Hillarycare, The Sequel

September 17, 2007

If Hillary Clinton were unveiling an energy policy, it would generate a fair amount of attention. When Hillary Clinton unveils a health care policy that would offer universal coverage to the nation, it’s a much bigger deal.

Democratic presidential candidate Sen. Hillary Clinton announced a $110 billion health care reform plan Monday that would require all Americans to have health insurance.

Clinton unveiled her plan during a high-profile speech at a hospital in the key campaign state of Iowa, surrounded by supporters, American flags and campaign banners. […]

Under the plan, federal subsidies would be provided for those who are not able to afford insurance, and large businesses would be required to provide or help pay for their employees’ insurance. […]

“I know my Republican opponents will try to equate this plan with government-run health care. Well don’t let them fool you again,” Clinton said, explaining that her plan would allow participants to “keep the doctors you know and trust” while it would expand “personal choice” and keep costs down.

It’s obviously a multifaceted plan, but the campaign is emphasizing three points — affordability (tax credits to pay for premiums), availability (insurance companies won’t be able to discriminate against those with pre-existing conditions), and reliability (lose your job, keep your coverage).

The early reviews are very positive. Ezra said, “The short answer is that it’s a very good plan, similar in style and scope to Edwards, substantially better than Obama’s.” Jonathan Cohn noted the many similarities to the Edwards plan, though Clinton “also has some new wrinkles, too. Among them, she wants to stop using taxpayer dollars to subsidize generous insurance benefits for the wealthiest Americans.”

Clinton’s top rivals, meanwhile, are doing their best to step on her toes.

The Obama campaign released a statement that suggested the Illinois senator has better experience on the issue.

“I commend Senator Clinton for her health care proposal. It’s similar to the one I put forth last spring, though my universal health care plan would go further in reducing the punishing cost of health care than any other proposal that’s been offered in this campaign. But the real key to passing any health care reform is the ability to bring people together in an open, transparent process that builds a broad consensus for change. That’s how I was able to pass health care reform in Illinois that covered an additional 150,000 children and their parents, and that’s how we’ll prevent the drug and insurance industry from defeating our reform efforts like they did in 1994.”

Notice the several digs — “open, transparent” process is a subtle shot at Clinton’s 1993 effort, and the reference to the “drug and insurance industry” is a subtle reference to Clinton’s willingness to accept lobbyists’ campaign contributions.

That said, a major onus now shifts to Obama — proposals from Edwards and Clinton both include individual mandates, while Obama’s plan does not. He’s going to have to explain why.

John Edwards, meanwhile, will reportedly tell the SEIU today that he has a new strategy to get his healthcare plan passed.

Edwards will … propose a bill to strip Congress of their health coverage by mid-2009, as well as the president and political appointees, if Congress fails to pass a universal health plan for all Americans.

It’s a little over the top — Congress would never pass such a bill, even if it were constitutional — but it might play well on the campaign trail.

Taking a step back, Ezra alluded this morning to what he called the “healthcare wars.” This is almost certainly going to come across as silly, but watching the Dems’ top tier engage in a fairly serious debate over healthcare policy, and how best to offer insurance to every American, is a reminder of why it’s good to be a Democrat. Republicans are debating how big to make Guantanamo, how big tax cuts should be, and who hates MoveOn.org the most.

Dems are just on another level of substance and class.

I’d rather get sick and die on the street than elect someone who voted for the “Patriot” Act.

  • More affordable same old same old. Kucinich has the only healthcare plan even worth talking about. All the others are still rewarding the insurance cos. When will America stop being the only industrialized nation without an adequate health care plan for all. We want a single payer, not for profit, national healthcare plan with no deductibles…period. Our government can be extremely efficient regulating such a plan that would make the majority of Americans satisfied and secure with their coverage while not taking anything away from the treatment and care we would receive..
    A Kucinich plan has already been introduced in the House yet all we hear about from the media kings is “top tier candidates plans”. The press just keeps trying to pretend Kucinich doesn’t exist yet he’s always been there and done that by the time the other candidates are still trying to figure it out. Wish the press would do a run down on the Kucinich plan.

