Obama’s new mailing is awful — but it’s not Nazi awful

The Obama campaign is getting hit hard for a new direct-mail piece it’s sent out, and in this case, the criticism is entirely justified. The mailing, criticizing Hillary Clinton’s healthcare plan, is really awful. Indeed, after a couple of weeks of relative silence about the “conservative frame” discussion, this Obama mailing brings it all back to the fore.

But there are limits on how bad the piece is.

Greg Sargent posted images of the direct-mail piece — it’s a little big to reproduce here — but the mailing’s front and back hammer home the message: “Hillary’s health care plan forces everyone to buy insurance, even if you can’t afford it. Is that the best we can do for families struggling with high health care costs?” The image includes a couple at a kitchen table, presumably to connect the mailing to the “Harry and Louise” ads that helped bring down the Clinton healthcare plan in the 1990s.

Paul Krugman, who’s been less than shy in his concerns about Obama, wrote:

The Obama campaign sends out an ugly mailer. Sorry, but this is just destructive — like the Obama plan, the Clinton plan offers subsidies to lower-income families. And BO himself has conceded that he might have to penalize people who don’t buy insurance until they need care. So this is just poisoning the well for health care reform. The politics of hope, indeed.

Ezra added that Obama’s plan is “pretty good,” but the senator runs into trouble by deciding to “respond to the inadequacies of his own policy by fear-mongering against not only better policy, but the type of policy he’s probably going to have to eventually adopt.”

All of this strikes me as completely fair; Obama’s ad is just a mess. It’s the kind of thing I really wish his campaign wouldn’t do.

And all of this might have even hurt Obama a bit, if the Clinton campaign hadn’t gone too far in its response.

First, the Clinton campaign, understandably angry about the healthcare mailing, would have more authority to complain if it hadn’t sent out an anti-tax mailing in New Hampshire and Nevada that looked like it had been written by the Republican National Committee. Those who revel in conservative frames lose the high ground when faced with criticism through conservative frames.

Second, while the Obama ad is extremely unhelpful when it comes to the progressive message on healthcare, it’s not dishonest. It’s using a conservative frame, and it’s hard-ball politics, but it’s not factually wrong. Regrettably, Clinton’s anti-tax mailing was factually wrong.

And third, the Clinton campaign hosted a conference call with reporters this morning that went wildly off-message.

The Clinton campaign convened a conference call with health policy experts to denounce Obama’s new mailer, which attacks Clinton’s plan for “forcing” Americans to sign up for insurance, and which features a couple at a kitchen table that recalls, for some, the famous insurance-industry-financed “Harry and Louise” ads against the original Clinton plan.

“I am personally outraged at the picture used in this mailing,” said Len Nichols of the New America Foundation, a leading supporter of mandatory insurance, who called it a “Harry and Louise evocation.”

“It is as outrageous as having Nazis march through Skokie, Ill.,” Nichols said. “I just find it disgusting that this kind of imagery is being used to attack the only way to get to universal coverage.”

Goodness gracious. I agree with the concerns about the Obama mailing; it’s the kind of thing the campaign shouldn’t have done. No doubt about it — I denounce the direct-mail piece without reservation.

But comparing the mailing to Nazis marching through Skokie not only takes the outrage several steps too far, it changes the nature of the story. Now, instead of the headline reading, “Awful Obama mailing wrong about healthcare,” the new headline is, “Clinton campaign compares Obama mailing to Nazis.”

Later in the Clinton conference call, campaign spokesperson Howard Wolfson disavowed the Nazi reference. I’m glad, but it’s sometimes tough to get the toothpaste back in the tube.

Last night’s debate was quite pleasant. It was nice while it lasted.

Nothing in this ad is dirty or a “distortion” of the truth. Hillary’s plan does mandate that all citizens have heathcare regardless of if they can afford it or not. I can see if this was a half truth but its not…just face facts. You have to come up with something better than this.

  • Can we adapt the Homeland Security Threatometer to the Obama/Clinton campaigns. Perhaps an Orange alert when they are peevish with one another? Green when they’re colleagial. Red when they’re hate-mongering on each other?

    This would be a guide for us blog commenters to raise or lower our level of animosity when posting about their supporters online.

    Green: I will gladly support either of the candidates if they are the Democratic nominee.

    Red: Liberal Fascists!

  • I’m an Obama supporter, and all I can say is…ouch. His plan mandates coverage for children…”even if you can’t afford it”. Not cool.

    That said, Obama’s plan is likely to lower the cost of health care more than Clinton’s, thereby making his plan more “universal” than hers (calling her plan “universal”, as she did in the debate last night, doesn’t make it so).

  • In a just-previous column, Paul Krugman rated Obama’s health care plan as weaker than Clinton’s, conceding that neither would likely have been developed to their present state without the insistent populist message of John Edwards.

    I’m not a Hillary fan, but I don’t much care for seeing her unfairly criticized. Leave that for the Republicans.

  • Steve – I agree that the mailing is tough, but accurate. I also think Krugman, Klein, et al., along with Hillary are misleading when they claim that a mandate will ensure that all of the uninsured are covered. Without any teeth in the mandate (the missing piece to Hillary’s plan), some individuals will decide not to enroll in one of the available plans. Mandatory auto insurance has the same problem. To me, Hillary wants the credit for a mandate but wants to avoid any of the downsides, including publicizing the penalties and acknowledging that even a mandate with penalties would not cover all of the uninsured.

  • I tried to give everybody a heads up about why both Clinton and Obama are both right and both wrong on the mandated health insurance schema in a do your homework before the debate diary on Kos yesterday:

    http://www.dailykos.com/story/2008/1/31/123659/474/505/446985

    Short version:
    Obama is right that it will wind up as unaffordable subsidy to for profit health insurance industry. He is wrong that his plan is better, insofar as it is equally unaffordable and just insures less people as its solution to unaffordability.

