Don't take Obama's word for it on health care, read what the experts say

[ProSense]

Health Mandates: Why Paul Krugman's Wrong -- And A Talk With Obama's Health Advisor

Posted November 30, 2007

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The main difference between Obama's plan and his rivals' is this: They would mandate health coverage first and fix cost problems later. Obama would do the opposite. While both approaches are problematic, there is a strong case to be made that Obama's plan is fairer - and more politically progressive.

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…So I discussed the issue with David Cutler. Cutler is Professor of Applied Economics at Harvard, Obama's senior health advisor, and the principal architect of the Obama plan.
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"I'd like to start with a general comment," Cutler began. "Two possible reasons why people don't have health coverage are usually given. One is that the uninsured are gaming the system. The other is that they can't afford it and don't know where to get it. Most of the literature suggests that the explanation is mostly the latter. That means the single biggest thing we can do to help the uninsured is to make coverage affordable and accessible."

"That's why all the Democratic plans focus on removing excessive profits where they exist, improving information technology, and so forth," Cutler continued. "All the plans do those things, although I think the Obama plan does the most."

"The mandate argument is: You must buy something - but I'm not going to tell you what it is, how much it will cost, or where you're going to get it."

"It comes down to this," said Cutler. "You'll never get someone to buy something if it's not affordable and not accessible. People just don't do it."

That's an area where the Edwards campaign has taken the lead. They suggest automatic enrollment whenever an American intersects with the health care system or government services.

"You can enroll them," Cutler replied, "and then forcibly collect the premiums. That's one way to solve the problem. But it's not necessary to do that."

"A better approach is to do everything possible to make it affordable and available. When it is, almost everyone will have it."

There are a couple of concerns about that approach. One is the problem of "adverse selection." Sicker people - or people with a greater likelihood of becoming sick - will enroll. That will drive plan costs up, making it prohibitively expensive.

"Let's look at the level of coverage you can get without a mandate. Our estimates, based on studies in the literature, is that we can get 98% or 99% coverage without a mandate for adults. There may be some small pockets of people who choose not to buy it."

What about those people?

"If there are free riders, Obama is open to mandates. But what he is saying is 'Look, mandates seem like a panacea, but that's not where the hard work needs to be done.' Auto insurance is a mandate, too, and not everyone has that. You've got to prove to the public that you're willing to do the hard work.'"

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David Culter:

Honored for his scholarly work and singled out for outstanding mentorship of graduate students, Professor Cutler's work in health economics and public economics has earned him significant academic and public acclaim. Professor Cutler served on the Council of Economic Advisers and the National Economic Council during the Clinton Administration and advised the Presidential campaigns of Bill Bradley and John Kerry. Among other affiliations, Professor Cutler has held positions with the National Institutes of Health and the National Academy of Sciences. Currently, Professor Cutler is a Research Associate at the National Bureau of Economic Research and a member of the Institute of Medicine.

Professor Cutler is the author of Your Money Or Your Life: Strong Medicine for America's Health Care System, published by Oxford University Press. This book, and Professor Cutler's ideas, were the subject of a feature article in the New York Times Magazine, The Quality Cure, by Roger Lowenstein. Cutler was recently named one of the 30 people who could have a powerful impact on healthcare by Modern Healthcare magazine.

Barack Obama and Health Care.

85 health care experts.

[mrreowwr_kittty]

1. Thank you for that article! nt

[ProSense]

3. You're welcome. A lot of excellent information at the links. n/t

[sandnsea]

2. Child Support is Mandated too

And it's even automatically garnished these days. And we all know it's far from universal.

[truedelphi]

6. I am sorry -- I do not see the connection.

You choose to have a child, or at least you choose to have sex with someone.

This is a responsibility. Like car insurance. You don't want car insurance payments, then don't have a car. If the thought of a supporting a child is not to a person's liking, then either keep two legs together, use birth control or practice abstinence.

Health insurance is a goddamn right!

Until the income tax tables are re-structured, every man woman and child needs health insurance.


And every poor and working class individual, every middle income individual has already paid for it through their exorbitant income taxes. (At the age of twenty-one in 1972, While working as an uynderwrtiting trainee, I paid as much as Richard Nixon did! Taht taught me a lot about the regressiveness of the system!)

Where to get the money? Well, take all the income tax reductions offered to the wealthiest of individuals, from Bill Clinton offering the drop from 28% down to 22%, and Bush further reducing it yet another five points, take all those and re-adjust back upwards.

QUit allowing hedge fund managers to pay only 15% of their billions while school teachers pay throught the nose at 28%.

Et Cetera.

[truedelphi]

4. Your Op addresses the situation of high costs

Needing to be fixed first.

Once you hit the age of fifty, if you don't have a corpoate or job guaranteed package of bennies, you are screwed.

