Come on, people. A Medicare buy-in Option?

cross-posted on dailykos

Hillary Clinton gets it.  Oddly, so many of us here don't.  It's the Medicare-like buy-in option.  Many people here were certain Hillary Clinton wouldn't offer them the Medicare buy-in option, and yet, I was sure she had said she would.  It's in the literture: "If you have a plan you like, you keep it. If you want to change plans or aren't currently covered, you can choose from dozens of the same plans available to members of Congress, or you can opt into a public plan option like Medicare. And working families will get tax credits to help pay their premiums."  Still, there was a definite sense of uncertainty, so just to be sure I emailed Ann Lewis and asked her, can everyone buy in to the public plan?

And, here's what she told me, "Everyone will be able to buy into a Medicare-type program."  

That's significant because unlike the Massachusetts plan that does not have a provision for buying into the public plan(I know, I asked, I would have bought-in like I suspect most Massachusetts residents who didn't qualify for the subsidized insurance program), Hillary's plan ensures that private insurance companies will have to compete with one of the most successful government programs you've never had access to before.  

To me, the understated Medicare opt-in is all that really matters.  It's a path to single or quasi-single payer healthcare if ever there was one.  And, it's packaged so well that people on both sides of the political ailse seem relatively happy with it.  See, it's like the name of the plan "American Health Choices Plan".  You want government administered health coverage, choose it.  It's quite brilliant.

Now, we could still just end up passing Medicare for All with Hillary at the helm.  She hasn't ruled it out.  According to Ben Smith at Politico:
"Clinton was asked directly about the relative modesty of her approach in a revealing, unpublicized New York talk in April, in which a board member of the Community Service Society of New York, Jonathan Greenberg, asked her why she "continue[s] to see the solution" as private insurance, rather than a single-payer national system. "Well, I didn't say that," Clinton responded, to the audience's apparent surprise. But she added that "for the short term, it'll probably have to build on the employer-based system, but with a lot of changes in how it operates and what the insurance companies are expected to do." She also proposed providing "options to people to buy into government health care." A far broader program known as "Medicare for All," she said, "would be something to be considered" if Democrats can win at least 55 seats in the Senate.""

Andrew Cline at the American Prospect argues "If she had the votes in Congress to push single-payer health care, she'd do it before you could turn your head and cough."  Sounds good to me.  Ultimately, it's up to Congress.  As "Laurie Rubiner, Clinton's top health-care policy adviser, told the Washington Post, Clinton would let Congress work out the details. "We're going to leave a lot of this to the congressional committees," she said."  Mhmm.  So we either are going to have a regulated large insurance pool with a public option buy-in, or better yet, when this issue finally gets debated, and we have Hillary in place, and if we have enough of a bottom up movement to support it, we'll pass Medicare for All.

I'm often stunned by people who argue that it is Hillary who will cower to insurers.  She's the only one talking about eliminating subsidies to private insurers through Medicare.  She mentioned this in her webcast last night, and this according to AIS Health Care.com(a "health care managers" information website)"Perhaps most ominously, Clinton says that "we have to crack down on the overpayments in Medicare to private plans. Those plan payment rates are around 12% higher than Medicare traditionally pays to treat the same beneficiaries. Reducing those overpayments could save Medicare $10 billion to $20 billion.a year.""  

And, consider this recent exchange between Hillary and an audience member at the National Association of Black Journalists conference, according to the New York Times.:"The audience member - who later identified himself as Kiara Ashanti, a freelance writer and blogger and a Republican - asked Mrs. Clinton why she was "still insisting" on bringing British- and Canada-style "socialized medicine" to the United States, asserting that such forms of universal care would hurt the black community. "Oh man, I can't answer that in 30 seconds, that was a string ofmisrepresentations," Mrs. Clinton, a Democratic presidential candidate, told the gathering of more than 1,000 black reporters, editors, and other journalists.
"I have never advocated socialized medicine, and I hope all the journalists hear that," she said. "That has been a right-wing attack on me for 15 years." Mr. Ashanti interrupted her with persistent criticism of government-run health care; Mrs. Clinton challenged him at one, asking if he thought Medicare was socialized medicine, and he indicated that he did. "You are in a small minority of America, because Medicare has literally saved the lives and saved the resources of countless generations of Americans," she said. Mrs. Clinton praised the health systems in Canada, Britain, and elsewhere in Europe as having better outcomes and results on some performance measures than the United States. Then she offered to share her statistics with the if he wanted to introduce himself to her staff. That is, she added, "if you're interested in being educated instead of being rhetorical.""  Does that sound like someone who highly values insurance companies?  

