Mandates or no mandates, the healthcare push is coming

If you’ve watched any of the debates for the Democratic presidential candidates, received any of the campaigns’ direct mail, or read any of Paul Krugman’s 712 columns on the subject, you know there’s one key difference between the healthcare plans presented by Hillary Clinton and Barack Obama: mandates.

Putting aside who has the better policy, it’s good to know that either one of them isn’t going to push for universal coverage on their own. Jonathan Cohn has the story.

Today the Service Employees International Union (SEIU) announced it would be launching a $75 million election-year campaign on behalf of universal coverage. According to the union’s press release, which doesn’t seem to be available online, the effort will feature paid advertising to “draw sharp distinctions between the Republican and Democratic presidential nominees’ approach to health care, and what those differences will mean to working families.” But it’s not just a bunch of television and magazine spots the union has in mind. They’re also planning to finance what sounds like a pretty substantial ground effort, including a rolling publicity tour to stage events across the country and an outreach effort designed to collect stories of hardship — which, surely, will help spread the word about reforms, as well.

I honestly don’t know whether $75 million counts as a lot of money for this sort of thing. But, according to this old 60 Minutes story, the entire drug industry spent about $100 million on campaign contributions and lobbying during the fight over the Medicare drug benefit a few years ago. So $75 million certainly sounds like a lot.

It does, indeed. Moreover, unlike in ’93 and ’94, when unions were slow to defend the administration against the insurance and pharmaceutical companies — it came shortly after the fight over NAFTA — this time around, advocates of universal coverage are on the same page, they’re getting started early, and they’re intent on establishing an electoral mandate.

As for Dems, if the SEIU is going to help “draw sharp distinctions between the Republican and Democratic presidential nominees’ approach to health care, and what those differences will mean to working families,” it’s going to help the party’s nominee, no matter who it is.

Why? Because John McCain’s healthcare plan is a joke.

The cost of health insurance for workers at Cheryl Rash’s Blue and Gold auto-salvage company in Goose Creek, South Carolina, jumped 31 percent in October.

While Rash says she may have to end the benefit if that happens again, “I already think about whether it’s worth the money we pay now,” said the company’s manager, Dena Roach. She says she feels tapped out from the $272 a month she contributes for the plan provided through Carolina Care Plan Inc.

If her boss stops paying the $770 difference, Roach’s family may have to go without coverage: “If I have to pay the whole thing, I couldn’t manage.”

Workers like Roach want insurance that stays affordable, and the Republican presidential candidates say the best way is to give individuals tax breaks to help pay for coverage. Critics, including Democrats who advocate a broader government role, say these plans won’t hold down rising costs, much less put a dent in the 47 million uninsured Americans.

“As laid out, the [GOP] candidates’ proposals don’t fully address the problems of affordability, access to coverage and cost,” Roberton Williams, principal research associate at the Washington-based Tax Policy Center, a joint venture of the Urban Institute and Brookings Institution, said in a Dec. 24 interview.

The more this issue is front and center through the fall, the better the Dems’ chances of winning the White House. It’s that simple.

Strong move! It will be great to get more focused health care reform. I want to see lots of other organizations, foundations etc make some commitments – and not just the progressives – about spending money! that’s when this will start being for real.

  • Krugman wrote, “The Clinton plan is, however, more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies.

    Seems? A little vague for a numbers guy like Krugman. In fact, Obama puts more money into his plan (specifically into various components such as prevention and reinsurance) in order to drive down premiums. Lower premiums need fewer subsidies.

    Krugman’s assessment of the Clinton plan also made assumptions about items not specified in her plan. When copying Edwards’ plan, Clinton specifically removed enforcement mechanisms of the so-called mandates. I say “so-called” because with little or no enforcement, there are no mandates, and we don’t have the “universal” coverage promised.

    In addition, even with limited costs based on income, premiums under the Clinton plan would still be higher if the plan is underfunded and the mandates are unenforceable (as has been shown in Massachusetts).

    With or without mandates, “universal” will not be achieved until we drive down costs first, and that’s precisely where Obama’s plan excels.

  • (Psst. Your third link is broken.)

    The GOP will never realize that screaming “Booga Booga! Socialized Medicine!” only works if the majority of people feel they have adequate health care coverage. Once Joe Schmoe (who really doesn’t care about anyone but himself and his family) starts to feel insecure, HitleryCare starts to sound pretty damn good and people saying HitleryCare is bad start to sound insane.

    Another thing the GOP will never realize: Eight years of allowing the HI industry to run amok and crap like Medicare ScamVantage only sped up the process. So in a way, if we get national health care within the next four years or the HII gets a major spanking, we’ll have to give a nod of thanks to the greedy rats on the right who gnawed away the foundation of their rich friend’s house.

