I don't understand the love for private insurance "mandates". That is the most un-Democratic idea ever to be proposed. Have the government force you to pay for an insurance company CEO's swimming pool?... It sounds like a Republican dream idea, and, in fact, it is...
Romney, Schwartzenager, and even our friend in Ohio Ken Blackwell have all either endorsed or implemented "mandates". A bet a bunch of other Republican gubernatorial candidates were for it, too. Romney's plan was all the rage a couple of years ago. Why not? Taking money from private citizens and giving it to the rich? That's a Republican dream plan!
Mandates would be so unpopular, it would set the cause of universal health care at least a generation. Ask people in Mass. how they like their "mandates" for overpriced junk insurance. Yet, too many Democrats have been duped into this very Republican and authoritarian "government get involved in every aspect of your personal life" position. It is a sure loser in so many ways, as well as being an affront to our values as Democrats.
Now, maybe there's a way that "mandates" can be made more Democratic, less invasive, and more fair, but at the moment, I don't relish the government putting the gun at my back to pay some rich guy a lot of money for overpriced junk insurance. I'd like a better option.
Thanks,
Mike
Fortunately for you, no candidate has proposed requiring anyone to buy insurance from a private insurance company. In fact, the existence of a public, Medicare-like option is a central feature of the Clinton/Edwards plan.
That's yet another deceptive ploy Obama's been using to try to make his health care plan sound more "progressive" than Hillary's (when it's really less). Obama acts like all Hillary does is "force people to buy insurance they can't afford", when Hillary's plan actually GIVES PEOPLE A CHOICE of either an affordable private plan OR opt-in Medicare. Oh yes, and her plan has just as many measures to make health care more affordable (if not MORE!) than Obama's.
So yet again, we have a health care myth from Team Obama that's just been debunked. ;-)
It's worse. They don't admit that these plans as I understand them provide for subsidization so the argument is false on its face. But that's rather the point. They can't win on a straight up and down comparison of what the plans actually say.
One of the problems, though, is that it's not precisely clear how much of the costs will be subsidized and how substantially Clinton will be able to reduce premiums. Clinton has not been able to say exactly what a person who makes, say, $50,000/year will be paying for health insurance. That's because the actual amount will depend on so many complex matters like how the insurance is underwritten (premiums, deductibles, copayments, etc.), the ability of Clinton's plan to lower costs, and exactly how substantial the subsidy would be for a given person.
As a result, until Clinton provides assurances of affordability, it's disingenious to speak so confidently about her plan's universality. Moreover, without specific information about costs, it's difficult to evaluate whether the burden associated with a mandate is fair. If insurance is going to cost someone $1000/year, that is far different than $5000/year. I might not oppose a mandate in the case of the former, but I certainly would in the latter. Adding $5000 per year as a state-imposed burden (which is effectively like a tax) would be very big deal to your average middle-class person--certainly, more than it would be for a wealthy person. That raises serious fairness issues, as well.
This post does a good job of describing the problem.
http://sentineleffect.wordpress.com/2007 11/28/even-more-on-mandates-and-the-80- solution
Mandates may ultimately be an appropriate thing to do (although, I'm skeptical), but first we need to make put the plan to work without mandates so that we can evaluate feasibility and cost considerations.
Also, mandates are not going to be popular at all in a general election. I'm convinced at this point that single-payer is more palatable to the average voter than hybrid approaches involving mandates.
What exactly makes you think that Obama's plan will be any cheaper? In fact, by insuring only sicker people (with younger, healthier population opting out), it will be even more expensive and therefore further away from achieving true universal health care.
I never said his plan would be cheaper. I just said that mandates shouldn't be implemented until we can be certain that the burden imposed is affordable and fair. Presently, I see single-payer as the only fair way to ensure that everyone is covered. That is, the only progressive way to finance social insurance like this is through normal income tax collection; otherwise, the distributive burden is going to be regressive (at least partially).
THe problem is that the benefits will be hard to come by without eliminating issues like free riders from the mix. In other words, the very things you are requiring much like the conservatives approach to such discussions will help guarantee failure.
She does say that it will be capped at a percentage of income....
She doesn't say what the percentage will be, but since she does acknowledge a realistic view of the current cost of insurance, I'm hoping the percentage cap would also be realistic.
In contrast, my Congressman thinks a $600 tax credit would help the situation which I think is a laugh, not a plan.
From page 9 of her plan.