  • ***yeah JKap*** voting for the ‘Patriot Act’ was like backstabbing the people. Guranteed that they never even read that huge, huge document. Kucinich read the whole thing before he voted against it. One of the reasons I’m for him…does his fucking job.

  • Still with the private insurers, Hils? Guess it helps to have them on your team crafting policy.

    No such thing as real choice in healthcare. It’s either live or die. Make it single payer and hoof out the private insurance firms for everything like basic coverage (“extras” like cosmetic surgery can still be covered under private insurance.)

  • I would prefer a single-payer plan. What’s wrong with Medicare? Why not enroll everyone in Medicare? The insurance companies are a big part of the problem, and their profits are an unnecessary medical cost.

    The only sensible reason not to cut the insurance companies out is to keep them from fighting reform – as they always do.

  • If medicare were expanded to cover those over age 45, the risk to private insurers would be cut greatly and the rates for everyone else would fall dramatically, even if the pre-existing conditions would have to be covered. Health care is easy to solve if we look at the medicare model. Of course the insurance companies would not get as much in premiums, but their losses would be less. Remove the power of the insurance companies and the healthcare problem can be solved.

  • Like many of y’all, I’d much prefer a single payer system without private insurance companies. The question is can you get there from here politically. As I’ve said elsewhere, dumping the politically powerful private health insurance business would probably require a nearly complete collapse of the system, which would be horrific to live through.

    What Hillary is doing is offering the health insurance industry a lifeline, giving them a chance to be part of a sustainable system. The question is will they take it. I think their most likely response will be to try to do again what they did ’93 – put on a full court press to destroy the new proposal. If they do then we’re committing to a scenario where the system eventually collapses. The health insurance industry’s future in that scenario isn’t a lot better than that facing the rest of us.

    One thing that has impressed me about Hillary is the masterful way she’s moved the pieces invisibly behind the scenes to make her nomination nearly unstoppable. If she brings the same sorts of smarts to this proposal, she might even get it passed this time.

  • Health care CEO pay as listed in Forbes Magazine 2005 survey (Latest data I can find):

    United Health Group: $124,774,000
    CIGNA Health Care: $13,312,000
    AETNA: $22,219,000
    WellPoint: $24,9700,00

    These guys make a lot of money. Betcha’ that they make a buttload more under HillaryCare.

    Buying coverage is mandatory but apparently, controlling overhead and profits is optional.

    Why not just give the health care companies the keys to the U.S. Treasury and be done with it?

  • “[Hillary’s] health care reform plan… would require all Americans to have health insurance”

    What, no pony? Fuck, why didn’t we think of this: just, you know, *require* everyone to have health insurance. Then they’ll *have* it!

    Sarcasm aside, I hope she has some method of requiring health insurance *providers* to actually provide *coverage*, because I hear that’s one of the flawed incentives for health insurance executives: if you provide “too much” health care, you can’t get that summer home with the *fifth* bedroom.

  • “I’d rather get sick and die on the street than elect someone who voted for the ‘Patriot’ Act.”

    No doubt you would.

    By all means, push for your ideal in the primaries. However, if she wins the nomination and progress by large steps proves impossible, I’m willing to go with small increments and gradual reversals.

  • jimBOB — interesting theory re: Hillary’s lifeline to health insurance companies. I wonder if she, or they (or both), realize that if this doesn’t work, the *next* plan will be something they’re going to like *even* *less*.

    Also, re: Hillary moving the pieces behind the scenes: you may be right, but it ain’t *that* hard to get the political-media establishment to kneecap more liberal/progressive Democrats to the benefit of a moderate/centrist campaign. Here’s hoping she recognizes that’s part of their incentive structure…

  • Re: #5 Chris: I think that gets to the heart of the matter; it is not so much about getting people to get insurance, it is about getting the insurance companies to provide the services they are supposed to cover.