Pre-exisitng conditions means that no one wants you. I had ample resources in 1999 to pay for health insurance - no one wanted me at any price!

Now through joining the Writers Union I can get coverage for myself and spouse - but it costs about $ 900 a month. (It would also involve signing on to CIGNA, an insurance company that gets very low grades in Michael Moore's SICKO)

But I no longer ahve the means to afford insurance, as medical needs wiped out my ability to pay.

[Triana]

5. I DID read what the NON-partisian, NON-Obama-affiliated experts say...

..and here it is:

http://www.urban.org/publications/411603.html

Author(s): Linda J. Blumberg, John Holahan
Other Availability: PDF | Printer-Friendly Page
Posted to Web: January 29, 2008
Permanent Link: http://www.urban.org/url.cfm?ID=411603

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

The text below is an excerpt from the complete document. Read the full paper in PDF format.
Abstract

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.

Introduction

Our contention that an individual mandate is critical to achieving universal coverage rests upon three points. First, many individuals will not choose to obtain coverage under a purely voluntary system. Second, adverse selection will occur under a voluntary insurance system. Third, it is politically difficult to redirect current government spending on care for the uninsured to offset the costs associated with new broad-based reforms unless the full population is insured.

Evidence on Voluntary Participation. There is abundant evidence that without an individual mandate a health reform would fall well short of achieving universal coverage. As part of the work that we did early in the debate over universal coverage in Massachusetts,we showed that voluntary approaches without an employer or individual mandate would only cover about 40 percent of the uninsured; adding an employer mandate would still leave about 50 percent of the uninsured without coverage. We found that Massachusetts could achieve universal coverage only with an individual mandate, even when we assumed relatively generous subsidies provided to those with incomes up to 400 percent of the FPL, government-sponsored reinsurance for high-cost cases in the private nongroup and small-group (fewer than 100 workers) markets, and an organized purchasing pool.

Other analysts have reached similar conclusions. In a study that analyzed health reform options for the state of New York, the Lewin Group found that voluntary measures including a public expansion and subsidized buy-in to a state health plan reduced the number of uninsured by 29 percent. Adding an employer mandate (but not an individual mandate) to these voluntary measures reduced the number of uninsured by 36 percent. In an analysis extending the Massachusetts type plan to the United States, Jon Gruber found that voluntary measures, including income-related subsidies and a purchasing arrangement, would reduce the number of uninsured by about 50 percent.

Opponents of an individual mandate argue that they can come close to universal coverage with a combination of income-related subsidies, more options for purchasing affordable coverage (e.g., through purchasing pools), and administrative mechanisms for facilitating enrollment in insurance. The most recent data indicate that there are 47 million uninsured people in the United States. Even if subsidies, benefits, and administrative simplifications are sufficient to reach two-thirds of the uninsured (a reach beyond what any study to date has shown for a voluntary system), this would still leave 15.5 million people uninsured. This would be admirable, but would be considerably less than full coverage, and, as health care costs and insurance premiums increase, these numbers could easily erode unless further government dollars were injected into the system.

[truedelphi]

7. Your experts don't take into consideration

Two things

Number one: Universal Health Care Single Payer style is affordable IF we get the insurance companies out of the mix. One example gleaned from Editorials in major newspapers:

In Rhode Island, a single hospital there has been trying to get payment increases from the insurance company that handles all the patients and their payments.
Year after year the cost increases are denied.
Meanwhile the insurance company CEO makes as much as all 2200 employees at the hospital. Something is wrong here.

Number two: You give me an equitable and progressive taxation system and I won't whimper one bit about paying some of the costs of Universal Health Care.

But the middle income citizen is now paying the most taxes in the most regressive way of any citiazen on earth! (Yes, taxes in Europe are higher but many of those are due to VAT's, and with the taxes comes the health insurance.)

But I will still demand that it be Single Payer god damn it.

Not a penny should continue to go to those corrupt executives inthe insurance companies. These people have stressed us out while we are trying to work and take care of the very loved ones whom they deny deserved care. These executives have stonewalled us on policies that we hare paying hundreds of dolalrs a month on. And they have outright SLAUGHTERED many Americans.

They need to be cut out of the system, like any cancer would be cut out.

And Senator Clinton is not gonna be the one to do it. I have my doubts about Obama going ahead with Single Payer U H C also, but at least I won't be fooled by the same person twice!

[creeksneakers2]

8. I read what these experts said

and when they are backed into a corner and have to discuss the actual details they admit Obama would have to pass a mandate too.

Obama ought to buck up and be honest about his mandate. Obama experts draw a distinction that they'd have cost control first and the mandate second. Hillary's plan will do that too.

Obama is being dishonest when he says he plan has no mandates.