The average family premium for employer-based coverage (including employer and employee contributions) is over $12,000.ix For half of Americans, this total premium accounts for at least one-fourth of their annual income.x This helps explain why two-thirds of the uninsured have incomes below 200 percent of the poverty limit (roughly $40,000 per year for a family of four). (snip) The American Health Choices Plan will make health insurance more affordable for the millions of Americans who want it. It includes a number of straightforward policies to achieve this end: 1) Ensuring Premium Affordability Through Refundable Tax Credits: Premiums have skyrocketed over the last several years - nearly double since 2000. The American Health Choices Plan helps working families afford coverage through refundable, income-related tax credits to ensure that accessible, high-quality health coverage is affordable to all. 2) Limiting Premium Payments to a Percentage of Income: This credit will ensure that securing quality health care is never a crushing burden for any working family. This guarantee will be achieved through a premium affordability tax credit that ensures that health premiums never rise above a certain percentage of family income. The tax credit will be indexed over time, and designed to maintain consumer price consciousness in choosing health plans, even for those who reach the percentage of income limit.
(snip)
The American Health Choices Plan will make health insurance more affordable for the millions of Americans who want it. It includes a number of straightforward policies to achieve this end:
1) Ensuring Premium Affordability Through Refundable Tax Credits: Premiums have skyrocketed over the last several years - nearly double since 2000. The American Health Choices Plan helps working families afford coverage through refundable, income-related tax credits to ensure that accessible, high-quality health coverage is affordable to all.
2) Limiting Premium Payments to a Percentage of Income: This credit will ensure that securing quality health care is never a crushing burden for any working family. This guarantee will be achieved through a premium affordability tax credit that ensures that health premiums never rise above a certain percentage of family income. The tax credit will be indexed over time, and designed to maintain consumer price consciousness in choosing health plans, even for those who reach the percentage of income limit.
All bunk if the plan isn't passable in congress.
Never forget that there have been great health-care (some "Universal") plans proposed over the last 38 years, but none have been passed due to a lack of political will and bipartisanship from from both sides.
I guarantee you that Hillary will have a problem getting this passed as it is. Simply won't pass. A blue-ribbon panel with unimpeachable economists and health-care experts from both sides of the aisle will need to come together and publicly put a plan together, that we can all agree with. I doubt a mandate will be agreed to by both sides unless the democrats have an OVERWHELMING majority in congress. This is where Obama's advantages and ability to get everyone together comes in.
"no candidate has proposed requiring anyone to buy insurance from a private insurance company. In fact, the existence of a public, Medicare-like option is a central feature of the Clinton/Edwards plan."
You understand of course that doctors have the option of refusing to take lower payout medical insurances, just as many do today and refuse to care for Medicare recipients. And when you look at the variables left that could conceivably lower medical costs apart from insurance company profits, exuberant drug costs, and outrageous hospitalization costs, people who opt for the Medicare-like option will get the Medicare-like option and all the drawbacks that it entails.
Until we get a single payer not-for-profit universal health care system, the kind that Hillary abhors, we will not control medical costs and rationing will continue. This system, which feeds the corporations, is part of the Republican Lite version of the Democratic party Hillary and Bill are attempting to bring back.
We can do better than this and with a Democratic Congress, it is doable.
"Until we get a single payer not-for-profit universal health care system, the kind that Hillary abhors, we will not control medical costs and rationing will continue. This system, which feeds the corporations, is part of the Republican Lite version of the Democratic party Hillary and Bill are attempting to bring back."
The problem with the health care system is the cost which shuts people out and rations care.
The cost is so high because we have a private system that is inefficient. And it's inefficient because we support a parasitical insurance industry through our health care payments. Every other advanced industrialized country in the world does it a different way.
That way is single-payer health care. Eliminating costs by eliminating profits from the middle man.
Any attempt to graft universal coverage over the top of our present broken system will only dramatically increase costs and would be unsustainable.
Naturally, this is a political loser for everybody. Obama's coverage is NOT universal. Hillary's isn't really universal either. But, frankly universal health care will be WILDLY UNPOPULAR if it is put into place by mandates because you are forcing millions of people (the young and healthy) who don't currently pay for health care to purchase it.
Why? Because unless you eliminate runaway cost from the system, by getting the insurance industry out of it, you're forcing people to pay more for health care coverage, to cover the older and sicker.
Maybe that's sensible, even necessary, but it they won't like it. At all. And those are only the tip of the iceberg flaws with the way both plans are proposed.
