possibility for savings is speculative at this point.) Are these plans politically "realistic"?
The insurance companies will resist guaranteed issue and community rating, as well as other requirements in some of the plans (e.g., Edwards would require that they spend at least 85 percent of their revenue on medical care).
Business will resist a mandate that they purchase insurance. (In Massachusetts, they were unwilling to pay more than $295 per employee, and even objected to that small fee.)
None of these plans improves the situation of those who currently have insurance. Thus they are unlikely to generate strong popular support.
The proposed subsidies -- amounting to about $2,400 per uninsured individual -- are about half the cost of purchasing group insurance today. Millions will continue to find insurance unaffordable. (The attempt to impose an individual mandate in Massachusetts is already showing that, as long as the program continues to rely on private insurers, very large subsidies will be needed if coverage is to be both affordable and comprehensive; without such subsidies, either coverage will be limited, or it will be unaffordable.)
Millions of Americans who are currently underinsured, and threatened with bankruptcy in the event of serious illness, will continue to be underinsured and insecure.
These plans would add significantly to our overall spending on health care, already the highest in the world, with much of the additional spending going to insurance company administrative costs and profits.
Conclusion: These Plans Will Not Work! None of these plans will truly provide universal access to care. They do not overcome the very significant deficiencies of private insurance. None assures the American people of comprehensive coverage, none offers a realistic way of containing the rising cost of health care, and all would add additional funds to an already too-costly system.
They are at best a diversion from the direction we should be going, toward the creation of a single national, publicly-funded insurance pool that can provide comprehensive, continuous, cost-effective coverage along with the budgetary tools needed to begin containing costs.
Katrina Vanden Heuvel is editor of The Nation.
© 2007 The Nation
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25 Comments so far
Show AllIt never fails-- the moderates and partisan loyalists always begin by coming on like Stern Parents, grimly imparting their superior wisdom, pragmatism, and plain common sense to disabuse the rest of us of our wacky moonbat idealism. Unlike wingnut trolls, they usually point out how they agree with progressive sentiments, values, and goals, but dispute our nonsensical refusal to buy into their standard "lesser evil", "baby steps" formulae.
When the rest of us give better than we get, and kick out the numerous rotten or warped timbers propping up this no-brainer, no-nonsense approach, these voices of sweet reason drop the gloves and turn into snarling, hissing, pissed-off balls of self-righteous fury. So much for the earnest, civil façade, eh?
Oh, and thanks to drift for the spot-on Twain quote, to which I can only respond, "fuckin' A"!
If I am in a car accident I'd opt for a medical surgeon over a tailor, but generally, modern medicine has not moved too far from the days of bleeding people with leeches. Our bodies are magnificent instruments programmed to heal a vast array of diseases and disorders. Several disabling mechanisms are at play that function against our best therapeutic interests. These include the bombardment of chemicals in our air, soil, water and thus food/bodies. Second, the stress levels from noise 24/7 and the vibrations being emitted by all the techno gadgets around us. Third is karma: our nation has become a moral blackhole and its dark activities reverberate in ways that impact our "spiritual" fields.
GRANT: Good points.
As for mandatory insurance, seems like extortion to me. Given the fact (SICKO showed it) the profit managers are the ones who determine what treatment programs the "payee" is destined to receive, medicine is not in the hands of healers (however limited they are by the MDeity's paradigm of practices) but the merchants of more. How can they get blood from a stone? If someone makes $900 a month, where would they "get" the $400 for insurance which like a ponzee scam may or may not bring THEM any coverage if and when their body's require it? It's sheer disgusting, just another free bee for the bloated insurance industry which Gore Vidal said functioned as "the piggy banks" to the big corporations. So they poison us so we pay them to 'fix' us with more poisons. Sure. Not such better living through chemistry, my friends... the onus of learning to heal ourselves is coming home.
Again...Len Rodberg's article failed to mention Kucinich (but at least Katrina Vanden Heuvel does!)when discussing universal, non-profit health care as the focus is on the so-called three front runners.
You'll never find a sane American abroad who says the U.S. system is better than what they're experiencing living in a foreign (industrialized) country. In fact the universal, non-profit health care systems have been so successful abroad that many countries are actively pursuing more inclusive proposals such as universal dental plans.
America is at least 50 years behind the rest of the world in this area.
Single payer healthcare is the only way to go. There is so much waste built into the current system that it can never be cost-effective. Each medical facility needs hords of clerks to check eligibility, referrals, authorizations and then more people to bill the claims and then rebill them again. What is happening now is that most policies include large deductibles and copayments from the insured who are already paying large premiums. It is impossible to collect all deductibles and copays at the time of service, so the patients must be billed and many don't pay. So who gets hurt? Not only the insured, but the hospitals and doctors offices who must do the insurer's job of trying to get paid. In addition, how can you convince someone that they must pay a premium of, say, $250 per month, but before they get any services they must satisfy a $2500 deductible, and then add in a 20% copayment? Hillary has mentioned tax credits, but what good do tax credits do when your income is so small you don't pay much in taxes anyway? Who has the cash to pay the premium in the first place?
