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 Postfront 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.

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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.

(c) 2007 The Nation