    Clinton is wrong insofar as it it is a forced subsidy to the private for profits. She is right, that once you have made the mistake of leaving the private for profits in place, that her plan will get more people insured and that without mandates less people get covered and the folks who are betting they are healthy and stay healthy will opt out making it more expensive for everybody else.

    Which is why we need single payer, the only way to get to Universal coverage (everybody), Comprhensive coverage (covers everything needed) and Cost-control (affordable for individual and country).

    Still supporting HR-676!

  • Actually, that’s not what was said on the call. Here’s the full quote:

    “It is outrageous as having Nazis march through Skokie, Illinois, or some other things we could think of probably if I had more time and my heart was beating less quickly,” he said.

    Clinton campaign senior adviser Howard Wolfson said on the call: “I heard someone make a reference to a march in Skokie in comparison to the photograph in the mailer which is not a comparison that we would make. And everyone on the call is obviously very passionate about this issue, and rightfully so, but that is not a comparison that we would make.”

    Political Punch

    That’s right. I got the actual quote from Political Punch. Oh, the irony. (Not Tapper, though, obviously)

  • The success of a president depends largely on selecting the right staff who are not only competent but understand the the tone and content of the president’s message. This crap make one wonder about the ability of both candidates to surround themselves with the right people.

  • I thought Obama’s plan would include enough subsidization that it could not be “unaffordable” for anyone—for their children or otherwise.

    Am I missing something here?

    Based on the details that emerged in last night’s debate, Obama would subsidize his plan so that everyone could afford it—even fully subsidize it. So if you opt out you have only yourself to blame and have a penalty if you need it later. As for children, the decision is above their pay grade, so it is required.

    Whereas Hillary described hers as a tax credit arrangement. Which implies a different method of collecting for it as opposed to subsidies—might be semantics, I don’t know. But as long as she refuses to be clear about the mandates and associative penalties, I think her claim here is weak.

    Obama is overly harsh, and I wish he hadn’t sent it, but it isn’t untrue. And is sure as hell ain’t the Nazis. Unbelievable.

  • Apparently, no one is quite willing to risk advocating for single payer UHC so the details of both plans could matter less to me. I only hope that either plan is a step on the way to UHC and that whomever is elected can get their plan through Congress. UHC, because of the influence (Read: money) wielded by the health care companies and big Pharma is the real Third Rail of American politics.

  • As someone who has been looking for reasons to feel less depressed about Edwards getting out of the race, so that on Election Day I stand half a chance of actually feeling good about my vote for the Democratic nominee, and who was feeling a little better today after last night’s debate, this latest offering from Obama has sent me back in the other direction – and that pretty much ticks me off.

    What was Obama thinking? That mailer, whether he pulls it or not, is going to be Exhibit One in the Republican revolt against anyone’s universal plan. It won’t matter to them that he’s trying to contrast his plan with hers – what will matter is that big, fat headline – coming soon to an attack ad against either Democratic candidate.

    This is the kind of advertising that makes me wonder how much he believes in universal health care, and how committed he is to achieving it.

    Might be time to lose the “right on Day One” meme, because this was just wrong.

    Makes me think that the change of which Obama speaks so passionately is really just, well, “changiness.”

  • What happens without mandates – let’s say insurance for 5 people of the same age and gender is $300/mo. Persons A & B say, “That’s too much. I don’t spend anywhere that amount on medical expenses” and both opt out. Persons C & D decide to stay in. Person E says, “With my diabetes, that’s a good deal – I will buy it”. Without persons A&B contributing, the insurance cost climbs to $400/mo. Person A comes down with cancer and decides to hop back in, driving the expenses even higher to $500/mo. Person C says, “$500/mo is too rich for me – I am out”. With only 3 people insured and 2 of them running large bills, the rate climbs to $750/mo. Person D now drops out. Repeat until the chronic unhealthy are left in the program.

  • Opposing mandates is a legitimate position to hold. It is also legitimate for Obama to send out a mailer highlighting a difference between himself and Clinton. The fact that conservatives might also agree on this point (while still opposing his health care plan) does not make it any less valid a position to hold.

  • Er, Krugman doesn’t have much standing given his noted silence on Clinton’s anti-tax mailer.

    Further, Krugman and Clinton invited a demagogic debate by mischaracterizing both Clinton’s plan and the likely effects of a “real” mandate (ala John Edwards).

    Some points:

    1- A mandate without teeth doesn’t accomplish anything more than a plan without a mandate at all

    2-Clinton’s mandate (unlike Edwards’) has no teeth, and as such is not substantively different from Obama’s.

    3-Even if Clinton’s plan did have teeth, it still wouldn’t be “universal”. It would probably cover ~98% of the population, which leaves ~6 million uncovered. This is based on European countries that do have mandates, with teeth, and even John Cohn, at TNR (sorry, their archives are f’ed right now or I’d link to it) acknowledged as much in his throaty defense of mandates. As such, framing the debate as between non-universal and universal is fundamentally dishonest. In reality, the debate is between near-universal (obama), near universal w/ symbolic-but-impotent mandate (clinton), and very near universal w/ real mandate (Edwards). But we never had that debate. Instead we had a quantitative difference (# left uncovered-15 mil v 6 mil) re-cast as a qualitative difference (univ. v non-univ).

    4-If you can’t sell a mandate in a Dem primary, then how the hell do you plan to sell it in a general election?

    5-As noted, Obama’s mailer isn’t even a mischaracterization of Clinton’s plan except to the extent that it gives her more credit than she deserves by actually assuming the mandate is anything more than symbolic, which, at this point, it is not.

    So, yeah. Kinda funny to see Krugman & Clinton engage in demagoguery for something like 2.5 months straight and then get all offended when someone hits back in kind.

    I fully understand why some are so passionate about the need for a mandate, and further I understand why they wouldn’t want to throw under the bus someone speaking out for that principle. But they set out on a dishonest debate, and are no crying foul when someone hits back honestly? Please. And Krugman especially, after his silence on Clinton’s dishonest, right-wing-framed tax mailers, just comes off as trading on his credibility with the left to pass off agitprop as legit analysis.