And, then, there's Hillary's recent SCHIP proposal, which Bob Novak labeled her "grand design".  Novak describes Hillary as a "principal sponsor" and calls her amendment a "massive expansion" "furthering her promise of "step by step" advancement toward universal health care." Novak claims, "The overall effect would make three out of four American children accustomed to relying on government care no matter what course their parents take. In sum, SCHIP turns out to be socialized medicine for "kids" (and many adults)."  So, Hillary is already working toward government funded healthcare.  In fact, the SCHIP amendment provided the perfect testing ground for the public's reaction to federally funded healthcare.  Bush took up the issue, waged war on it, arguing the expansion represented "a step "down the path to government-run health care for every American."  And, like all of Bush's wars, he basically lost.  Most americans were unmoved by Bush's scare tactics.

So, when I see Hillary's health plan, I see a path toward single payer or some sort of quasi-system popular in Europe.  

Articles sited:
http://www.spectator.org/dsp_article.asp ?art_id=12035
http://thecaucus.blogs.nytimes.com/2007/ 08/09/a-testy-exchange-on-health-care/
http://www.realclearpolitics.com/article s/2007/06/socialized_medicine_for_kids.h tml
http://www.nytimes.com/2007/07/23/washin gton/23health.html?_r=2&hp&oref= slogin&oref=slogin



Display:


Hillary's Medicare buy-in Option? (none / 0)

Bookgirl:

I agree with everything you have written. However, from a political standpoint, Democrats would be well served to keep the obvious implications of the Medicare buy-in option on the down-low.

The Medicare buy-in is clearly a way to get from here to the final destination by "changing planes in Chicago" -- so to speak. The reality is that the Medicare buy-in option will be, by far, the most popular of America's Health Choices.


by hwc on Thu Sep 20, 2007 at 12:35:26 AM EST

Re: Hillary's Medicare buy-in Option? (none / 0)

Yes, I know, but I mean, who's reading this?  I'm sick of the people here implying that Hillary is bought and paid for by the insurers just because she understands that in the end Americans have to choose if they want Medicare for All or some such thing.  It can't just be foisted on them from above.  


by bookgrl on Thu Sep 20, 2007 at 12:38:42 AM EST
[ Parent ]

bookgrl, do I need to go back (2.00 / 0)

and look up the times when I praised this aspect of Edwards' plan, only to have you (or sometimes other Clinton supporters, but usually you) taunt me that Congress would never pass that? Saying that Hillary would propose health care reform that Congress would actually pass?

This is an extremely important issue for me. I am glad that Hillary is on the same page as Edwards on this point.

But I find it incredible that after you repeatedly dismissed Edwards' health care proposals as unrealistic and impossible to pass, you now turn around and praise the same idea once Hillary endorses it.


John McCain: 100 years in Iraq "would be fine with me."
by desmoinesdem on Thu Sep 20, 2007 at 12:41:58 AM EST
[ Parent ]

AMEN. (2.00 / 0)

And after watching Hardball, sorry, HRC is not the way to go, period.  She is bought and has sold OUT.


by iamready on Thu Sep 20, 2007 at 12:43:07 AM EST
[ Parent ]

Whatever, Edna. (2.00 / 2)


by bookgrl on Thu Sep 20, 2007 at 12:49:20 AM EST
[ Parent ]

It's the FRAMING (none / 0)

You seem to have no grasp of national politics.  Edwards framed this all wrong because he wants to bring back Hillary's "regional markets" and he totally missed the lesson on small business mandates.  If you read the diary, you'd learn that Hillary is the ONLY candidate talking about eliminating subsidies to insurers under medicare, and that she proposed a major expansion of SCHIP early this year, BEFORE Edwards proposed his plan.  