  • Paul Krugman’s 712 columns on the subject

    Not counting his 7000 blog posts – but in his defense, Krugman’s arguments are all based on the assumption that McCain loses and a Dem is sitting in the Oval Office – his argument is only that Obama should quit attacking Hillary from the right, and I agree.

    But I still support Obama because for me foriegn policy is top priority, and the distance between these two candidates are huge. (consider Hillary’s recent lie about Iraq)

  • Talking about Universal Healthcare and getting it passed by Congress are two distinct things..

    I am one of the 47 million without coverage. It is THE most important issue for me. But like I said..they can promise all they want..its up to Congress to deliver it.

  • David Rees: Clinton, Obama, and Cluster Bombs

    “Cluster bombs and landmines are particularly terrifying weapons that wreak havoc on communities trying to recover from war. They are fatal impediments to reconstruction and rehabilitation of agricultural land; they destroy valuable livestock; they disable otherwise productive members of society; they maim or kill children trying to salvage them for scrap metal.

    Over 150 nations have signed the 1997 Mine Ban Treaty. It pains me that our great nation has not. But in the autumn of 2006, there was a chance to take a step in the right direction: Senate Amendment No. 4882, an amendment to a Pentagon appropriations bill that would have banned the use of cluster bombs in civilian areas.

    Senator Obama of Illinois voted IN FAVOR of the ban.

    Senator Clinton of New York voted AGAINST the ban.”

  • Prediction: Look for Hillary to drop out SOON

    Why? See below.

    If Obama does really well tomorrow, Hillary may have to pull out soon for financial reasons; she only raised $10 million in Jan, but spent $17 million – she’s running out of money. Obama doesn’t have to win the whole thing tomorrow, just be viewed as performing really well and having the momentum going into Feb 9th.

    On Feb. 9th, there are two caucuses (where he’s already set up), and primaries in KS and LA. He’s got the endorsement of the Gov of KS (where his mom was born), and Louisiana has a large AA population, so I don’t think the 9th is going to be a good day for HRC.

    Next up – on the 10th to the 19th, there are primaries in MD, DC, and VA (large AA populations), and caucuses in HI (Obama’s home town), and ME. If HRC gets wiped out on the 9th of Feb, that will be a significant blow to her because the following few weeks are set up for Obama.

    If Obama does well tomorrow (again he doesn’t have to score a TKO), look for HRC to drop out SOON (maybe this month?). After a string of defeats from the 9th to the 19th, her cash flow will dwindle to a trickle – right before the big state contests in OH, TX, and PA. HRC can’t afford to go toe to toe with Obama in those states (financially anyway). Under these circumstances, if she doesn’t drop out, she’ll be left with a mountain of debt from her campaign.

    She says OH is her next firewall, but the TX primary is on the same day (more delegates), and Obama is surging there big time.

    Her only hope under this scenario is to convince the DNC to seat MI and FL delegates, which Obama will fight tooth and nail.

    Basically, HRC is TOAST if Obama does well on Super Tuesday.

  • I’m a former, broken-hearted Edwards person and the only thing keeping me from whole-heartedly supporting Obama is the healthcare issue. Yes, the single most important element is driving down costs and keeping the insurance companies at bay. However, without mandates (and, yes, their enforsement) we’ll never get to universal coverage. I don’t understand why Obama doesn’t want to try. I’m starting to think that he’s staked a position, attacked his opponents and, even now knowing that they’re right on this and he’s wrong, just will not admit that he made a mistake. Sound familiar?

  • “Seems? A little vague for a numbers guy like Krugman. In fact, Obama puts more money into his plan (specifically into various components such as prevention and reinsurance) in order to drive down premiums. Lower premiums need fewer subsidies.”

    Sorry, but this won’t work. Costs are high in our privatized system for three major reasons:
    profits, sales and underwriting. The last is what it costs to keep access limited to the healthiest risks and to aggressively challenge claims. Sales and marketing costs are very high, especially when you consider all the advertising and lobbying the companies engage in. Profits speak for themselves. You aren’t going to reform the system by asking companies making a fortune to please play nice. Their job is to make money, not nice.

    Krugman’s columns are spot on. They’re not popular with liberals lately because they are critical of Obama’s plan, and in our current environment Obama is as pure as the driven snow, while Hillary is as evil as the wicked witch of the west.

    That’s not conducive to an objective analysis of policy.

  • One thing that never gets talked about in relation to costs is investors. One of the reasons that gasoline prices are so high is that with all the hype in the market about how oil is getting scarce, investors have bid up the stocks to get big rewards. The same thing is happening in the healthcare industry. Investors look at demographics and think there is a killing to be made off of baby boomers spending money on healthcare so investors are flocking to healthcare type investments. Investors demand returns, which raises prices. I don’t know what the answer would be since we live in a capitalistic society, but it seems to me that if healthcare were run by the government, there would be no money to be made, therefore prices would actually reflect usage and not profit. Making insurance companies nonprofit wouldn’t work because nonprofit doesn’t mean that you can’t make a profit. You actually have to make a profit to continue in business, just maybe not as much as if you were for profit…

    Maybe we need an awareness campaign that WE are the investors (mostly through retirement accounts), so the enemy is us in a sense. However, it is mostly the wealthy who are doing the investing through hedge funds and private equity investment funds that the SEC and Congress have been unwilling to regulate.