    Sad.

  • Dennis_D,

    That is not a valid comparison. It is unlikely very many people will not get coverage if the coverage is affordable. One point of health insurance is to have coverage should an unexpected problem develop. You wouldn’t be able to just wait until you have a problem and hop back in. This is a pure straw man argument which is not based upon what is actually proposed.

  • This is from Hillary’s plan:

    • Provide Tax Relief to Ensure Affordability: Working families will receive a refundable
    tax credit to help them afford high-quality health coverage.

    • Limit Premium Payments to a Percentage of Income: The refundable tax credit will be designed to prevent premiums from exceeding a percentage of family income, while maintaining consumer price consciousness in choosing health plans.

    • Create a New Small Business Tax Credit: To make it easier—not harder—for small businesses to create new jobs with health coverage, a new health care tax credit for small businesses will provide an incentive for job-based coverage.

    • Strengthen Medicaid and SCHIP: The Plan will fix the holes in the safety net to ensure that the most vulnerable populations receive affordable, quality care.

    • Launch a Retiree Health Legacy Initiative: A new tax credit for qualifying private and public retiree health plans will offset a significant portion of catastrophic expenditures, so long as savings are dedicated to workers and competitiveness.

    I’m no policy wonk, but I think her criticism of his plan is that it does not mandate coverage, so even if there is some penalty to be paid by those who would “opt out” of being insured, the pool that does have insurance is more heavily-weighted with risk, and that will eventually drive the cost up.

    I haven’t read the plan in detail, but I would imagine a refundable tax credit would be similar to the Earned Income Tax Credit, where even those who would otherwise not have to file – or pay – taxes, would receive a check to purchase the insurance – and since the premiums will represent a percentage of income, insurance automatically becomes more affordable to those at the lowest end of the spectrum.

  • People think they “can’t afford” health insurance when the can pay for it. 46.6 million people currently don’t have health insurance, most of which are middle class. What they are doing is gambling that they won’t have any major medical problems. As long as they don’t have any major medical problems, not having medical insurance saves them money. Obama’s plan lets them keep on gambling. I would think the 15 million number would be low.

  • When Clinton distributed the false anti-tax mailing about Obama, Anne writes, “Clinton can’t blink without someone being all over her – rightly or wrongly.

    When Obama distributes a true (albeit unfair) mailing about Clinton, Anne writes, “this latest offering from Obama has sent me back in the other direction – and that pretty much ticks me off…What was Obama thinking?…This is the kind of advertising that makes me wonder how much he believes in universal health care…this was just wrong

    Anne’s outrage (or lack thereof, as the case may be) smacks of hypocrisy.

  • “It is as outrageous as having Nazis march through Skokie, Ill.,” Nichols said.

    He’s right. Arlington Heights or Rosemont would be much nicer. 🙂

    At least Wolfson disavowed the ridiculous comment.

    Honestly, I guess I don’t see what’s wrong with the flyer, and this happens to be something I disagree with Obama on, but it is a key difference between them.

  • I think most observers on the left (except, perhaps, Ron C) have agreed that the Clinton (and Edwards) plans are preferable to Obama’s. And that Obama is in a better position re Iraq. So maybe it is because I have many, many more (and closer) friends and relatives at an age or life stage where they need health care services than I do friends and relatives directly impacted by Iraq that I give the advantage ot Hillary.

    Anyone who criticized the Clinton NV tax mailer should be consistent and criticize the Obama UHC mailer. The adoption of Republican frames harms the entire progressive cause, not just one candidate.

    As for the Nazi reference, that was an independent third-party who is zealous about healthcare reform, and it was immediately disavowed by the campaign, on the spot. Tarring the campaign with the Nazi reference is almost as egregious as the initial Obama mailer.

  • Shelly, I’ve been through this before. Anne peddled debunked claims in the comments section to the very post that debunked them.

    No point in even trying to engage her in good faith, or at all. Your good faith won’t be reciprocated.

    But what do I know? I’m too busy trying to get this Kool-Aid off my shirt and oil the gears of my Obamabot engine.

  • Dennis_D

    As long as they don’t have any major medical problems, not having medical insurance saves them money. Obama’s plan lets them keep on gambling.

    But in effect, they are gambling with everyone else’s money. If they are wrong, and they end up in emergency care, you and I and everyone else pay for a very inefficient solution — that is, the gamble is easy because their risk is limited while their reward if they are right is high. Moreover, their decision to opt out means those of us who aren’t as sure of our health – or who are, but are just more risk averse – form an insurance risk pool that is skewed toward those needing care. That is, it overstates the risk in the population because of healthy, middle aged persons opting out to “take the gamble.”

    It is both inefficient and unfair for some who could be insured to gamble, raising the cost for everyone else to the point where some who want to be insured cannot afford the coverage.

  • I think most observers on the left…have agreed that the Clinton (and Edwards) plans are preferable to Obama’s.

    I think not. I THINK most observers on the left have agreed that Obama’s plan will lead to lower premiums and, therefore, cover more people.

  • Zeitgest–

    I denounced the NH and Nevada mailers b/c they were dishonest, not because they adopted Right-Wing frames. As such, I don’t find the need to denounce this.

    As for harming mandates, I don’t really care; I don’t like nor do I want mandates. I think the mandate is a wolf in sheep’s clothing. It is, afterall, an idea hatched by private insurers, not lefty policy wonks. Because subsidies + mandate to buy insurance when there is still a private market is just corporate welfare, only the checks are sent through the citizen to the corporation. All I care about is the adoption of a public option that opens a path to single-payer. I want something that can bridge the gap between s-chip and medicare and could be easily intergrated with the two to create one public option for all age groups, and a path to single payer. Both Clinton’s and Obama’s plans offer that, so I like them both. Clinton’s plan includes a symbolic mandate, which really changes nothing. At least Edwards had the balls to put out there his enforcement mechanisms and admit that without those, the mandate is meaningless.