You don't say "my plan may lead to single payer", you say :I want americans to have their choices".  That's framing.


by bookgrl on Thu Sep 20, 2007 at 12:46:51 AM EST
[ Parent ]

So, let us get this right... (2.00 / 0)

because he was "honest" with the public, and his "framing" did not work, that Clinton "stole" majority of his proposal, and "framed" it so the public will like it.  How does that read?  Because that is the "you know what" you are asking desmoinesdem to swallow.


by iamready on Thu Sep 20, 2007 at 12:49:10 AM EST
[ Parent ]

Oh, please. Your just sour because (none / 0)

Obama has the most conservative plan.


by bookgrl on Thu Sep 20, 2007 at 12:49:56 AM EST
[ Parent ]

Re: Oh, please. Your just sour because (none / 0)

I agree and Edwards has the BEST PLAN.


by iamready on Thu Sep 20, 2007 at 12:50:33 AM EST
[ Parent ]

Nope. Regional markets (none / 0)

couldn't get through the first time around and they won't this time.  Further, the small business mandate is a poison pill.


by bookgrl on Thu Sep 20, 2007 at 12:57:10 AM EST
[ Parent ]

Re: It's the FRAMING (none / 0)

If insurers lose their Medicare subsidies, how will they try to recover that revenue?  Through more cherry-picking, or higher premiums and deductibles?  I heard Clinton on GMA, and she said she would stop insurers from cherry picking and cap premiums based on a percentage of an individual's or family's income.

So, if the insurance industry is really, truly, a loser in the Clinton health care plan, why aren't they fomenting more opposition among right-wing, big-business-is-God columnists?  

More to the point, has Clinton laid out the exact nature of these caps, and how friendly are they to the working class?


Take out the trash. Down with Saxby Chambliss!
by CLLGADEM on Thu Sep 20, 2007 at 05:10:07 AM EST
[ Parent ]

Re: It's the FRAMING (none / 0)

The insurance companies take a hit by not being able to "redline" high risk customers (either denying them coverage or charging exhorbitant rates). However, this hit is offset by 47 million new customers in the system -- many of whom are low-risk young people. So, from an actuarial standpoint, the additional high-risk customers they are forced to accept are offset by new low-risk customers in the system.

The combination of a carrot and a stick has the insurance companies at least will to listen at this point. It's still early, of course.


by hwc on Thu Sep 20, 2007 at 05:23:01 AM EST
[ Parent ]

Re: It's the FRAMING (none / 0)

The answer makes sense, thank you.  When I have time, I'm going to check the websites of Clinton and Edwards, do my own analysis of the competing health care plans, and write a diary.  Hope to hear from you then.


Take out the trash. Down with Saxby Chambliss!
by CLLGADEM on Thu Sep 20, 2007 at 05:46:16 AM EST
[ Parent ]

Re: It's the FRAMING (none / 0)

HWC had a good response. One small thing to note, I think that the insurance industry has pretty much accepted that some for of substantial health care reform is going to pass so for them its choosing the best out of the "worst" option.


by world dictator on Thu Sep 20, 2007 at 10:44:24 AM EST
[ Parent ]

and another thing (2.00 / 0)

the Edwards health care plan also allows Americans to choose and does not "foist" anything on them "from above."


John McCain: 100 years in Iraq "would be fine with me."
by desmoinesdem on Thu Sep 20, 2007 at 12:44:52 AM EST
[ Parent ]

Re: Hillary's Medicare buy-in Option? (none / 0)

Agreed.

The America's Health Choices plan is is an example of brilliant political framing by a campaign that really "gets it".

I am stunned that most of the mainstream Republican pundits are reasonably complimentary of the plan. I just about dropped my dinner plate when Charles Krautheimer agreed that it was a "reasonable plan".

The most politically deft touch? Co-opting the entire Republican health care stance by offering choices of private plans and tax credits to help individuals pay for them. To incorporate the Republican Party platform in a proposal that will move the country very firmly towards single-payer is just a stunning piece of political jujitsu. It's no wonder the CEO of Merrill Lynch became a fundraiser for Clinton after two lunches discussing health care.


by hwc on Thu Sep 20, 2007 at 12:54:22 AM EST
[ Parent ]

Exactly. (none / 0)


by bookgrl on Thu Sep 20, 2007 at 12:56:18 AM EST
[ Parent ]

when Hillary testified before Congress in 1993 (2.00 / 0)

The Republicans praised her all day long.

