This is the third installment of a weekly candidate-supporter diary series
The biggest domestic topic facing our nation is the health care crisis. Our health care system is broken, and we must act to fix it. The per capita outlay in our system is over $6,000 per person, double that of European countries, and they have at least a universal health care system that covers every citizen(some use the single-payer model,) whereas in our overpriced system we have 45 Million people without health care.
Much has been written about the competing health care plans of the candidates. I would like to focus on Clinton's health care input and plans, but encourage additions and comments.
Let me state that Clinton's entire health care plan has not been released yet, the final installment of the program is expected within the next 3 to 4 weeks. From what I have read I expect the system to be closer to Edwards' plan than Obama's plan, but will most likely not include insured-mandated coverage (a major drawback to Edwards' system, IMO.) It has been claimed that you HAVE to impose insurance mandates to make the system universal, but that is not always true, in fact most European countries don't include them and they achieve universal coverage. Whatever it may be, this final piece of Clinton's health care plan will have to wait for a later merit discussion in a few weeks.
Let's go with what we already know, and part of the history.
Let's go way back to 1993. The health care system was not nearly as broken as it is today, the per capita outlay for our health care system in 1992 was $3,165 per capita. In contrast, in 1992 Germany's per capita expenditure on health care was $2,476 per capita, France's was 2,119, Canada's was $2,008 and Sweden's was $2,528 per capita.
source: OECD figures
We had the most expensive health care system in the world even back in 1992, but the differences were not nearly as drastic as they are today. Our expenditures per capita exceeded those of other major industrialized nations by about 30% to 40%.
Against that backdrop came Bill Clinton's proposal to overhaul our health care system. The Task Force on National Health Care Reform was set up, headed by First Lady Hillary Rodham Clinton, to come up with a comprehensive plan to provide universal health care for all Americans.
http://en.wikipedia.org/wiki/Clinton_hea lth_care_plan
In a major speech to Congress president Bill Clinton made these comments:
Millions of Americans are just a pink slip away from losing their health insurance, and one serious illness away from losing all their savings. Millions more are locked into the jobs they have now just because they or someone in their family has once been sick and they have what is called the preexisting condition. And on any given day, over 37 million Americans -- most of them working people and their little children -- have no health insurance at all. And in spite of all this, our medical bills are growing at over twice the rate of inflation, and the United States spends over a third more of its income on health care than any other nation on Earth.
The plan ultimately failed to pass. There were mistakes made when the plan was put together, but the main reason for it not gaining enough support was that conservatives were able to portray the plan as too convoluted and complex and the question was raised whether there was indeed a health care crisis present in the first place. Many in the media and many political figures looked at the 1992 per-capita health care expenditures (and the relatively small difference in such expenditures to UHC nations like Germany and France) and shortsightedly dismissed that a major health care crisis was already afoot and was bound to get progressively worse. All one had to do was to look at given health care growth rates and compare them to projected growth rates of expenditures in other industrialized nations to realize what was to come.
Fast forwarding to 2006 we are now clocking in at over $6,000 per capita health care expenditures, a doubling of our health care costs per capita, whereas the other industrialized nations referenced above saw very slight increases in coverage cost. Instead of being 1/3rd more expensive than Germany, France, Canada, Japan and Sweden our health care system is NOW THREE TIMES the expense of these other nations on average.
An illustration of the explosive growth in this chart comparing expenditures from 1992 and 2002.
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S-CHIP a major step towards UHC:
Four years after the Universal Health Care proposal failed, Hillary Clinton helped pass the State Children's Health Insurance Program (S-CHIP.) She helped negotiate the bill with Congress and later was the point person working to ensure that parents across the country knew about the program and signed up their children. "Over the course of a year, the program, financed jointly by the federal government and the states, provides health insurance to six million children in families that have too much income to qualify for Medicaid but not enough to buy private insurance." [White House Press Release 10/17/00; New York Times, 3/14/07]
Enacted Single Largest Investment in Health Care for Children since 1965. The five year, $24 billion State Children's Health Insurance Program (SCHIP) will provide health care coverage for up to five million children. Two million children have already been enrolled, and in October 1999 President Clinton announced new outreach initiatives to enroll millions more uninsured, eligible children. Last year, the President launched a nationwide "Insure Kids Now" campaign that will bring together major TV and radio networks, healthcare organizations, religious groups and other community-based organizations to help enroll more children in the Children's Health Insurance Program, with the goal of enrolling 5 million of the estimated 10 million children eligible for health insurance under CHIP within 5 years. This year, the budget includes several of Vice President Gore's proposals to accelerate enrollment of children in CHIP. The President is also proposing a new FamilyCare program, which would give States the option to cover parents in the same plan as their children. [White House Fact Sheet, 1/11/00; White House, 2/23/99]
source: http://clinton4.nara.gov/WH/Accomplishme nts/health.html
This program has now grown well beyond its original scope. The initial plan gave medical coverage to 5 Million children who lacked eligibility for Medicaid, with elegibility capped at twice the poverty level (approx. $40,000 for a family of four.) In some 14 states the program now covers hundreds of thousands of adults (using wavers to cover parents, pregnant women, etc.) to the point where in Minnesota 92 percent of money spent under the program is going to adults, and the other 13 states covering adults with universal coverage to varying degrees under this program. Other states are looking to expand coverage to adults under this program as well. Incrementally, the S-CHIP program has been used by states to expand health coverage to many of their citizens who are beyond the scope of Medicaid. It is not hard to see how expanding this system and raising the elegebility threshold one eventually arrives at a system that comes close to covering many of the currently uninsured.