  • God bless the kool-aid drinkers, for they sure do make life interesting in the comments sections of the blogs. And it is nice that they support and fight for their candidates 100%.

  • Reality check: No candidate’s plan is going to go through as proposed. Differences of the kind we see between HRC’s and Obama’s plans are the kinds of things that get negotiated away in order to get legislation through. Furthermore, these plans are developed in relative isolation, which to my mind makes them more like proposals than vetted plans. Maybe they give some insight into how they’ll approach things, maybe they represent what campaign staff thought was workable at the time. But they aren’t going to be implemented as is.

  • By the way, the Clinton campaign isn’t up in arms about this because they think Obama’s plan is inferior. It’s really not about the specific policy differences at all. They’re crying foul because this is a subtle but unmistakable personal attack meant to drive up her negatives. So it’s not about Clinton’s plan but about Clinton herself. Provided they make the Harry and Louise connection (something I doubt many do at first, but more will be reminded later) it says to the voter: “remember how you felt about Hillary Clinton back then? Well, here’s a not so subtle reminder.” That’s why they’re so ticked off.

  • The weird thing for me is that Obama has been saying this pretty routinely for some time now. He doesn’t like mandates because he thinks people are rightfully afraid that what they mean to most people are “I have to buy insurance whether I can afford it or not.” Instead, he insists that if we actually work to make health insurance affordable, he really believes there will be almost universal enrollment. So he opts to say, let’s give people a plan that makes them want to enroll instead of just insisting that they have to enroll. None of that spiel is new, which leaves me scratching my head that he put into a mailer what he has said very publicly and firmly in both speeches and debates.

  • I dont’ like either of their “health plans”, speaking as one of the elderly, sort of poor, types. We need something that can clearly lead to universal care, even if it doesn’t start exactly that way. Something that will get the insurance racket out of our health.

    I thought that Clinton decided to use the Edwards plan ? It all sounds a little muddy to me.

  • beep52 (#27 above) —

    Excellent point! In truth, Obama could end up signing a plan with mandates and Clinton could end up signing a plan without them. As you said, we should consider how they’d approach things.

  • God bless the kool-aid drinkers, for they sure do make life interesting in the comments sections of the blogs. And it is nice that they support and fight for their candidates 100%.

    What a substantive response! Not demagogic at all! I even enumerated the points so you could easily highlight different portions and debate honestly. I think the mandate policy is one on which reasonable, intelligent, well-informed people can disagree. You, however, seem to think that anyone who disagrees is a mindless hack shilling for his/her candidate.

    So who’s the kool-aid drinker here?

  • Evergreen:

    both Clinton’s and Obama’s plans have clear paths to single-payer. Edwards’ path was, by my eyes, the quickest, but all 3 definitely have paths there. If you want, I can dig up links to Brad Delong and Tim Noah describing Obama’s path and Noah describing Clinton’s path…but it’ll take a bit and I’m about to step out to lunch, so it won’t be for awhile.

  • One thing Obama said during the debate that Hillary should have hit hard on was when he said that if someone didn’t buy coverage and then went to the emergency room, that person would have to pay back premiums. This is exactly the wrong incentive. It basically allows EVERYONE to not to buy insurance until they need it. If they never get sick, they save all that money. If they get sick, they just pay back what they would have paid to begin with. It’s a no lose proposition to wait until they get sick. With Obama’s plan NO ONE would buy into the program.

  • Michael #32,

    I wouldn’t worry about bubba. If he disagrees with somebody, he just labels him or her a kool-aid drinker (he also said it in an earlier post today). He learned that technique from listening to talk radio. Saves time and effort.

  • So who’s the kool-aid drinker here? -Michael

    I like cherry!

    All due respect, I’m not sure bubba was aiming that comment at you, but was rather making a broad observation. I could be mistaken, but I don’t think it was meant as a personal slight.

    I think a lot of us have been having a bit o’ the ol’ bug juice lately. Just make mine with artificial sweetener, please. It just shows how passionate we are about the whole process. It is good to be in a ‘community’ who cares.

    The more you know…

    (Cue the shooting star.)

  • agreed re bubba – i took that as a good natured ribbing of a broad cross-section of commenters here. and i prefer my kool aid with a little Absolut, especially on a Friday afternoon. . . 🙂

  • I suppose it’s hypocritical or dishonest or wallowing in denial or one of those “lacking in good faith” things I’ve been accused of to say that my problem with Obama’s mailer is that it weakens the argument for universal care because it can be used quite easily and quite well by those on the GOP side who so vehemently oppose it.

    My disappointment in the mailer has nothing to do with whether it is factual or dishonest – it’s the message it sends and the damage it does to the chances for ever having universal care.

    Both Shelly and Michael, if they were capable of pretty basic reading comprehension skills, would have understood this. And perhaps could have made a reasoned argument why the mailer does not damage the cause of universal care.

    Oh, well.

  • If it wasn’t meant to be antagonistic, I apologize. However, “just don’t get it” actually is right in line with “kool aid drinker”. And I’ve been called both a kool-aid drinker and an obamabot on this blog, many times, which I really don’t think is fair at all. So I admit I’m a little over-sensitive to the charge

  • Anne-I already explained why I think mandates are ancillary to the cause of universal healthcare. But to reiterate, they – mandates – neither achieve universality nor do they create a path to single payer (only a public option does that). So, really, I don’t give a crap about them. All I care about is a public option for health care.

