Physicians for a National Health Program (PNHP) comment on plans of Obama, Clinton and Edwards

[caligirl]

The leading Democratic presidential candidates’ (Clinton, Edwards, and Obama) health care proposals would require everyone (or every child, in the case of Obama) to carry health insurance and offer federal subsidies to help reduce the cost of private health insurance. The centerpiece of their plans is an “individual mandate,” requiring everyone to buy health insurance, and an “employer mandate,” mandating that employers help cover workers. The following experts can comment:

DON MCCANNE, M.D., is senior health policy fellow of Physicians for a National Health Program. He said: “The administrative complexities of refundable tax credits and means-tested premium caps would still leave many without coverage. Coverage will never be universal unless it is truly automatic for everyone. If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.”

Dr. McCanne continues: “Neither Clinton’s nor Obama’s plans get us to universal coverage. Clinton claims that her plan is going to get universal coverage because it has an individual mandate, but that’s been tried and failed in several states. … Obama claims his plan gets universal coverage by making coverage affordable for people, but if you look at his proposals, there’s very little substance to it.”

http://www.pnhp.org


Single payer resource page http://www.pnhp.org/facts/single_payer_resources.php

DAVID HIMMELSTEIN, M.D., is associate professor of medicine at Harvard Medical School. He said today: “Hillary Clinton is combining two failed Massachusetts plans: the Dukakis plan, which fell apart 20 years ago, and the Romney plan, which is in the process of falling apart. Clinton is advocating the Marie Antoinette approach to health care: ‘Let them buy their own coverage.’ She is attempting to force middle class families to buy coverage without making it affordable. Clinton wants to keep the private insurance industry in the middle of the system.” Himmelstein is co-founder of Physicians for a National Health Program. http://www.pnhp.org

QUENTIN YOUNG, M.D., is national coordinator of Physicians for a National Health Program. He said: “It’s always ironic to hear Clinton talk about standing up to the insurance companies. She’d tried to work them into her plan , which is a large part of why it failed. The biggest insurance companies actually backed her plan for a time while the smaller ones opposed it.” http://www.pnhp.org

DONALD FREY, M.D., is Roland L. Kleeberger Chair in the Department of Family Medicine at the Creighton University School of Medicine in Omaha, and is a member of Physicians for a National Health Program. He has written and spoken extensively about wasted overhead in American insurance companies, and says other countries spend less money to get far better, measurable health care outcomes. He said: “Though well intended, the Clinton plan leaves an enormously wasteful private insurance system intact, ensuring that increased coverage will only come at extremely high cost. Federal dollars will be funneled through high-overhead private companies, ensuring that millions of tax dollars that could be going to pay for health care will actually wind up as enhanced corporate bottom lines. In many ways, the plan is far more a corporate welfare program than a social welfare plan.”

Full Comment on Sen. Clinton’s Health Care Refrom Proposal By Don McCanne, MD, PNHP Senior Health Policy Fellow

Hillary Clinton’s proposal “preserves existing health insurance,” and includes the responsibility of individuals “to get and keep insurance” through the current private insurance market, or through a “Health Choices Menu” of private FEHBP-type plans, or through a Medicare-type public program.

Thus her proposal is an individual mandate to purchase private insurance that is no longer affordable for average-income individuals, or to purchase a public plan that will be even more expensive because of adverse selection.

To make the plans affordable for individuals, she would use a combination of refundable tax credits and a cap on premiums at a percentage of income. Assuming that the plans would provide adequate benefits and adequate protection against financial hardship, the increased spending through the tax system would be exponentially more than the estimates in her plan. And most of the proposed savings to pay for these increases are largely nebulous, and some of those measures would actually increase costs.

Further, the administrative complexities of refundable tax credits and means-tested premium caps would still leave many without coverage. Coverage will never be universal unless it is truly automatic for everyone.

If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.

Many will try to contrast the differences in the Clinton, Obama and Edwards proposals, but they are all basically the same. In spite of their rhetoric, they have each made the protection and enhancement of the private insurance plans a higher priority than patients.