It is unconscionable that private healthcare administrators make gobs of money and have beautiful new facilities with brand-new furntiture and lovely landscaping while thousands are going without healthcare. Our premium payments should not be subsidizing a luxury lifestyle.
We won't get single payer health care because Big Pharma is writing the law, not Hillary or Obama. These two are filling their war chests with Big Pharma contributions and certainly will repay them with favorable legislation. That's how our system works now. No more we the people. Now it's we the corporations.
All I want for Christmas is a STATESMAN.
Hoa binh
Since the metaphor here is a "horserace" I think the candidates should wear jackets emblazoned with the logos of their "sponsors." Honesty in advertising because that's who they are running to represent and the People have a right to know.
Is there a LOGO for "butt crack aperture"?
since1492:
"All I want for Christmas is a STATESMAN."
(As you know, there is ONE in the running...D.K.)
Jaded Prole: "I think the candidates should wear jackets emblazoned with the logos of their "sponsors."
(Then Dennis Kucinich would need either a very LARGE jacket for all his grassroots followers or NO jacket for the corporate "bribes" he DOESN'T take!!!
"individual mandate" -- the government telling me that I have to buy something that it provides to others for free.
And what if I refuse to buy such a policy. I have two kids in college, another a couple years away. Hey, if my employer didn't offer it, I couldn't afford health insurance on my own. Yet Mrs. Klingon and the rest would pass a law requiring me to get it?
A solution that arises is I could refuse, go to jail, and then get free health care like all inmates in the US receive. Talk about dysfunctional.
Hey, all the Obama and Hillary maniacs: you got a reply to this?
RicZow: Boy! Are YOU full of crap!!!
Kucinich is Croatian and a devout Catholic.
Maybe you should start getting facts before you start pissing phlegm?!
And, by the way, the rest of your post is horse shit also!!!
I am a Hillary/Obama "maniac" and I do have a reply to this.
The Obama/Clinton plans are a step in the right direction. You are not going to get universal health care in this country overnight. There are too many people who hate the idea because 1) they are afraid the government will tell them which DR to go to, and/or 2) they don't want to have to subsidize the health care expenses of the less fortunate.
But's let think about the uninsured a minute. Are we really just talking about the poor and unfortunate of our society? Have you ever tried to buy health insurance on your own if you have a pre-existing condition? YOU CANNOT GET IT! Period! This could be YOU if you lose your job, or it could be YOUR kid if he/she graduates and cannot find a job. It could be your kid if your group policy won't cover him/her while he/she is away at college. In America today, even if you have the money, there is not equal access to health care.
I completely agree with what has been stated above regarding corporate greed while people die because they can't get health care. But we have to start somewhere. The change to universal health care will need to an evolution. A revolution is not going to happen. You know that. Grow up.
"The change to universal health care will need to an evolution. A revolution is not going to happen. You know that. Grow up."
Well, corporations will still be the primary funders and will be responsible for their delivery, which means that life and death will still be part of the profit motive. Should we be happy that they throw us two crumbs instead of one in the near future? If a healthcare corporation wants to increase profits they cut costs. How? By delivering less service and less preventive care. They'll also need to grow so as to attract investors, so the pressure to reduce costs always goes up. So what is the evolution then oh wise one? What utter nonsense. You know what these corporate sellouts want? They want just enough of you to have just good enough healthcare that there isn't widespread calls to radically change the system. You want the middle ground because you aren't willing to do anything but sit on your ass and vote for some knight in shining armor who's going to save the day and solve all your problems. Instead of doing what your parents did, passing this problem onto the next generation, why don't you get out and directly challenge the people calling for these policies and back someone who has a solution, something other than a less than worse case healthcare system. There's a reason why we're ranked 37th in the world and pay twice as much per capita for that system and it isn't only the system itself, it's the citizens who make excuses for people like Clinton and Obama. This is why this country never solves any damn problems, they're always bending over backwards to not take on big business. Grow a pair and challenge them, if not move out of the damn way.
Grant, NICE! Way to drive the point home. Nice post, good comeback to dmia. And dmia, you'd have to be mental to support a corporate oligarch like Hillary on Common Dreams.
RicZow, you know, if you vote for DK, you'll be voting for universal health care. Then once you're covered, you'll be able to get the psych meds you so clearly need.
WE may not get single payer "overnight," but we never will by following the "stepped" approach outlined by dmia--all that does is substitute one form of corruption with another.