I remember back in 1993 Bill Clinton talking up his health-care proposal at the time. He asked the audience what percentage of them liked their HMOs. He looked absolutely shocked that so many people HATED managed care (for reasons that everybody understands now).
Democrats need to avoid being chained to an albatross of "universal health care" that is neither universal, nor solves the problem of run-away cost, and is wildly unpopular to boot.
If we get caught in the trap of "doing what's possible" even though it won't work, we'll be crushed by the Republicans for years afterwards. The first failed attempt to introduce health care reform helped bring down the Democratic congress in 1993. We can't afford another mistake like that!
Keeping talking.
You put the problems with both the Hillary and Obama plans, which exceed their trivial differences, in a nutshell. They do not come close to the liberal social democratic systems in play in the EU and the English speaking countries.
Hillary has said repeatedly that she would support and sign a single payer bill if it passed Congress, she favors single payer. It is deception to say "she abhors" single payer, that's obviously untrue. Even the Congressional sponsors of HR 676, the Conyers/Kucinich single payer bill, insist we must build the political will and movement to get single payer in the US, now far too many Americans no longer trust government to administer a single payer program, only 35% favored single payer in the last major poll, while over 50% favored the hybrid plans, like the Clinton plan, that preserves their choice to keep what they have now if they like it. 80% of Americans are report being relatively content with their current health insurance, many because they have never needed to use it for a major, or chronic illness, and put it to the test to see whether it really meets their needs.
well, you actually have a choice in Hillary's plan.
You can buy into a public plan similar to Medicare, you can keep your insurance as you like it, or you can buy into any of the congressional plans that will be opened to the public.
The CEO's wont be lining their pockets, as under Clinton's plan, they will be forced to cover pre-existing conditions.
Maybe you should actually examine the plans before you jump on the "putting a gun" to your back and being forced to do something meme.
Also, Obama says if you "try to game the system, you will be punished." WTF does that mean? you wanna take a shot at answering?
"You can buy into a public plan similar to Medicare, you can keep your insurance as you like it, or you can buy into any of the congressional plans"
So I'm forced to buy something? I've been through years (thankfully long past) when my total annual income was $600 or less. If I have to buy into a plan, even if I'm reimbursed 15 months later when I file a tax return, it's just not acceptable to me. If the plan caps the amount to a percentage income up front, rather than reimbursing me later, and has a cutoff income below which I pay nothing, then we might have something workable.
Someone else mentioned that a mandated cost below $1000/year is acceptable... If I'm making under $10,000, I'm going to resent being forced to pay $1000 for healthcare - even if it's returned to me after April 15 the following year.
If you are making under 10,000 a year you will be eligible for 100% subsidized insurance, plain and simple. In Massachusetts, where mandates are in effect, over 60,000 people have been granted waivers to not buy insurance because there is no affordable plan available to them, no one is forced to buy what they cannot afford. All families will only have to pay a small percentage of their annual income toward health insurance, the amount is capped in Clinton's plan.
Obama's health care plan is significantly less courageous than Clinton's, and it doesn't make sense. If you do not require a mandate for everyone to have health insurance, but require the insurance companies to grant policies to everyone who asks for them, people will be able to buy policies AFTER they get sick - this is like buying home owner insurance after your house is already burning. The insurance companies will never agree to such a program, and there is no way to make it economically sustainable, even if we had single payer national health insurance available. Health insurance will only work if it requires "everybody in, nobody out."
I want to point out strongly that among low income people who are eligible for Medicaid and other free public health insurance programs offered in the states, out of 100% of those eligible, only approximately 47% will sign up. This is true across the US. So there are many reasons that people do not sign up for health insurance outside of "they cannot afford it" as Obama claims. In Massachusetts, where there is now a mandate in effect, 92% of those eligible for free health insurance sign up. That is a huge improvement. Now a tremendous number of low income people have free health insurance who did not have it before, including preventive care. It is really a mandate on government to provide health insurance to the poor. Obama's plan betrays low income people.
The contradictions and obvious lack of teeth in Obama's health care plan, along with his nasty attacks on the far more progressive Clinton plan cause me to severely distrust his integrity and grasp of adequate solutions to this life and death issue. Along with his absurd claims that he will have his health plan adopted within the first year of his administration. Everyone in healh care understands how ridiculous that claim is. There is no way for his proposals to work, they are just so much verbiage. Worse, he adopts right wing talking points to destroy the dream of universal health care.