    I know some people fear the “death spiral” effect of non-mandates–only people who really need healthcare buy into the new market, which drives up costs, which makes more healthy people opt out, etc etc. I don’t agree with it. There’s a reason Obama’s plan has aggressive measures to not simply freeze premiums (which in and of itself basically addresses the concern) but actually lower them. Beyond that, I mandate doesn’t do much for me, and I think it is neither necessary nor sufficient for universal coverage

  • But, to add to my last post, I think the “death spiral” is a legit concern. As I said, reasonable, well-informed people can disagree on these points. And I think Ezra Klein’s point is also a good one: that once you get even “universality” agreed to in principle, but not in practice (as in the case of a mandate), there’s no going back. However, I disagree with Klein in that he’s not particularly concerned with getting to single-payer; I am. And, as I said multiple times now, I don’t think a mandate gets us any closer to that. Your mileage may vary, but I don’t think my position is unreasonable, nor is it particularly controversial. Many of Obama’s healthcare backers (and he has plenty) have made the same points, and many of the proponents of mandates have made a lot of my points (re: 6 million uncovered; toothless mandate meaningless; etc)

  • Now I’m going to lunch, hopefully I got 4 points in a row in there. 😀

    Will pick this back up later, hopefully

  • I will offer my best answer to that, Anne, if that will help.

    I consistently prefer progressive policy proposals. However, I consider myself a Burkean conservative in that I think you shouldn’t just instigate a program because you think it will be better. You actually have to let the idea prove itself.

    From this point of view, you see Universal Healthcare as most probably the best solution and simultaneously think that the best way to get there is to offer cheap, affordable, effective government-maintained health insurance to everyone and let it prove itself as the best option. As it does so, it will consistently push the competition out of the market until the move to true government-sponsored universality is most symbolic.

    In contrast, you see attempts to mandate Universal Healthcare into existence as troubling attempts to rig the game in your favor. Mandates don’t actually test to see if the idea is as viable as we think it is. Instead, they insist on this fact from the beginning and then hang the citizen if it turns out that the programs suck. Mandates also encourage poor management by removing any mechanisms for negative feedback. People have to be enrolled in the programs whether they suck or not, so there is less incentive to make sure they work effectively or efficiently. In many ways, this is the problem many of us run into with healthcare already. It isn’t that we don’t want it; our options for getting it are just terrible so we feel forced to accept less-than-great options.

    Therefore, attacking mandates as Obama does, both in this mailer and as he has in debates and such, is rather tangential to the possible implementation of desirable Universal Healthcare. It means that UH will have to earn its place in American life instead of being decreed by fiat. That may mean UH will take longer to get here, but it also means the program that is implemented will likely be better for everyone.

  • Hmm, i would really like an option for health insurance that didn’t force me to choose between paying my rent and paying for health insurance. My boss isn’t going to offer a company plan, and realistically, he couldn’t offer one that would be affordable to either him or me. I’m lucky to have a job in my area…much less one that i actually like. And my other employment options wouldn’t offer insurance either. I know that i’m hardly alone in this situation.

    Honestly, i don’t think that either of their plans will take wings, much less fly as the candidates currently describe them. So it bothers me that they’re arguing about details. And i worry about the idea of mandates. Let’s just say that the government passes a health care plan that is bad, or gets bungled, and we’re all mandated to be a part of it. What then? (I’m a cynic, so my trust in the government handling anything efficiently and effectively is low.)

    I’m not sure that tackling this issue at the federal level is the way to go about it. Having been a legal resident of two EU countries and S. Korea, i have actually participated in universal coverage…and its really, really nice. (I also participated in Russia’s universal coverage, but we don’t want to talk about that.) The difference is that the countries that do this successfully are smaller than the US, both population wise and geographically. I’m slowly coming to the conclusion that we might make better headway doing this through the States, and use the Federal government to make sure that if you move your coverage is transferable. Or try and get the federal government to provide the most basic coverage and use the states to enhance the coverage.

  • Just a couple of hours ago, bubba responded to a post with, “Please put down the kool-aid you are drinking…

    Good natured ribbing? No.

    Lazy and arrogant? Definitely.

  • Zeitgeist – I agree 100%. That’s why any universal health insurance plan has to include mandates. Otherwise, people will spend their money on 50″ HDTV’s and hope they don’t get sick.

    JB – can you give some examples of people who think Obama’s plan will result in lower premiums that Clinton’s? My understanding is that they have similar cost controls (the exact details of which are vague). Clinton has done a ton of research into controlling medical costs and it is hard to believe that Obama has a better plan on that front. Here is the AFL-CIO comparison of their health plans.

  • Responding to Dennis_D
    Robert Reich

    “[Hillary Clinton] says [Obama’s plan] would insure fewer people than hers. I’ve compared the two plans in detail. Both of them are big advances over what we have now. But in my view Obama’s would insure more people, not fewer, than HRC’s. That’s because Obama’s puts more money up front and contains sufficient subsidies to insure everyone who’s likely to need help – including all children and young adults up to 25 years old. Hers requires that everyone insure themselves. Yet we know from experience with mandated auto insurance – and we’re learning from what’s happening in Massachusetts where health insurance is now being mandated – that mandates still leave out a lot of people at the lower end who can’t afford to insure themselves even when they’re required to do so. HRC doesn’t indicate how she’d enforce her mandate, and I can’t find enough money in HRC’s plan to help all those who won’t be able to afford to buy it. I’m also impressed by the up-front investments in information technology in O’s plan, and the reinsurance mechanism for coping with the costs of catastrophic illness. HRC is far less specific on both counts. In short: They’re both advances, but O’s is the better of the two. HRC has no grounds for alleging that O’s would leave out 15 million people.”

  • RE: Mandates

    [via Mark Kleiman’s blog] More than 80 clinicians and health policy experts penned an open letter on the two plans, and focused on the mandate issue. Key part:

    The remarkably similar health plans proposed by Senators Clinton and Obama have the potential to reduce the number of uninsured Americans (citizens, permanent residents, and others lawfully present in the U.S.) to two percent or less of the population. Achieving this goal would require full implementation of these plans’ subsidies and insurance market reforms, plus robust outreach efforts to get everyone to sign up for coverage.