[papau]

1. Excellent summary :-)

[caligirl]

2. please rate this and kick this up, its great info for everyone to copy down.

[sandnsea]

15. Oh, so now mandated health care sucks

And the Mass plan won't work and tax credits are not effective.

Unbelievable. You were just defending it a few minutes ago.

[caligirl]

19. This is another problem with the way they want to fund it, it creates

more bureaucracy, more expense to deliver this to the public. If they just did it the right way upfront, single payer, without Aetna BCBS or CIGNA, people would easily have access to medical care.

This is what I was trying to say:“The administrative complexities of refundable tax credits and means-tested premium caps would still leave many without coverage. Coverage will never be universal unless it is truly automatic for everyone. If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.”

[papau]

21. I agree - but this is actually a cost saver compared to the current transfer of cost around the loop

system that is eventually paid for by the tax payer.

It does not achieve the 20% savings that is the low lying fruit of a single payer, but it reduces local town taxes by more than the extra funds the state is putting in - and it is simpler for everyone.

Only the federal folks can pick up that 20%, and mandated w/ medicare like option is a slow way to achieve it - but it at least puts us on the path.

And you are of course you are right about it not being truly universal until that medicare like policy goes from something you buy into to something you pay for via taxes and are entitled to.

[truedelphi]

34. You go, girl

The powers that be already have the middle income person strapped to the treadmill of two jobs (in some cases two jobs for each of two parents)

And those jobs are taxed heavily.

Meanwhile the investors and those who "feel" they are "middle class" are receiving more and more from government. The rich have more disposable income than ever.

Now in addition to the taxes that the middle income pay, the middle income person should try and pay health care out of pocket?

*After* the high paying jobs already have left the country, inpart because, as GM said, "The cost of doing business in America, with high benefit payments, is too prohibitive."

SHEESH!

[papau]

20. Good grief you just choose to not understand that single payer is the goal and mandated w/ Medicare-

like option is the way to the goal

without the mandate the goal becomes a lot harder to reach.

The Mass plan "won't work" means that none of the Democratic proposals will work - do you really believe that?

[sandnsea]

26. The mandate will bankrupt people

if it's implemented too early. That's why they have all those exemptions in Massachusetts. Edwards doesn't mandate anything at the front end either.

Yes I understand none of these plans will ultimately work. I also understand that we aren't even going to get the first step if we start pushing mandates before people are convinced they can handle the costs and quality won't suffer.

[papau]

35. Now that is a reason for "no mandate" - if GOP votes are needed and they feel as you do that

we can't be "pushing mandates before people are convinced they can handle the costs and quality won't suffer" - then not having mandates may be the only way to get the change passed.

I do not agree this will be the situation - but the reasoning is quite reasonable.

[rhite5]

18. There is ONE plan that cuts out the insurance corporations ........

This is the Single Payer Plan proposed by Dennis Kucinich.

It would provide coverage very similar to what people are getting in most western countries right now.

No H.M.O.s that can deny coverage. No hidden "co-pays". Every citizen is eligible.

Best of all, an entire layer of profitable insurance corporations is left out and tons of paperwork is eliminated.

This is what Physicians for Single Payer want.

[papau]

22. true - indeed that is what we all want - but selling "no choice" to Americans is not happening

[stimbox]

30. I'd rather have one good choice than 100 shitty choices. n/t

[avrdream]

3. This one particular question about Clinton's plan keeps coming up:

"If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone."

This is the ideal way to go about it but the realists of the candidates know that we are going to have to take down the insurance industry bit by f-in bit, they are that strong.

[caligirl]

5. I am betting on Edwards because of this.

[tammywammy]

4. recommended!

[caligirl]

6. thanks.

[tammywammy]

7. And thanks for the link

I'm going to check out that site more tomorrow. :)

[maximusveritas]

8. "they are all basically the same"

That's my impression as well.

There's one sensible solution: a single payer plan

[killbotfactory]

9. Yep. Single payer is the only real solution

Now if we can just win a super majority in congress...