Enter S-CHIP expansion
Watch it:
Hillary Clinton is one of two principal sponsors of the S-CHIP expansion bill. The Clinton-Dingell bill passed the Senate (altered) by a vote of 68-31 on 8/3/2007 and is awaiting reconciliation with the S-CHIP expansion house bill, which was passed on 8/1/2007. The Clinton S-CHIP expansion bill included a reauthorization of S-CHIP for another 5 years, spending of $50 Billion over 5 years, and an expanded scope of coverage to allow states to increase coverage level to up to 4 times the rate of poverty, which would make eligible a family of four earning up to $82,600. Also increased was the age of eligibility, allowing states to cover children up to 25 years of age. Individual states abilities to also cover adults under this bill was not curbed. The compromise alteration of Clinton-Dingell now allows for 3-times the poverty level (up to $61,000 earnings for a family of four) and a $35 Billion budget over 5 years.
More after the flip:Bush threatened to veto S-CHIP expansion
http://thinkprogress.org/2007/07/25/case y-clinton-schip
Bush has promised to veto the SCHIP expansion. Today in an event at the Center for American Progress, Sens. Bob Casey (D-PA) and Hillary Clinton (D-NY) sharply criticized the veto threat:Casey: [Bush] wants to give a billion dollars a year of an increase for children's health insurance, and tens of billions -- by one estimate as much as a hundred billion dollars -- in tax cuts to wealthy people. ... I don't understand it and we are not going to accept that because fortunately, unlike a lot of things on Capitol Hill, there is bipartisan agreement on this.
Clinton: If he wants to have part of his legacy be vetoing the child health insurance program then we'll try to override the veto because this is absolutely an imperative. ... I just think it's outrageous and offensive that the President would threaten to veto this legislation.
In terms of moving progressive values forwards in the area of health care, Hillary Clinton has done a lot more than most Senators currently active, certainly more than any candidate running against her for the presidency. To wit, Clinton's bill was pegged to add about 7 Million additional children and also many parents, legal guardians, pregnant women, etc. to the scope of S-CHIP, which currently covers ca. 6.1 Million. That would have made a total of 13 Million people who are not eligible for Medicaid covered by S-CHIP, chipping away at the unsustainable 45 Million "uninsured" level with a system that is as close to the envisioned universal health care system as one can imagine.
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Plan for universal coverage
Hillary Clinton is proposing her Universal Health Care plan in 3 steps, the final step to be released in 3 to 4 weeks.
Naturally, I will be laying out the first 2 parts of the plan here.
Part 1:
Reducing health care cost and improving value
Hillary Clinton Announces Agenda to Lower Health Care Costs and Improve Value for All AmericansToday, Senator Clinton laid out a major plank in her framework for providing affordable, quality health coverage for all Americans: her 7-step strategy for lowering spiraling costs. The rising cost of health care is threatening working families, American businesses, and the nation's economic competitiveness. Premiums have almost doubled since 2000 - up 87
percent - four times higher than wages. And if left unattended, health care spending will double to $4 trillion per year over the next 10 years. Senator Clinton stressed that the necessary commitment to cover all Americans will require the reform of our often irrational, inefficient and wasteful policies.
Right she is. I laid out at the beginning of the diary that health care cost have more than doubled from 1992 to today while every other industrialized nation has stayed almost put at the same level as they were at 15 years ago. There is something seriously wrong with our approach, and it needs a major overhaul.
Senator Clinton proposed a series of initiatives that will cut the spiraling rate of growth by one-third over time. Her health care modernization strategy achieves this by targeting the drivers of health care costs, including (1) our back-ended coverage of health care that gives short-shift to prevention, (2) the nation's reliance on an antiquated, wasteful, costly and even dangerous paper-based medical records system, (3) unmanaged chronic illnesses such as
diabetes and heart disease which account for over 75 percent of health care spending, (4) the over-utilization of medical interventions that provide little added value and the underutilization of those that do, (5) and excessive insurance, drug, and malpractice costs.Senator Clinton's proposals would reduce costs and improve quality in the health care system. Taken together they would lower national health spending by at least $120 billion dollars a year. If businesses received a proportionate reduction in their health benefits spending, they would achieve at least $25 billion in savings in 2004 dollars. Families
would substantially benefit as well. In fact, Business Roundtable has estimated $2,200 in national health savings for the typical family. And these savings would be reinvested in the system to help cover the 45 million uninsured.