    The necessary outreach will not be easy, and it will be fruitless unless health insurance is made affordable and accessible to all. Some believe that an individual mandate to buy health insurance should be part of this effort; others hold that a mandate would be paternalistic or too onerous for families at the margins of affordability. Regardless of our feelings on this issue, what is clear from the evidence is that mandates alone, without strong incentives to comply and harsh punishments for violation, will have little impact on the number of uninsured Americans. Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions. There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible.

    The inaccurate claim that an individual mandate alone would reduce the ranks of the uninsured by 15 million draws attention away from the challenges we must surmount to make good medical care available to all. These challenges include adequate public subsidies, insurance market reform, outreach to people at the margins of American life, and long-term control of medical costs. Individual mandates may have a role in health care reform, but there is risk of a specious “Mission Accomplished” moment. It is a time for rolling up our sleeves and addressing the hard work required to get everyone care. The central challenge is to make health insurance affordable and accessible, and to reach out to all Americans to help them obtain coverage. Voters should insist that candidates for president address these very real issues.

    The complete text is here at HuffPo. I don’t know who these experts are, or what their agenda is, I’m just throwing it into the discussion…

  • Come on, Michelle. Robert Reich hates the Clintons, so he is not an impartial observer. There are lots of people out there with opinions on healthcare, so citing one isn’t very compelling.

    Here is an analysis by a think tank highly recommended by Ezra Klein:

    In this brief we conclude that, absent a single payer system, it is not possible to achieve universal coverage without an individual mandate. The evidence is strong that voluntary measures alone would leave large numbers of people uninsured. Voluntary measures would tend to enroll disproportionate numbers of individuals with higher cost health problems, creating high premiums and instability in the insurance pools in which they are enrolled, unless further significant government subsidization is provided. The government would also have difficulty redirecting current spending on the uninsured to offset some of the cost associated with a new program without universal coverage.

  • Michelle, from the same post by Ezra Klein:

    Obama is, of course, right that affordability is an issue, and needs to be in place before a mandate. But what a mandate does is, additionally, force you to think about affordability. The Clinton campaign does that, with a plan that limits total expenditures to a percentage of income. Not a dollar amount, a percentage. If you make very little, your total expenditure, by law, can’t be very much. Obama’s plan has a more traditional subsidy mechanism that simply goes on a sliding scale by income, and given how much money goes towards his reinsurance plan, he’s actually got less in there for subsidies than Clinton. So while he’s warning that she’ll make you pay even if you can’t afford it, she’s actually got the right affordability mechanisms in there — she keeps it to a small percentage of income. By pretending her plan lacks those and is just a mandate, he’s misrepresenting its fundamental premise, in much the way the Clinton campaign misrepresented his arguments on Social Security taxes.

    In the end, his plan is not universal, does not attempt to be, and is probably less generous in its affordability provisions than Clinton’s. And even so, I wouldn’t really care, as it’s still a pretty good plan, except that he’s decided to respond to the inadequacies of his own policy by fear-mongering against not only better policy, but the type of policy he’s probably going to have to eventually adopt. It’s very, very short-sighted.

  • “Good natured ribbing? No. Lazy and arrogant? Definitely.”

    Did you bother to read what it was in response to? Someone took one small, and incomplete, tidbit out of a comment and then proceeded to misconstrue the entire comment. It was stated after explaining the purpose of the original comment (which I, at least, think was pretty clear and in no manner was rendering judgement on anything–but I have been in error before). Lazy and arrogant–I think not. 100% accurate in response to that one post–and it was not even an entirely negative tone in that I had hoped to get the person to put the past behind him/her and actually focus on the future for his/her candidate, as that would be the most productive use of that person’s time, instead of misconstruing comments on blogs such as this.

    As for the comment above, it was good natured ribbing–applying to all the kool-aid drinkers for all the candidates who are represented here, and followed by a compliment that it IS nice that they back their candidates 100%.

  • ***Shelley***Bullshit. As soon as the topic was brought up CB began downplaying the significance. “…And all of this might have even hurt Obama a bit, if the Clinton campaign hadn’t gone too far in its response.”…”…First, the Clinton campaign, understandably angry about the healthcare mailing, would have more authority to complain if it hadn’t sent out an anti-tax mailing in New Hampshire and Nevada that looked like it had been written by the Republican national Committee…” …”…But comparing the mailing to Nazis marching through Skokie…” So rather than really just looking at what had been done which CB admitted was really a mess, suddenly it was being justified by “she hit me first” justification. Her mailing was wrong…further down the road…his mailing is wrong…it’s not more understandable because hers was wrong. Say anything about Obama and watch ’em jump. It’s not hypocrisy to say “Damn, I thought we were done with this kind of shit, yet here we go again.”

    The only way to make universal single payer national health care affordable for all is to make it NOT FOR PROFIT. Remember, It’s not just having the coverage, it’s also ‘being’ covered. Not being denied care just to increase the profit margin of the corporations bottom line. That’s the main point we are being distracted from, getting the treatment we need without having to worry about the stockholders profit. Socialized medicine is when the doctors and hospitals are owned and operated by the government. National health care is when the “INSURANCE” for health care is provided by the government. Medicare and Medicaid work already, can be improved on, can be made to include everyone, and can be functional for all of us within 3mos.And are extremely affordable
    The health ins. lobbyists and big pharm are out there trying to make sure that profiteering remains in our health care system and our 2 candidates are both trying to figure the most affordable way to keep the hand of profit in our healthcare. Neither Obama nor Clinton is willing to stand against this army of lobbyists in order to get the profit out of our health care system and this is where we should be focusing our attention. Talk about aiding an economic stimulus package. We have answers to most of our problems but they are stonewalled by privatizing and profiteering. Our bridges, our roads, our education and our health care could all be paid for by one year of spending on Iraq. These should not be privatized or profiteered. Maybe we should send a mailing of our own to both candidates showing how health care can cover all and be affordable. When will they listen to us?

  • read the facts the Nazi statement was not made by the Clinton Campaign. The Clinton Campaign did not like that statement and said so. About the mailer, The people pictured are the ones that make it mandatory that everyone get insurance. Diamond earrings and a wedding ring with a lot of diamonds and they can’t afford insurance? Look at the mailer

  • Anne said: “Might be time to lose the “right on Day One” meme, because this was just wrong.”