[sandnsea]

17. They aren't all basically the same

The only way one could consider them basically the same is if one wasn't going to have any problem making a monthly insurance premium payment.

[papau]

23. LOL - I have a problem paying taxes - but few find that of interest if taxes are via progressive

rates in the law - meaning ability to pay is taken into consideration.

All the plans have subsidy - and are therefor progressive - but as you know - Only one plan - Obama's - continues the current system of folks being told it is OK to not be covered because the rest of us will cover you for somethings - and just forget about preventive care for all and accept the idea of preventive care for a lot of folks - and forget about expensive things and just die - and god forbid we incent folks to better health via taxes or premium based concepts that must be paid - much better to continue the role of worthless tiny coverage policy sales - or non-sales - via insurance salesmen. A classic GOP choice approach.

[sandnsea]

27. Edwards doesn't mandate immediately either

They ALL continue insurance. Every single one of them. They ALL have a public plan along side the insurance.

And working income people get EIC refunded in their paychecks to help offset taxes. Nobody has said they are going to do that, although Obama's plan is based on subsidy, not end of the year tax credits.

[slipslidingaway]

10. K&R n/t

[burrowowl]

11. K&R

Only Kucinich has a real single-payer health plan!

[penguin7]

12. Why have so many sold out to these other candidates?

Is it ignorance or what?

I will probably vote for Obama or Hillary in the general holding my nose, but why in the world are people actually sending money and volunteering for these candidates? It is all beyond my comprehension.

[caligirl]

13. I am supporting edwards, but people have vering tolerance levels

and can look or overlook things you or I cannot. these three got to where they are for reasons other than single payer, patient centered priorities. They care more about their future and survivng in DC than our need for single payer. We may all be holding our nose election day, we should hold them to account for this short coming in their health care plan NOW.
The CNA has a video on Obama's plan, I posted it in GDP.

[CTyankee]

28. Well, as far as health care plans, I think the major candidates feel that taking on the powerful

health insurance industry is not viable and they are not going away. Also, HRC herself said that some people told her (focus groups) that they liked their plan and were afraid they'd get something "less" with a "government plan." I've actually heard that myself, but that is purely anecdotal, I realize.

The other issue has to do with convincing the Republicans. In "The 2% Solution" Matthew Miller talks to a Dem and a Rep member of Congress about univeral health coverage. The Rep was for it, however, he felt it could only be sold to Reps as a "tax credit" deal. Giving people tax breaks is the thing with them. Miller takes the position that we must resign ourselves to having health care industry in our health care, but argues, somewhat lamely IMHO, that Dems should just look at it as a "jobs program."

[eridani]

39. The opinions of people who have never been expensively sick are worthless

80% of the population doesn't know what any more about what they are getting for their insurance dollars than they know about whether their local fire department is any good--and if they are really lucky, they never will.

Has everybody forgotten that SiCKO was about people who were INSURED? They all thought their insurance was good until they actually had to use it.

[sandnsea]

14. We have SCHIP and children are cheap to insure

We will not be requiring parents to have plans that cost hundreds of dollars. It is not the same as mandating expensive adult care.

Obama's plan is also not contingent on tax credits.

They are not the same. In spite of their rhetoric.

[papau]

24. Expensive adult care is paid by either patient or taxes needed to subsidize hospitals - there is no

savings for anything via Obama's no mandate - there is just a shifting of who pays - and a decrease in the quality of health of the population that is likely to result.

[annie1]

16. thanks.

[Cameron27]

25. Thanks

recommend!

[durtee librul]

29. Imho, the first place to start 'saving'

dollars is to take ALL the $$$ the pharma companies are spending on useless stupid denigrating television ads and put it to helping pay for un and underinsured Americans.....but then, that would be way to easy for them.

Plus, take Montel's bus away from him and let him use his own car to peddle his dope.

I could think of a lot more places they could cut 'costs' and put a dollar where it would do more good, but I just get too angry even thinking about it.

