Tag: health care

Obama’s unhealthy choice


Ezra Klein hits the Obama campaign for a short-sighted attack on the Hillary Clinton’s healthcare proposal. The campaign is sending out a mailer (above) that, as Klein points out, is remarkably similar to the Harry and Louise ad (below — both images are from Klein’s blog) the insurance industry ran in the early 1990s to squash what Hillary Clinton’s task force was proposing.


Here’s what Klein has to say:

The Obama campaign kept their hairstyles and barely even changed their clothing — which is really quite unfair to Harry and Louise, who probably let go of the plaid years back. What’s worse is that the argument they’re making is applicable to any kind of universal health care arrangement, including the arrangements Obama himself will eventually have to adopt:

An “automatic sign-up,” a la Medicare, would still force Americans into health care they may not want to pay for, or may feel overburdened by. Some seniors feel overburdened by Medicare’s cost-sharing now. Meanwhile, Obama not only has a mandate for kids in his own health care plan — what if the parents can’t pay, one might ask? — but he said, in last night’s debate, “If people are gaming the system, there are ways we can address that. By, for example, making them pay some of the back premiums for not having gotten it in the first place.” That, of course, is exactly what a mandate does. Gaming the system, in this context, means not purchasing health care. And Obama is now threatening to force them to pay back premiums. That’s a harsher penalty than anything Clinton has proposed.

The key, as he points out in another post on the Urban Institute’s report on health care mandates, is that you can’t achieve universal coverage without some form of mandate. Otherwise, you create a tiered system with the poor being served by Medicaid, the rich buying their own Cadillac care and the rest left to fend for themselves without any recourse.

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The Blog of South Brunswick

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Debating health care

Paul Krugman has been correct about the recent rightward drift of the Obama campaign, especially on health care, as the Illinois senator attempts to separate himself from Hillary Clinton and John Edwards and potentially draw in some independents. And Krugman is right that health care is probably the most important domestic issue of this campaign.

But, as this post from Scarecrow on FireDogLake demonstrates, the Clinton and Edwards plans are only partial fixes, better than Obama’s incomplete plan and everything that has been offered by the GOP.

A key point is that “mandates” require penalties, and you need economic experts to design a “good” penalty system that will lead companies (or individuals) to make rational decisions that are consistent with the result you want to achieve, without adding significantly to the total cost.

Individuals also face these kinds of choices. If they confront a “mandate,” the rational thing to do is to consider the “penalty” for non-compliance versus the cost and benefits of complying. In Massachusetts, the Legislature was leery of imposing tough penalties on the uninsured, so the first year penalties are quite small — only a fraction of what it would cost to purchase insurance on your own. Result: many people are deciding, quite rationally, not to purchase insurance.

Finally, there’s the state subsidized pool. The rational thing for employers and individuals to do is to avoid providing/paying for insurance on their own, pay the small penalty, and move those who choose this route to rely on the subsidized insurance pool. Perfectly rational; perfectly predictable; and that’s what’s happening.
Because of the incentives, thousands of people are winding up in the state subsidized pool, and the Legislature is looking at $150 million or more in unanticipated costs. And that apparently has been the pattern in other states that have tried “mandate” approaches to universal coverage, but gave up because they weren’t willing to raise taxes to cover the rising costs of state subsidies. You need a broad tax base for that, and progressive taxation.

And that’s OK, as far as it goes. But penalties and taxes — especially when taken together — leave the insurance companies in place. Despite what Krugman says about there being a public option, mandate-based programs still rely on insurance companies to cover the bulk of Americans — while also creating a potential situation in which the poorest people are forced into the public portion of the program. That could raise the cost of a public program artificially, making a move to a full public system difficult down the road.

And make no mistake, if we are to ensure that all Americans have adequte insurance — and the issue isn’t just about the 47 million without coverage, but also about the millions who are underinsured — then we need to move to a single-payer system.

Unfortunately, only Dennis Kucinich among the presidential hopefuls is talking about this. And he isn’t being taken seriously by the news media, meaning that single-payer has been removed from the table.

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Unlucky 13 — for the GOP

President George W. Bush’s veto of the State Children’s Health Insurance Program is going to stand — for now — because 13 more Republicans could not be convinced to do what was in the best interest of the nation’s children.

Opponents argue that the expansion of the SCHIP program would extend it to some middle-income families, and possibly some upper-income families.

My response is so what. Health insurance in this country is a travesty and government has — or at least it should have — a responsibility to do everything it can to ensure that as many people are covered as possible. SCHIP is not a perfect program, but it is a necessary stop gap until we all wake up and realize that a single-payer, national plan is necessary.

Shame on the president for his veto and on those members of the House of Representatives and the Senate who voted to uphold it.

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A word on health care

I received this response today to one of my columns in The Progressive Populist (maybe this one). Thought I’d pass it along:

Mr. Kalet:

I saw your column in The Progressive Populist.

We voters know what to do to get government to work. It seems obvious that we do it at our jobs every day. If I have missed something, will you tell me what it is?

There are at least 4 things we do to make a business work: hire employees, decide what we want them to do, tell them, and hold them accountable. The same requirements apply to almost any enterprise. But we voters aren’t deciding what we want our employees in Congress to do, telling them, and holding them accountable. We know 47 million need health insurance. We know Medicare works. But HR676 Medicare-type universal health insurance legislation is stuck in the House. Is this because we voter/taxpayers fail to instruct and motivate our lawmaker employees to serve their employers? Is this why business works better than government?

In the enterprise of government, we employers need to function as effectively as we do in a business or a professional association. A well-funded organization will enable voters to have televised discussion of a proposed law, such as HR676, followed by telephone polling to see if two-thirds of us want our employees to enact it. If so, two-thirds of registered voters can send millions of coordinated E-mails to lobby them to do it. Then we can hold them accountable at election time. We voters need to decide we will accept all 4 of our obligations as employers of the lawmakers in our government, which is our most important enterprise.

Details of the steps needed to effectively supervise our employees are on the Web at thirdmillenniumagenda.us, August 28, paragraph 4. f. “We can implement in government the functions essential to business,” about 500 words.

Most voters would probably jump at the chance to lobby their lawmakers directly if they could join millions of others to press for one specific policy change at a time, such as HR676. Am I wrong? Is there any reason why registered voters couldn’t, shouldn’t, or wouldn’t do this?

Best Regards,

Stephen Claflin

Food for thought.

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