    Obama, wrong on Day – 353.

  • C’mon Dennis_D. Your “Reich hates the Clintons” argument isn’t true and doesn’t sell — but you can use it anyway if it makes you feel better. Reich is an economist and former Secretary of Labor…Klein is a writer.

    That said, per your own post, Klein agrees with Reich: “Obama is, of course, right that affordability is an issue, and needs to be in place before a mandate.

    With regard to Klein’s argument, “given how much money goes towards his reinsurance plan, he’s actually got less in there for subsidies than Clinton”. That’s like saying that since Obama’s putting more money into diabetes prevention, he’s got less in there for foot amputations (picking up an analogy Obama used last night). The reinsurance component is critical to lowering actual premiums…hence, fewer subsidies are required.

    Incidentally, the reinsurance component was an essential party of John Kerry’s healthcare proposal in 2004.

  • I think it’s something the Bush administration has added to the water so we are all involuntary kool aid drinkers. Such eagerness to attack. Such thin skins. None of us would survive an hour as politicians.

  • The guy is running for President, and can’t even do a simple mailing.

    Anyway, OT, but some good news…”Snipes Acquitted of Tax Fraud”! Good for him! Convicted on “three misdemeanor counts of failing to file a tax return”, but beat the major one/s. American’s are tired of paying taxes, and especially tired of the IRS. We need to do away with the IRS, bring in the FairTax system, but Politicians like Obama won’t allow it.

    Cut Taxes until the Politicians can’t spend…can’t spend for anything beyond defense and protecting the rights of individuals!!!

  • This is a great ad by Obama.

    Commenters have said he is using Republican frames but what you really mean is that he is using the visual imagery from a highly successful ad that in part spurred 12 years of Republican control of the House and that reminder brought back painful emotions.

    Sans prior history, there’s nothing objectionably wrong about the ad. You would think if you wanted to win that you would want Democratic candidates to choose the form and style of previous ads that resonated with the public.

    But apparently it more important to some people to avoid being reminded of past failures than it is to have a candidate who learns from those same mistakes.

  • …he is using the visual imagery from a highly successful ad…– Observer

    True. Except that the highly successful, historical ad the brochure conjures is an icon for bullshit framing — and one that took universal health completely off the table. The image completely backfires for someone trying to claim honesty or promote universal health care.

  • Michelle, Reich is mainly a pundit now days. He doesn’t have any expertise in health care. Read his blog and see that it is all over the place. Klein is a writer who’s expertise is health care. Read his blog and you well see lots of posts on health care issues. Reich is not impartial when it comes to Bill and Hillary Clinton as he considered himself Locked In The Cabinet. So far, Klein has refused to endorse either candidate and has been equally critical of both.

  • If I’m reading this right, both sides seem to be dodging the real issues and just fighting for position. So it’s a draw.

    I think at this point they should just say “Here’s my plan, but we’re going to study the health care options that are available to people in all the industrial nations, and figure out how to combine the best ideas from America and other countries like ours”. After the election have lots of town hall meetings and get the experts to hammer out a plan. Everything they’re proposing now could end up on the floor, and if they do it right and we’re lucky we’ll get a UHC system that learns from all the ones out there.

  • Health Care 101:

    Convert to single-payer. Buy the coverage in bulk, paid for in advance. Whoever needs a medical service goes to their neighborhood physician. Getting into the hospital means getting an okay from that neighborhood physician. Get rid of the unwarranted trips to the emergency rooms. Costs go down.

    Place a “night duty” requirement on medical licensing. establish centralized medical facilities that become “pre-admission units” (PAUs). If you get sick or your kid wakes up with a high fever in the middle of the night, simply call the local PAU and let them know you’re on the way. All doctors are required to spend a few nights every year working in their local PAU as part of renewing their licenses. Single payer pays for these units, their equipping, and their staffing. They can be nothing more than a 3,000-square-foot storefront operation—and not an 18,000-square-foot, for-profit emergency center that costs several thousand dollars an hour just to maintain and won’t see anyone that doesn’t have the “right kind of insurance.” Costs go down.

    For an emergency, utilize emergency response via paramedics. Just about every fire department has a few of these floating around, and the bulk up-front payment also pays for constant upgrade training for these first responders. If it’s truly an emergency, the first responder paramedics have the ability to make immediate determinations in the field and to begin initial triage and treatment both before and during transport. Two paramedics and a squad unit also costs less than your average trip to the emergency room—so costs go down.

    Paying for everything up front means medical facilities and their physical plants (buildings/infrastructure/equippage) move into preventive maintenance and upkeep. That CT unit gets changed out when it needs to be, and doesn’t keep getting patched back together. Same with primary x-ray equipment, ICU stations, monitors, computerized drug-delivery mechanisms—right down to pillows, sheets, and hospital gowns. Everything gets bought in greater centralized quantities, so there’s a bulk-rate discount. Increased demand for everything equates to increased production and manufacturing—causing increased manufacturing capacity and more jobs—invoking more funding into the single-payer program without increasing the cost-per-person. Costs go down.

    Giving people the ability to seek medical attention on Day One instead of Day Twelve means they receive medical care quicker, and the time required to be under a physicians care is reduced. If the illness is something contagious, the sick person spends less time giving that illness to others. If an illness or injury is trested right away, there’s less time lost from work and family. Costs go down.

    Rather than everybody badmouthing the other guy’s plan, why not just go all the way out on the limb with three little words?

    COSTS GO DOWN.

    “HillaryCare” couldn’t even bother with that little detail; they played up the sob-story of millions without healthcare coverage. Now, everyone wants to throw in the red meat of “forcing people to buy coverage.” If someone’s kids have empty tummies, do you think they’re going to give a rat’s backside about a requirement to buy insurance? You can seize someone’s car and their driver’s license if they don’t have auto insurance. What does the big bad government propose repossessing if someone doesn’t buy health insurance? Body parts? Internal organs, maybe?