Then they turned around and destroyed her.

If you think they are sincere in their praise for Hillary's plan and not just trying to sucker us into nominating a weak candidate, you are mistaken.


John McCain: 100 years in Iraq "would be fine with me."
by desmoinesdem on Thu Sep 20, 2007 at 12:57:09 AM EST
[ Parent ]

Re: when Hillary testified before Congress in 1993 (none / 0)

...and you think they won't try to destroy Edwards? Or Obama?

Let's be realistic here. We have all said here before that the Repubs will go after whoever is chosen as the nominee.

We have to determine which candidate is better able to handle the attacks and WIN.

The answer clearly is HRC.  Like it or not.  Edwards doesn't stand a chance against the Right Wing Spin Machine.

Mainly, he comes off as a HYPOCRITE; which the Repubs are going to exploit and, literally destroy him. Obama doesn't have the perceived persona as Edwards. He might fair a little bit better against the Right Wing Spin Machine.


by lonnette33 on Thu Sep 20, 2007 at 09:09:12 AM EST
[ Parent ]

Yes but with all her "experience" (2.00 / 0)

why was Edwards the one smart enough to "get" that before her?

That clearly goes to qualification, doesn't it? Is it because, she's been too long in DC to think out of the box? Or it is because she's accepted that dealing with the lobbyists is part of the business?


It's an election, not an auction.
by cosbo on Thu Sep 20, 2007 at 01:03:53 AM EST
[ Parent ]

Re: Yes but with all her "experience" (none / 0)

Edwards didn't "get" anything before Clinton on health care. She has known this stuff cold for 14 years. All Edwards did was waste his one big shot (announcing his "plan") back in February before anyone was paying attention.

Forget the plans. This is about political skill, both in campaigning and governing. You can have the best plan in the world and you won't get to first base if try to pitch it with a political tin ear.


by hwc on Thu Sep 20, 2007 at 01:09:38 AM EST
[ Parent ]

well, obviously (none / 0)

My husband and I will gladly ditch our overpriced private insurance policy for a Medicare-style policy at the first opportunity, and so will millions of other Americans.


John McCain: 100 years in Iraq "would be fine with me."
by desmoinesdem on Thu Sep 20, 2007 at 12:43:41 AM EST
[ Parent ]

Exactly. (none / 0)


by bookgrl on Thu Sep 20, 2007 at 12:47:13 AM EST
[ Parent ]

Re: well, obviously (2.00 / 1)

I suspect that the expanded Federal Employees Benefit plan will also be extremely popular. The bidding by the insurance companies to get a piece of those pools will be intense.

Right now, those options include several versions of Blue Cross/Blue Shield -- high deductable and low deductable -- plus a number of HMO options in each market across the country. They are already big pools with just the Federal employees. Opening up these pools to include the entire country will make them extremely competitive as higher cost/more frills options to the public Medicare buy-in system.


by hwc on Thu Sep 20, 2007 at 01:06:10 AM EST
[ Parent ]

Re: well, obviously (none / 0)

I think Clinton has an excellent approach to this. By opening up Medicare (and expanding SCHIP and Medicaid) I think the end result will be that millions of employers and tens of millions of Americans will dump their private insurance plans and become part of a Medicare based UHC system. If ever given the chance I will enroll in Medicare and be done with the insurance companies.    


BlueSunbelt.Com Netroots for the Sunbelt states robwire.com My personal blog
by robliberal on Thu Sep 20, 2007 at 12:23:00 PM EST
[ Parent ]

Exactly. That's what many of (none / 0)

the European plans are like.  A social plan with some boutique private plans.


by bookgrl on Thu Sep 20, 2007 at 12:43:42 PM EST
[ Parent ]

You're probably right. But I had a few (none / 0)

people, desmoinesdem for one, who I had to set straight.  I am so completely tired of the "Hillary is bought and sold" meme.  Did you know Edwards actually chastised John Kerry's 2004 plan(which is basically Obama's current plan) for being too large?  


by bookgrl on Thu Sep 20, 2007 at 01:02:34 AM EST
[ Parent ]

and I supported Kerry in those primaries (none / 0)

Edwards was the most gifted campaigner, but he didn't have the best policy agenda. He was running too much of an Axelrod-type campaign.