    I don’t know what the answer is, but we need to address more than healthcare use and health risk issues (like obesity and diabetes).

  • The Answer is Orange said:

    The GOP will never realize that screaming “Booga Booga! Socialized Medicine!” only works if the majority of people feel they have adequate health care coverage. Once Joe Schmoe (who really doesn’t care about anyone but himself and his family) starts to feel insecure, HitleryCare starts to sound pretty damn good and people saying HitleryCare is bad start to sound insane.

    It only works if Democrats, when the Republicans scream “Socialized Medicine”, meekly mumble that isn’t what they want and then go back to hiding under their desks.

    Democrats need to get in the face of these Republican blowhards and ask, “Since you’re so opposed to ‘socialized medicine’, when are your going to give up YOUR government run health coverage and buy private insurance like a good free-marketeer?” And “Since you say government run health coverage is so bad, why are your inflicting INFERIOR HEATH CARE on YOUR family?”

    It would be even better if the Democrat then turned to the corporte-controlled press-titute and asked, “Why do _I_ have to ask these questions? Aren’t you supposed to be the journalist?”

    Of course if wishes were fishes, we’d be up to our asses in basses.

  • Sorry, but this won’t work. Costs are high in our privatized system for three major reasons: profits, sales and underwriting.

    I’m not clear on what this person is asserting.

    Is he (or she) arguing that Obama’s proposal has profits, sales and underwriting expenses and the Clinton plan doesn’t? If so, then he’s mistaken.

    Is he arguing that once you deal with profits, sales and underwriting, nothing else needs to be done? If so, then he’s mistaken again. We all know that an ounce of prevention is worth more than a pound of cure and investing in preventive care saves money. In addition, reducing the risk via affordable reinsurance would drive down premiums as well.

    To deny these facts is, well, to be in denial.

  • It’s getting tiresome to constantly hear people fretting about Obama’s health plan not having quite as many mandates as Clinton’s. As someone who hopes (and expects) to retire well before I’m 65, I don’t want to be placed in the position of being forced to sell my house to purchase health insurance (in the event my health savings account doesn’t exempt me from penalty). But enough about me. As Robert Reich points out in TAP, the mandates in dispute would amount a tiny fraction of the public, and the dispute over who can come closest to “universal coverage” through unfunded mandates is a sideshow that detracts from the small but relevant differences between HRC and OB (and huge differences from Rethuglicans):

    http://www.prospect.org/cs/articles?article=the_road_to_universal_coverage

  • I too am one of the 47 million Americans without coverage. It matters a great deal to me, but i think that foreign policy and some degree of fiscal sanity are more important at the moment.

    By biggest beef is that i just don’t see either (any) plan getting through Congress quickly or in a final form that looks anything like the proposals from the candidates. And my faith in the federal government is rather low, which i know is a horrible thing for a ‘liberal’ to say.

    I’m far from a policy expert on this, but couldn’t we all just form one 350 million person risk pool and buy a policy together? We could gather our finest minds, set them up somewhere…like Philadelphia…and let them come up with a succinct contract which we then ratify by referendum.

  • My biggest beef is that i just don’t see either (any) plan getting through Congress quickly or in a final form that looks anything like the proposals from the candidates. — jackpine savage, @ 16

    Depends a bit on the composition of the Congress, no? Which is why it’s as important to get as many Dems and, especially, real progressives into both houses as it is to get the “right” president. If Obama’s coat-tails are longer, down-ticket, than Clinton’s (and I believe they are), then he’d be more likely to get things accomplished, with less hassle.

  • You want health care?

    Go to Starbucks and put in 22 hours/ week to qualify for benefits. Why should I pay for you? You got family? That is what they are for. Retire? If you can not afford insurance then work like my dad did until the day he died! I owe you nothing! Work! Work! Work! Quit complaining! I have 5 kids and am putting them through college w/o any help, because it is my responsibility.

    If you force health care, then it should be waited like car insurance and life insurance! Fat, smoke, drink, you pay more – should be required to get an exam to receive insurance. Have you people ever ran a business? You sound just like the people who bought a house 3x their net worth and now want me to pay! BS – I busted my tail to pay for mine in 15 so I would have enough money to put kids in college. I owe no one! Where is your self worth? Are you Americans or Comrades? Nothing is free!

  • Libra @ 16,

    Agreed, and wholeheartedly. I’m pretty lukewarm on both candidates; however, i’ll give Obama one important edge. I think his coat-tails could be longer and wider than Clinton’s. If he really can bring out the youth vote, they’ll vote straight down the ballot.

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