  • Next Up: Hillary solves the liquidity crisis by mandating that every man, woman and child in the US must open a new bank account and deposit ten-thousand dollars in it – said ten-thousand to remain on deposit for twenty-five years.

    This is fun! She could actually win in Iraq with a mandate that we each buy a rifle or pistol and 200 rounds of ammo, pay our own airfare to Iraq and start shooting every Iraqi we see on arrival.

    I’m waiting for her mandates on gravity and old age.

  • Thanks, Gracious; I’m sort of hoping her back-pocket threat (assuming she has one, other than inviting the HMO’s to sabotage her Administration if they don’t get what they want) is to nationalize healthcare 😉

  • Funny, I seem to recall much of the progressive press (and blogosphere) being complimentary of Governor Romney (albeit for the purpose of undermining him with his natural base) for a very similar mandate in Massachusetts. It appears there is an unbecoming knee-jerk reaction to who the proposal is coming from rather than to the proposal. I also don’t see a lot of people in this community making taunts about Edwards solving other crises by mandate – even though he also has a similar component to his plan.

    And I am even less able to understand #13 — her plan is not that different from Edwards or Obama, and Kucinich’s plan is even more radical of a change from what we have. The voters – particularly Democratic voters – care about healthcare. Having a detailed plan is mandatory this cycle. What is it about her plan, as opposed to any other plan from any other Dem, that you think gives the race to the Republicans?

    Flash-cut removal of private insurers from non-elective medicine is not realistic, either politically or, frankly, economically. Yes the insurance industry causes a lot of problems in healthcare provision and economics, but life is a little more complicated than waving a magic wand and having single payer non-profit, government-run healthcare (and for the kind of trolls that would equate MoveOn’s ad with Hillary – Mr. Giuliani, I’m looking your way, the fact that I mentioned HRC and government-run care in one post does not mean she supports such a thing).

    In Iowa, insurance companies, including health insurers, employ literally tens of thousands of employees (the same would be true of Connecticut and New York). If they suddenly had no role and went under, that is a lot of laid off people for the local economy to absorb. Who are most of those people? Data entry, customer service, and filignclerks – the same lower income, lower educated (likely Democratic) people we claim to be more concerned about than our Republican counterparts. I’m sure they’d be glad we were looking out for them as they wondered where their next paycheck was coming from. . .

    Theory is nice. But it isn’t reality. Change will have to be evolutionary, not revolutionary in the health care system.

  • There will be no Health Care Reform until and unless health care is take away from private insurers and returned the patient and her/his doctor.

    How big of a party will it be when insurance company’s have government guaranteed premium payments?

    That would do for health care what private contractors and government contracts have done for Iraq.

  • Hillary has it ass backward.
    The starting point for thinking about Universal Healthcare should be what is the best possible solution. The starting point should not be what approach will meet with the least resistance from corporate America. Once we have come up with the best solution, then we should think about how best to sell the system.

  • I wonder if she, or they (or both), realize that if this doesn’t work, the *next* plan will be something they’re going to like *even* *less*.

    Yes, exactly. Or if there ends up being no plan, then we are looking at healthcare armageddon, which will be even less fun.

    WRT the question of executive compensation in the health care industry, this is really a subset of the problem of overall executive overcompensation. My brilliant solution to that would be to set tax rates on corporate compensation based on the multiple of that compensation to the lowest-paid employees in the corporation. If the big shot got paid, say, over a hundred times the rate of his lowest-compensated employee, his tax rate would be about 95%. This would help put the kibosh on overpaid executives AND give a big fat incentive to raise the little people’s pay. Yes, I know, dream on.