    Please—someone go to these politicians and take their stupid pills away….

  • The mailer is certainly not helpful in our quest for universal health care. Is this what we can expect from “Mr. Hope?”

    Geezzzzzzzzzzzz

    BAC

  • Flip it and twist it, and make it about Hillary, not Obama.

    The statement was made by Len Nichols, who IS NOT part of the Clinton campaign.

    Jeebus, why don’t you just call yourself “fair and balanced?”

  • Why is it that Senator Clinton has been using the made up number of “15 million people” not covered under Senator Obama’s plan for months, and now one has blinked?

    Now when Senator Obama points out that Senator Clinton’s plan FINES people who can’t afford healthcare, that’s a problem?

    You already KNOW FOR SURE the Republicans may indeed bring this up, so give it a rest. The truth hurts. Deal with it.

  • Hey, “America” – you got it backwards. Obama’s is the plan that would, in essence, fine people who don’t sign up for health care. In fact, one of the criticisms of Hillary’s plan is that it has no “teeth” in it – no consequence for people who don’t sign up. In Obama’s plan, those people who get sick and then want in would have to pay back premiums to do it. Not sure how far back he goes, but it seems to me that if a person didn’t sign up because he or she couldn’t afford it, that person isn’t going to be able to afford back premiums AND premiums going forward AND the cost of the care received while uninsured. This is why Hillary’s plan MANDATES coverage. And why she has a plan to make it affordable, which was provided in short, above, and which is provided in detail on her website.

    Which I am pretty sure you won’t go look at.

    And the “15 million” you think was just some made up number was arrived at by some careful calculation – it’s true that others making similar calculations have arrived at differing numbers, but there is a consensus that Obama’s plan will not cover everyone.

    If you can go “big picture” for a couple of minutes, I think you should look at that mailer and ask if it advances or moves backward the fight for universal care. Go back and read Steve’s post, actually, and see what the argument is against it. While this thread has devolved into a wonky examination of the minutiae of health care plans, the original issue was what the mailer was going to do to the chances of ever having universal care.

    It was a case of short-term thinking at the expense of long-term goals. “Right on Day One?” I don’t think so.

  • Anne,

    Does that mean that this is yet another instance where you just bypass my commentary? I gave a response like it never existed? I responded to your worries, just like you asked someone else to do. You then ignore any of the issues I bring up as wonky and ignore their implications when they don’t favor your POV. It really is starting to get old.

  • socratic_me – I wasn’t responding to your earlier comment, so if you had the impression that I was – I apologize.

    Let me respond. You said:

    I consistently prefer progressive policy proposals. However, I consider myself a Burkean conservative in that I think you shouldn’t just instigate a program because you think it will be better. You actually have to let the idea prove itself.

    But you have to start somwhere, don’t you – it can’t just be the health insurance version of “hey, kids – let’s put on a show,” can it?

    From this point of view, you see Universal Healthcare as most probably the best solution and simultaneously think that the best way to get there is to offer cheap, affordable, effective government-maintained health insurance to everyone and let it prove itself as the best option. As it does so, it will consistently push the competition out of the market until the move to true government-sponsored universality is most symbolic.

    I’m not sure I said that, and I’m also not sure I see it that way. I know that some have said that the Medicare model ought to lend itself well to eventual universal care, and could begin by dropping the age at which people became eligible. It seems to me that the Medicare model is single-payer with choice – one central body that process and pays, with subscribers still having their choice of provider. I know there are problems with it – doctors are not happy with reimbusement rates, and more providers not accepting Medicare as payment in full for services. Most people on Medicare have supplemental insurance, so there is still an affordability element.

    In contrast, you see attempts to mandate Universal Healthcare into existence as troubling attempts to rig the game in your favor. Mandates don’t actually test to see if the idea is as viable as we think it is. Instead, they insist on this fact from the beginning and then hang the citizen if it turns out that the programs suck. Mandates also encourage poor management by removing any mechanisms for negative feedback. People have to be enrolled in the programs whether they suck or not, so there is less incentive to make sure they work effectively or efficiently. In many ways, this is the problem many of us run into with healthcare already. It isn’t that we don’t want it; our options for getting it are just terrible so we feel forced to accept less-than-great options.

    I don’t disagree with you that mandates and mandates alone are the answer. Even with universal coverage, the quality of that coverage and the quality of the delivery of service is going to vary wildly for the same reason these things always vary – one’s ability to pay for “better” coverage.

    Therefore, attacking mandates as Obama does, both in this mailer and as he has in debates and such, is rather tangential to the possible implementation of desirable Universal Healthcare. It means that UH will have to earn its place in American life instead of being decreed by fiat. That may mean UH will take longer to get here, but it also means the program that is implemented will likely be better for everyone.

    I agree that it is not going to get here overnight – but you’ve seen in this thread and in discussions all over the place, that the issues are complex enough that a mailer like Obama’s doesn’t begin to cover it – it can’t. No one’s mailer could possibly do justice to the issue.

    My concern was less with the details of each candidate’s plan than it was with the overall message it sent and how that message could be used by those who are flatly opposed to universal care – because I think when all is said and done, when both candidates attack each other’s plans, it probably just makes it easier for those opposed to just kill it .

    I truly did not mean to ignore you – sometimes I miss comments just like everyone else as I go from thread to thread. 🙂

  • D’oh! Re-reading my comment to you, socratic, you should ignore the first part – I misread your #70 – thought that you thought my response to “America” was a response to you.

    Argh – I’m making this worse – but I hope you can understand what I meant. The sun is out for the first time in a couple of days, so maybe it has partially scrambled my brain.

  • HMO’s suck. Can’t we agree on that? Wasn’t that the point of Harry & Louise?

    Anyway mandates do mean that you’re going to be forced to buy into a plan and the government is going to decide if you can afford it or not.

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