Like I always say, if Hillary does win the nomination I hope you are right about her determination to push for progressive change. I think you are going to be disappointed, though.


John McCain: 100 years in Iraq "would be fine with me."
by desmoinesdem on Thu Sep 20, 2007 at 01:51:37 AM EST
[ Parent ]

You refuse to take in information. (none / 0)

Did you read the diary?


by bookgrl on Thu Sep 20, 2007 at 01:53:42 AM EST
[ Parent ]

yes, I did (none / 0)

I simply doubt her sincerity to see this through. I think this is part of her blurring strategy for the primaries.

But I am glad she is on record supporting the option to buy in to a state plan modeled on Medicare. If she manages to get elected, we will need to hold her to this promise.

If she governs like her husband, she will announce with regret that we need to balance the budget and can't afford any expensive new domestic programs like the health care reform she promised.


John McCain: 100 years in Iraq "would be fine with me."
by desmoinesdem on Thu Sep 20, 2007 at 01:59:56 AM EST
[ Parent ]

You're so jaded. (none / 0)

With due respect, I doubt Edwards sincerity. I think most of what he is saying now is directed at the kookie Iowa caucus goers, the university professory types who want their ego's stroked.  


by bookgrl on Thu Sep 20, 2007 at 02:05:06 AM EST
[ Parent ]

I really did laugh out loud (2.00 / 0)

University professor types? Yeah, that's Iowa Democrats in a nutshell.

As for being jaded, I guess growing up during the Reagan presidency will do that to a person.


John McCain: 100 years in Iraq "would be fine with me."
by desmoinesdem on Thu Sep 20, 2007 at 02:17:59 AM EST
[ Parent ]

Re: I really did laugh out loud (none / 0)

You refuse to acknowledge her actual record.  It's all inuendo.  And, yeah, I'm not talking about the farmers.  I've read there is this contingent of caucus goers.  But I don't want to insult you.  I just find it absurd that you place everyone in higher regard than Hillary.


by bookgrl on Thu Sep 20, 2007 at 08:10:40 AM EST
[ Parent ]

Re: Come on, people. Hillary's Medicare buy-in Op (2.00 / 1)

You can win a lot of allies if you come up with a market-based solution that actually accomplishes a progressive goal.  It's smart to always be on the lookout for these opportunities.


"Another problem we have...is that in election years we behave somewhat as primitive peoples do at the time of the full moon." --Harry Truman
by Steve M on Thu Sep 20, 2007 at 01:33:54 AM EST

Re: Come on, people. A Medicare buy-in Option? (none / 0)

The problem with a Medicare type program is finding doctors, especially specialists that will accept Medicare. I haven't heard Hillary discuss how she would open access to individuals with Medicare.

One of my brothers is schizophrenic. He is mentally disabled (not challenged) and is incapable of making up his own mind what the proper care is for his disability. And yet the law states that because he is an adult he is entitled to make his own choices. Therefore he skips his meds and doesn't get any better. It's not that schizophrenia can be cured but it can be regulated and most not extremely severe schizophrenics can reach a state of level where they can at least function somewhat normally. So what does Hillary's plan say about fixing the inability of mentally disabled individuals to make their own choices?

When my brother's doctor was suddenly forced to shut down because of inadequate care we tried to find him another doctor. After several full days of phone calls and being told that the REAL doctors didn't accept Medicare we finally found him a new doctor. We do not know if this doctor is good or not because he hasn't been with him long enough and we are not entitled to any information about his mental health even though he has been judged by the federal government to be mentally incompetent. But the point is that we should have been able to find a reputable physician/psychiatrist that would have accepted his government sponsored Medicare without a hassle. The mentally ill people need care more than many of us. And yet the ones that need it the most are turned away.
How is Hillary's Universal Medicare system going to help my brother?


by DoIT on Thu Sep 20, 2007 at 03:23:06 PM EST


You are not logged in.

In order to post a comment, you must be logged in. If you have a member account, please log in to comment.

If not, you can make an account right here. It's quick and free.