  • “It appears there is an unbecoming knee-jerk reaction to who the proposal is coming from rather than to the proposal.” -Zeitgeist

    I won’t speak for anyone else, but I’m willing to risk having an “unbecoming knee-jerk reaction” based on the promoter of a proposal, because I think it might make a big difference in practical/negotiating terms. In Romney’s case, the proposal was for a small state (unlike Hillary’s national proposal); in Romney’s case, it was a Republican who might be seen as trying to find the most conservative plan he could possibly implement. Romney *came* to support universal coverage because he had to, in negotiations (at least, that’s my impression; I could be wrong). Hillary, on the other hand, is *starting* with a mandate that doesn’t seem to challenge health insurance providers much.

    Am I unduly hopeful to think that we should expect a better initial negotiating position from a leading Democrat than what a leading Republican has already accepted on a state level?

  • I think Zeitgest is on point on most of the issues here.

    My one thing is, I don’t like individual mandates, at least initially, because you aren’t guaranteed that the cost savings will be enough to actually make coverage affordable to everyone straight off the bat.

    In which case, you’re mandating coverage to a lot of people who are either going to ignore the mandate (not universal), or buy coverage they can’t afford (not good). Chances are, a mixture of both (my understanding is just that is going on in Mass.).

    Here in Florida we mandate car insurance, and yet I know of plenty of people who don’t buy it because they can’t afford it, fully accepting the risk of fine or worse.

    So, I was never that impressed with the Edwards mandate in the first place, nor that displeased with the lack of Obama mandate, and I’m not impressed by the Clinton mandate now, though Ezra Klein apparently reaches tumescence at the sight of the word.

    And as for Steve’s comment in the original post, about Obama explaining why he doesn’t have a mandate, he explained it to Time, as I recall, before he ever entered the race, in Oct/Nov of 06, saying he didn’t think a mandate was “consonant” with the character of the broader American public. He’s also said multiple times that if his plan doesn’t work, and leaves a few million people uncovered (either b/c they can’t afford it or by choice), then he’d go back and look at an enforceable mandate.

  • Aw hell, who needs mandates. I am all for people to choose to go without insurance. However, at the same time, they need to sign a rights waiver that basically absolves any doctor, hospital or other health care provider from any liability for refusing to treat that person.

  • Chris (#22) –

    I think you make a very good point about initial negotiating positions, and perhaps it points out a particularly tricky part of the relationship between campaigning and governing.

    I don’t want HRC or anyone else “negotiating” with me as part of the campaign. I want to know what they are proposing. And to take that one step further, I want to know what they can realistically accomplish. In negotiations with an opposing party, it may make sense to start outside of what is “doable.” But I don’t want a candidate telling me they will do the impossible just to get my vote — to me that is the definition of pandering.

    So if a politician is telling me that in the relatively brief 4 years they have to work with (since we really never know if they will get a second term) that they will provide universal, single-payer, no-deductable health care (with no loss of care or choice and no long waits!) and that they will get us out of Iraq and that they will solve all of our problems with Iran and N Korea and they will clean up my environment, improve my kid’s school, improve the lot of women, gays and racial minorities, find the right balance of immigration carrots and sticks, bring down the federal budget defecit, improve my job security, and improve the standing of my 401(k) well. . . they may as well promise me a pony and immortality to go with it because I am already assuming they are lying through their teeth.

    As Obama said, the public appetite and comfort-tolerance for a totally new paradigm may even make HRC and Edwards’ mandate-based plans unrealistic. I’m not sure she can credibly promise more on the campaign trial, even if it hurts her negotiation stance should she eventually be elected and have to negotiate with Rethugs and the insurance industry.

  • I think it is silly and unrealistic to mandate healthcare premiums to poor but otherwise healthy younger people, especially if they are already struggling to pay the rent and feed their families. If we are to really solve the problem, healthcare can’t be optional. I think there is already a vehicle in place to deliver healthcare to older individuals, and that is medicare. Lower the elligibility age to 45 or 50 and let the insurance companies fight for the younger lower risk group. Let the younger group recieve a basic policy, paid passively through a sales tax or some other tax that can not be avoided. I don’t think it would be hard to solve the problem for less money than we are now spending, but it will be hard for the politicains to say no to corporate healthcare interests.