I am a single payer advocate, and single payer uses progressive taxation to include everyone in the financing mechanism to provide health care for all. It is a mandate, simply in other words, using taxes to pay instead of premiums (with subsidies for the poor). Single payer would be far more efficient, however. We need a grassroots movement to press for single payer, the only economically sustainable way to provide adequate health care access to everyone.
Hi Mike,
It sounds like you genuinely didn't know that Clinton and Edwards' plans set up a public plan (similar to Medicare) that people can buy into if they choose. So nobody will be forced to buy from a private insurer.
What annoys me is that Obama's campaign has been pushing this patently false idea, to the point that a lot of people actually believe it. (A lot of pro-Obama folks online keep repeating this point too. I can't tell if they simply don't know they're wrong, or they don't care. It's hard to tell.) Again, this is part of the complaints many Democrats have with Obama--he's not content to have left mandates out of his plan, he also has to go make the Republican case against Democratic health care plans. So that he can get elected. As Ezra Klein said, he's lying. There's no other word for it. (Well, maybe there is another word: Paul Krugman called it "unscrupulous demagoguery."
Best wishes.
And yet, somehow Obama is seen as progressive...
Well health care can't be the only measure of that. For example, HRC supports draconian criminal justice and immigration policies.
Specifics please? I was at her town hall last week and heard a very sensible, pragmatic approach to immigration.
She's for removing due process from the immigration court system for immigrants that have committed a crime. People's lives were destroyed when her husband passed IIRIRA but this is even worse. People get into trouble. That doesn't mean they should be banished from the US and separated from their families.
She's against retroactive application of the USSC sentencing guidelines despite saying that she understands the prior guidelines might have been used in a discriminatory manner or had a discriminatory effect. More than a decade ago some fundamental fairness in the crack/cocaine disparity was tried but her husband shot it down and she's no better.
I think both this site and Krugman are way off base on this.
Almost everyone on our left side of the aisle agrees that single payer would be a better system, but to suggest that Obama's proposal is pathetic compared to Hillary's because of this one stupid issue of mandates is ridiculous.
Krugman is off his rocker when he keeps saying that Obama will never pass his version but Hillay will pass hers. Umm, no. Hillary's will be torn to shreds by Republicans running Harry and Louise ads. If she can't properly rebut Obama's questions about how she'll fine or garnish wages to enforce mandates in a democratic debate, in a setting where both sides agree we need universal healthcare, how is she going to do it against Republicans running fear mongering campaigns saying she's going to take your healthcare away?
They have the same damned plans. His is just more likely to be passed because it's much harder to slander and attack. And guess what, if his plan works, then in a few years you can gradually start to carrot and stick your way toward mandates and it'll be far less controversial because everyone will be used to the idea of government healthcare not being evil.
Obama is not a right wing guy and he's not the less progressive candidate. Hillary's plan is a general election loser. I'll happily vote for if she's chosen and happily support her plan if she then get elected president, but it's just so damned silly for Democrats to be tearing each other apart over this miniscule distinction about healthcare when we've failed to get healthcare passed since Truman.
You start with some seriously distorted facts. One, no one seriously claims that Obama's plan is "pathetic" without mandates. Go read the post again. Go read Krugman again. Go read the comments again. Two, Krugman never said Obama will never pass his version but Clinton will pass hers. That's not the argument. The argument is, Clinton's plan is better. Three, the post does not claim that Obama is less progressive than Hillary. Few people would make that argument. The criticism is directed at Obama's HEALTHCARE proposal.
As for your argument, it seems that you support disseminating dishonest arguments about healthcare proposals. You admit that Obama's Harry and Louise ads are taking a page out of the Republican playbook. Come time for the general election, the Republican Harry and Louise ads will only be ever more effective because they also came from Obama. The ads are dishonest. They also position Obama in such a way that he can not propose mandates, ever, if he were President.
And no, the candidates DO NOT have the "same damned plans." That's the whole point here. Mandates v. No Mandates is a very, very big difference.
Finally, do you really think Republicans will find it impossible to slander Obama's plan? That's ridiculous. Republicans are the masters of smear.
Krugman has done everything but call Obama Karl Rove ... oh wait, I forgot, MyDD just did that.