We have retiree coverage thru an automotive company and my doc just wrote a scrip for me only to have the mandated mail order place call her and 'suggest' another generic in it's place. Of course, the new 'generic' was much cheaper and therefore as we are on a budget, had to chose that option...and the damn things don't even work. Blood counts are back up, etc.....yepper, working good there. At least we have 'coverage.'

The next time I see a commercial for people in two bathtubs on a cliff overlooking the sea, I am going to do the same thing when I saw Ronnie Raygun's coffin sitting on a cliff - close my eyes, cross my fingers and hope for a localized earthquake where they all disappear.

[Laelth]

31. I am terrified by the thought of being ordered to buy insurance.

I do it for my vehicle, of course, but if I couldn't afford the insurance any more, I can still legally choose to not drive. According to the description in the OP, I'll be a criminal if I don't buy health insurance. I don't have health insurance now because I can't afford it. What if I can't afford it when one of these plans goes into effect? And, even if I scrape enough money together to buy the insurance, I likely won't be able to afford the co-pays, so, like now, I will just go without any medical treatment. Except, in addition, I'll be paying for insurance coverage that I can't use.

That's maddening!

-Laelth

[caligirl]

32. Edwards plan would at least make it possible

As of now, the plan doesn't explain how much employers must provide towards health market coverage, but it's a safe bet to assume that it's somewhat less than the total cost of health care, and so the incentive will be for employers to encourage their employees to purchase from the HMs. And that's where things get interesting. The HMs will offer a menu of private options that are totally community rated. The plan "will require insurers to keep plans open to everyone and charge fair premiums, regardless of preexisting conditions, medical history, age, job, and other characteristics." These days, though, community rating is a common enough.

Where the Edwards' plan takes a big step forward is in mandating, along with the private options, that HMs offer "at least one plan would be a public program based upon Medicare." And the intent is explicit: "Health Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."

In other words, the public sector will finally be allowed to compete with the private sector, and consumers will be able to decide which style they prefer. For Democrats, this is a significant step forward. From there, the plan offers the usual mix of sliding subsidies to ensure affordability, individual mandate to universalize coverage, pay-for-performance promises, and public health fixes. You've heard those bits before. What's new, and what's important, are the community rated health markets that include public insurance. Indeed, the plan satisfied every plank of my progressive health reform test from last week. http://www.prospect.org/csnc/blogs/ezraklein_archive?month=02&year=2007&base_name=the_edwards_health_plan

[eridani]

38. It is flat out not possible to "choose the plan that works best for you"

How in fawking hell can anybody anticipate serious health problems? There can never be a "market" for products that don't get used. People who never get expensively sick never use insurance--how could they possibly know what is "best for them"? 20% of the population is responsible for 80% of health care costs.

[no name no slogan]

33. Just throwing good money down a corporate sinkhole

Fattening up the pockets of corporate health care-- just what the nation needs.

Single-payer, universal health care has had enough popular support to be a plank on our party platform for years-- why won't the frontrunners WAKE UP?

Instead we keep getting warmed over versions of the plan Nixon was pushing in 1974. How sad is that?

[Cleita]

36. K&R

:kick:

[eridani]

37. Timidity won't work

http://www.pnhp.org/news/2007/february/timid_ideas_wont_fi.php

Like Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business. He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.

The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.

<snip>

Over the past year, a solid majority of those who do have coverage — 60 percent — experienced an increase in the amount they are responsible for paying under their plan, the Employee Benefit Research Institute says. Almost a third of covered workers reported difficulty in paying for basic necessities such as food, heat and housing because of rising health-care costs.

This isn’t much of a foundation upon which to construct a new system. In the years since Clinton tried to build on this inhospitable terrain, the ground has eroded further. It makes no sense to try to shore it up with an awkward hybrid of public requirements and private insurance that would keep in place unnecessary complexity and bureaucratic expense.

Edwards’ advisers say the candidate didn’t push public, single-payer insurance — like Medicare — because the employer-based system is what we have today and therefore, it would provide the quickest way to cover the uninsured.

But we also have Medicare today. The elderly still get care from private doctors and hospitals, and administrative costs are a fraction of what they are in the private insurance industry. And people tend to like it.