  • And speaking of shameless pandering (as I was in #25), along come Oven Mitt Romney to make my point for me, running away from his own record and engaging in the kind of mindless theatrics that only a rabid Rethug could love.

  • Thanks, Zeitgeist (#25); I agree that the relationship between campaigning and governing has some tricky parts, and I think there may even be a full-blown paradox for voters and candidates. You say you don’t want Hillary (or anyone else) negotiating with you as part of the campaign; you’d rather know what they’re proposing, and what they can accomplish.

    But they have to say what they *want* to do, and “what they can realistically accomplish” doesn’t just mean “what they can get done,” but it *also* means “what they’ll settle for,” and in that regard, any admission that they’ll settle for less than what they want represents a negotiation — with supporters and opponents at once. And since we can’t avoid that kind of implicit negotiation (okay, granted, Nixon’s “secret plan” did result in electoral success, if not war/political success), I’d lean towards having people stake out negotiating positions that are farther left (with the tacit assumption that they’ll move to the right as needed, though also with the assumption that they’ll hear from us if they go too far too fast for too little in return, which is my fear re: Hillary re: healthcare).

    Maybe what we should expect from pols is more along the lines of, “I’ll do what I can — and what you support me to do — to fix problems A, B, and C.”

    I’m not sure what to make of Obama’s public appetite/comfort-tolerance theory, though I will note that you’re probably right to read her as trying to navigate a fairly treacherous path with Republicans and HMOs, and I imagine she’s concerned about balancing the need to effect change and the need to not get preemptively blasted by the people who can cause her the most problems, but if they’re going to attack anything progressive, then there’s no percentage in not starting strong.

    (actually, that may be a universal principle of politics…)

  • I read this and think about Michael Moore’s Sicko – especially the lady who is denied coverage for the ambulance ride because she didn’t get prior approval. With Hillary’s plan, the lady might have said, “I’m forced to pay for the insurance, but what am I getting.” Of course, I don’t suppose Hill saw the movie.

  • Can someone PLEASE explain to me how handing over money to insurance companies to pay our doctors makes more sense than paying the doctors directly?

    I mean other than it keeps campaign contributions rolling into Edwards and Clinton’s war chests…

    Public health care isn’t great, we’re told. That doesn’t mean you can’t have private insurance TOO.
    Do all children go to public schools even though every one of them is entitled to it?

  • williamjacobs (#30) –

    for most routine preventative and basic diagnostic things, it would be just as effective, and likely moreso, to pay the doctor directly. the problem is catastrophic issues – emergencies, cancer, circulatory issues, etc. – and complex diagnostics (PET scans, nuclear treadmill tests). most people dont have the cash to pay the doctor directly on those. the point of insurance is to level out the costs to the consumer so that all procedures are affordable — I pay $10 when I go to the doctor for a sinus infection, I also pay $10 when I get a CAT scan of my coronary arteries. Those procedures do not cost anywhere near the same. But I have “prepaid,” in gradual increments, through my premiums.

    One “solution” that jumps out from that example is to have private insurance solely for high-cost procedures. But that likely would not be attractive to insurers or would be attractive only a prohibitively high premiums.

    There is a reason HRC’s earlier effort at health care reform was easily parodied for its complexity: this is unavoidably a complex problem with a lot of moving and interlocking parts.

  • Being in the pocket of insurance companies does not qualify one to solve the health care puzzle.

    It is also obscene to use (more) tax payers’ dollars to pay for health care, while gazillions of those same dollars are already being used for fighting wars all over the globe. Allocate the money and build a healthier society at home, first. Schools, housing, health care, jobs… A gazillion can buy a lot of that stuff.

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