Grant: "This is why this country never solves any damn problems, they're always bending over backwards to not take on big business." Absolutely 100000% correct!
Ok, while the rest of you dream about the perfect health system, wtf is everyone else supposed to do? Have you people ever worked for a living? If so, are you now sitting on your fat asses drawing nice pensions from the corporations you so eloquently malign? And I bet you're sucking up the Medicare like there's no tomorrow too, right?
That's the problem with you radicals. You're such a freak show that nobody will EVER listen to you because all you can do is sit at home and smoke pot, drink green tea, read Emerson, and halucinate about your perfect world while criticizing the work OTHER PEOPLE are actually doing. Grow a brain! There never has been a perfect world and there never will be. You can continue to sit on your butts in a semi-conscious state, or you help the rest of us get SOMETHING DONE!
Chicken shits!
PS: DK may have some good ideas, but he hasn't a freakin' chance. GET A CLUE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Ha, ha, ha...
Your true colors come out dmia. That's right, we're all welfare mothers driving cadillacs sucking up to the government teat. Or we're pot smoking deadhead ne'erdowells.
Sounds like "The No Spin Zone" to me.
Keep begging for those scraps of "realistic change" from the tables of the oligarchs. Like Hillary "I Campaigned For Barry Goldwater" Clinton.
Fuck that. And while I'm at it, Fuck you.
I suppose the American College of Physicians, the nation's 2nd largest organization of MDs fits your profile of progressive slackers since they, too, advocate single payer universal health care for all.
http://www.commondreams.org/archive/2007/12/04/5604/
The merits of Kucinich's plan go without saying.
Less known or discussed is Mike Gravel's universal certificate system. Read about it and see what you think. Correct me if I'm wrong, but it is the ONLY plan to include catastrophic care and nursing care. Text and video explanations below:
http://www.washingtonmonthly.com/features/2005/0506.emanuel.html
http://www.youtube.com/watch?v=2qfiar38BQg
And just because I'm magnanimous:
Go fuck yourself, dmia.
As Kucinich would say, he IS the mainstream candidate. People are just too meek, dumb, or brainwashed to get beyond the media gloss and vote in their best interests.
Who are the only 2 industrialized nations without universal healthcare? The US and... South Africa. That's even more disgraceful, because one of the prime reasons South Africa can't manage it is due to massive, massive poverty in the wake of apartheid etc. We take care of our citzenry properly, or we suffer more pandering do-nothings.
What a pity that among many of these posts, whether you agree with them or not, are sounds of people who are intelligent enough to take a stand and express it with conviction, that some of you have to resort to using four-letter words to admonish others with whom you don't agree. Isn't that a Republican tactic? It's disgusting, and I wish you could just discuss as rational, intelligent adults without using such foul language. Peace Czar and drift, you reading this?
"Under certain circumstances, profanity provides a relief denied even to prayer."
Mark Twain
dmia, you "moderates" were wise enough to ignore us "radicals" before the Iraq War weren't you? It wasn't based on lies and oil, Marxist nonsense. You were wise enough to ignore those idiot hippies and their environmental issues for the last 30 years. It wasn't practicle until it too obvious to ignore. Organic farming? We "radicals" were so off on our predictions regarding NAFTA weren't we? Oh, and the explosion in immigration has nothing to do with NAFTA and its effects on Mexico. That's loony lefty nonsense. The insurance companies WEREN'T parasitic elements in our healthcare system now were they? The industrial military complex doesn't have a corrosive effect on our country, right? Us exporting half the world's weapons and spending more on the military than the rest of the world combined IS sustainable and a net positive. Yeah, our country has done well ignoring us "radicals" and listening to you "moderates".
It is time for the politicans to tell the insurance lobbies bye, bye.
Private insurance is not and never will be affordable to all.
The system is not equal.
The politians will just have to have the same insurance as everyone else. They are just as responsible as the insurance lobbies for allowing the costs to run away.
Let me remind everyone what can be done when profit is removed from health care. In the late fifties, sixties, seventies,and into the eighties...health care was in most cases a charitable endeavor. Hospitals were run by communities, religious organizations, phianthropic institutions, doctors groups...all as non-profit organizations. The charitable nature back then encouraged people to bequeth moneys to such entities. Costs were generally contained and sevices were provided regardless of ability to pay...but i guess wall street and Ronald Regan saw a money making opportunity; teaming up with the greedy side of the medical profession to rework the system into a for profit (some would say for greed) system. You will not be able to ever keep up with costs in for profit health care because it defies market place restraints where costs are rarely considered and profits can be easily incentivised.
I am placing my bets on Kuchinich or Edwards if he listens to Dennis. I am tired of waiting two years to get treatment because my insurance company says so.