To achieve this goal, Senator Clinton's strategy would:1. A Groundbreaking National Prevention Initiative to Reduce the Incidence of Such Diseases as Diabetes and Cancer that Impose Huge Human and Financial Costs
2. Institute a New "Paperless" Health Information Technology System
3. Transform Care of Today's Chronically Ill Population to Improve Outcomes and Decrease Costs
4. Ending Insurance Discrimination to Help Reduce Administrative Costs
5. Create an Independent "Best Practices" Institute to Empower Consumers, Providers and Health Plans to Make the Right Care Choices
6. Implement Smart Purchasing Initiatives to Constrain Excess Prescription Drug and Managed Care Expenditures
7. Put in Place Common-Sense Medical Malpractice Reforms
SENATOR CLINTON'S 7-STEP STRATEGY TO REDUCE HEALTH COSTS WHILE INCREASING AFFORDABILITY, ACCOUNTABILITY AND QUALITY
1. Install a Groundbreaking National Prevention Initiative to Reduce the Incidence of Obesity and Diseases Such as Diabetes and Cancer that Impose Huge Human and Financial Costs: This century's plague is chronic illness including diabetes, heart conditions, obesity and other chronic conditions. Obesity rates have doubled among adults over the past
snip
20 years; in fact Medicare could save over a trillion dollars over 25 years if obesity among seniors could be returned to levels in the 1980s. One out of three children born in 2000 is at risk of developing diabetes, and today's children are at risk of having shorter life spans than their parents - for the first time in our nation's history. Chronic illness accounts for 75 percent of health costs, and two-thirds of recent cost growth. Only half of recommended clinical preventive services are provided to adults, and less than half of adults had their doctors provide them advice on weight, nutrition, or exercise.i Only 38 percent of adults receive recommended colorectal screening and roughly 20 percent of children do not receive recommended immunizations.ii
Part 2:
Watch it:
New policies can improve health care quality
She started with a speech in June on reducing costs, followed by Thursday's address on quality, and will outline her plan for universal health care coverage next month."My order here is deliberate," she said. "In order to forge a consensus on universal health care, we need to assure people that they will get the quality they expect at a cost they can afford."
Many people are afraid that universal health care means having to live with diminished quality. Clinton understands the apprehension and is outlining quality care as a major part of her health care plan.
To improve quality, Clinton said she would promote physician certification programs that help doctors keep up with the latest advancements, increasing Medicare reimbursements for doctors who participate in them. Nursing care would get a boost in the form of $300 million to expand enrollment in nursing schools, create mentoring programs for recent graduates and recruit more minorities into the profession."The nursing shortage has become a nursing crisis, and that means it is a crisis for everyone," Clinton said. "Our nurses are truly the eyes and ears, and in many ways the heart and soul of our health care system. When we've got fewer nurses, working longer hours and serving more patients, the result can be worse outcomes."
Clinton also called for overhauling a reimbursement system that she said often punishes doctors for doing the right thing -- spending time with patients or working with their colleagues to take a collaborative approach. She proposes higher payments to providers who use teams to provide coordinated care and ending payments for preventable infections and injuries sustained during hospital stays."We need a system that encourages instead of discourages quality," she said.
She said while her rivals tell voters "We're going to go out and make it happen," her message is different."You've gotta get the votes," she said later at a house party in Concord. "You've got to compromise, which is not a word people in a Democratic primary like to hear because we want to think we can go and do exactly what we believe in make it happen. The fact is, you can't."
Speaking later in Manchester, Clinton said her universal health care plan would not involve a single-payer government system. Instead, she said she would consider expanding Medicare and allow people to join the federal employees insurance program.
"I think you don't want to take choices away from Americans. We're big on choice here. But you've got to have some framework so the choices work better," she said.
Clinton said she also would consider allow people to purchase health insurance from companies outside their states.
"There is no really strong argument anymore why you couldn't buy insurance across state lines to get better deals," she said. "Why should you be limited to what companies want to come into New Hampshire?"
Part 3 of the Universal Health Care plan has not been released yet. It is expected to be revealed shortly.
I am very confident in Hillary Clinton's ability to propose and pass a comprehensive UHC plan, something I can not say for any other candidates.
I guess I am not alone with that confidence:
91% Of Dems Approve of Hillary On Health Care, The Highest of Any Candidate on Any IssueGallup: 'Her 91% rating among democrats on healthcare is the highest for any candidate on any issue within their own party': The Clinton administration's unsuccessful attempt to pass comprehensive healthcare reform in 1993-1994 has not shaken Democrats' (or independents') confidence in her to recommend the right thing for healthcare. Her 91% rating among Democrats on healthcare is the highest for any candidate on any issue within their own party.
source: [Gallup Poll, 7/23-26/07 ] http://www.galluppoll.com/content/?ci=28 252
She has done a great job with S-CHIP, and what better "training on the job" for Universal Health Coverage than working on and pushing through that program?
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