This is Krugman's fifth or six article about their healthcare plans. He's ended the last two stating that under an Obama presidency, healthcare will never happen. The real difference between the plans is miniscule. Mandates are a sideshow, especially because Hillary hasn't explained how she'll enforce them. Krugman's analysis depends on the assumption that Hillary's plan equals full coverage for everyone and Obama's means twenty five million people not covered. This isn't an argument being run in reality, it's being run in a fantasy land where Democrats are the only people who exist and the rest of the country won't have a say in healthcare.
In my personal opinion, and I don't claim it's anything more than that, Obama's plan is much more passable and that makes it a better plan. I do not claim that the Republicans will not slander Obama's healthcare, but that doesn't mean you need to make things easy for them. Hillary has failed to respond to the garnishing wages charge, in fact she basically confirmed it. Now to you and I, passionate democrats, that's not a big deal, but it's really a horrible thing to say for the general election. It's a tailor made campaign, and frankly, I don't have confidence in either of their plans to actually reduce healthcare costs fast enough to make a mandate reasonable. We absolutely can't get national healthcare off on the wrong foot, and people terrified that they're going to lose all their money by being forced to get healthcare they can't afford is exactly the wrong foot.
Obama's plan is well set up to survive a Harry and Louise attack for the same reasons everyone here is crapping on it. He's saying "I'm not going to do anything to you if you like your healthcare. I'm not going to force you to do anything." Now we all now that in the long term that's not realistic, but in the short term, it's absolutely the only way we're gonna get people behind healthcare. It's just like Congress. You ask people about congress and they say it sucks. You ask them about their congressman and they say s/he's great. People hate healthcare, but not their healthcare. At least that's true of a lot of middle class people who get their healthcare through their work and are sympathetic to poorer people who can't get coverage but don't actually want anything to happen to them.
Three initial matters. One, the post is comparing the anti-government rhetoric coming out of Obama's website to something that would come from Karl Rove. Honestly, if you look at it, it seems an apt comparison. That doesn't mean they equated Obama with Karl Rove. By those standards, you just admitted that Obama is a Republican Party operative, because he criticizes Clinton's healthcare with Republican talking points. I don't think any of us here think such things.
Two, as for what Krugman wrote, the last line in the linked article says, "If Mrs. Clinton gets the Democratic nomination, there is some chance -- nobody knows how big -- that we'll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won't happen." Krugman didn't say "healthcare won't happen," he said "universal healthcare won't happen." That's true almost by definition with Obama's plan.
Three, Krugman passionately believes in Universal Healthcare. I think his criticisms come from that perspective, not from some dislike of Obama.
For your argument, we should separate passability from what is a "better plan." You make good arguments on passability, within the given context. I simply disagree on whether the plan itself is better. I also think it's a strategic mistake to compromise before the sh*t hits the fan. Ask for a lot, then compromise later. Honestly, Obama should simply go for the brass ring. He can negotiate down later, if forced to.
Now, incidentally, I think this is especially tragic because I bet Obama would bring in bigger majorities in both houses of Congress at the top of the ticket. I also think Obama will do better in terms of leading the nation towards a more liberal / progressive agenda. I also think Obama is simply better at oratory and communication. It's tragic because I think, if Obama would just embrace mandates, he will have a far better chance of bringing in universal healthcare than Clinton does, due to all of the above.
Let's not forget that former Australian Prime Minister John Howard (a right wing Bush lapdog) also supported mandates, until the left in Australia beat him back.
I don't know what fever took over Krugman's brain when he anointed mandates as holy progressive dogma, but I sure hope he snaps out of it soon.
Single payer also mandates. Let's not forget you will try every talking point besides honesty.
The bigger problem is - Obama is LYING!
In his ad running in Ohio and elsewhere - "Universal health care" is prominently displayed - leading the UNinformed to believe Oblahma has a universal health care plan.
Obama is a LIAR!
I can answer for mandates and other things.
I was working and paying $320/month for the best United Health plan when I collapsed and was brought to the hospital by ambulance. When I woke up 3 days later, minus part of my GI tract, I was told I was 'indigent',
I asked what they meant by that - the hospital contacted the personal dept of my employer and gave me the phone. I was informed that:
1. They dropped my coverage effective the morning I went to the hospital (I had collapsed about 3:30 PM)
2. Since I was now 'disabled' I no longer worked there. I was in the hospital 5 weeks that time.
I have always called it the George Bush Healthcare/Retirment Plan.
The bills were enormous. With mandates - that wouldn't have happened to me or others I know.
