Some comments on the Hillary Clinton health plan:
The Huffington Post, Sept. 18, 2007
By Rose Ann DeMoro
The pundits might have it right on this one. Hillary Clinton did learn a lesson from her 1994 fiasco on healthcare reform. Unfortunately for most of us who don’t have an Inc. after our name or a private jet to cart us around, it was the wrong lesson.
In the days leading up to the announcement of her latest, much anticipated health plan, Sen. Clinton threw around the word “consensus” a lot. In this case, the consensus she was seeking was with the same industry that so savaged her prior experience with healthcare.
This time, she apparently wants to soften them up in advance with a proposal that will generate hundreds of millions of dollars in additional profits for the insurance giants. It’s probably not a coincidence that she is also the top recipient of healthcare sector contributions to her presidential campaign.
Looking past the bells and whistles — which do at least include some good sound bites on retiree health and giving regular Americans the same health plan options as members of Congress — the Clinton plan seems to rest on three shaky legs:
1. Forcing all Americans, who do not have current coverage and do not qualify for public assistance, to buy and maintain insurance;
2. Mandating large employers to either provide health benefits or contribute to the cost of coverage
3. Tax credits for just about everyone
If the central elements here sound familiar, they should. The plan is a smorgasbord of the worst elements of what we’ve seen and heard from some other presidential candidates and the plans floating around several state Capitols.
Ironically, given the overheated reaction from Republican candidates, Clinton’s plan most closely resembles the approach of two Republicans — the Mitt Romney-crafted law in Massachusetts and the proposal by California Gov. Arnold Schwarzenegger.
That’s hardly a badge of honor. The Massachusetts model is working best for those with public subsidies, and Schwarzenegger’s plan is now buried in the minutia of a special legislative session while public support for it has been plummeting in the polls.
The biggest failing of this plan, like the Romney and Schwarzenegger schemes before it and like most of the other Democratic candidates’ proposals, is the abject failure to challenge healthcare industry price gouging and runaway costs.
Insurance premiums have climbed 87 percent the past decade, and though they have slowed a bit in the past year, the increase is still double the average increase in wages. That does not include, of course, the rising cost of deductibles, co-pays, prescription drug prices, hospital charges, and, the latest fad, annual doctor fees, like what many people are charged for the privilege of having a credit card or checking account.
This is only the biggest healthcare story of the year. One recent example. Consumer Reports last month reported that more than half of the “underinsured” postponed needed medical care due to cost and a third had to dig deep into their savings to pay for medical expenses. Another third of those over 50 said decisions about their retirement were adversely affected by healthcare costs, one quarter had outstanding medical debt, 38% postponed home or car maintenance repairs due to medical bills, and only 37% said they were prepared to financially handle unexpected major medical costs in the next year.
Throwing more Americans under the wheels of the insurance industry will not solve this problem any more than criminalizing the uninsured is humane or sound health policy.
Clinton’s solution is a combination of tax credits, unspecified encouragement to drug companies to “offer fair prices,” and promoting “consumer price consciousness in choosing health plans.”
But tax credits mostly benefit higher income Americans. And families grappling with skyrocketing prices, and no controls on costs, will likely choose the cheapest, high deductible plans that provide the worst coverage. The sad outcome may be seen in a report earlier this year by the American Academy of Pediatrics that families with high deductible health plans are far more likely to put off needed care, including immunizations and recommended treatment, due to the cost.
Sen. Clinton might have drawn an entirely different idea from her prior unpleasant history with the healthcare industry. She might have decided to cut them out of the business of profiting off pain, suffering and medical debt, and proposed a very different solution, such as expanding Medicare, Medicaid, or the State Children’s Health Program to cover everyone.
Accommodating the insurance behemoths, and effectively offering them massive public subsidies — using the considerable power of government to force everyone to become paying customers of the private insurers — is not the kind of leadership on healthcare we need.
Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee and a national vice president of the AFL-CIO.
California Progress Report, Sept 17, 2007
By Don McCanne
Don McCanne is Senior Health Policy Fellow
Physicians for a National Health Program
Last Tuesday’s article from Health Access California, a supporter of AB 8, provides an overview of the legislation and the political activity taking place around it. For those interested, it is worth reading.
In a classic example of political irony, Democrats are abandoning their preferred option, single payer reform, in order to reach a compromise with the Republicans and the private insurance industry. They have crafted a model that they believe does not repeat the mistake of the Massachusetts reform program. California Democrats proudly proclaim that they will not require individuals who cannot afford private insurance to be covered by a program that is being inappropriately characterized as universal.
Not one Republican voted for this compromise, and Blue Cross of California is spending a couple million dollars in an advertising campaign opposing reform. So much for compromise. The Democrats have violated the first rule of negotiation. Before they even seriously sit down with the governor, they have removed from the table the most important polices that would bring comprehensive, affordable, high quality care to everyone.
When you read through AB 8, perhaps the most glaring defect is that the authors craft reform around the private insurance model – a model that served us fairly well in the last century, but one that has now become obsolete. Individual private insurance plans that are reasonably comprehensive and include everyone are no longer affordable for the majority of us. The model for this century is a universal risk pool that is equitably funded.
A report in the current issue of Health Affairs stated that the average annual premium for family coverage is now $12,106. With a median household income of $48,200, those numbers no longer work. Do we provide large government subsidies for a majority of us to purchase administratively-inefficient private plans, or do we reduce the benefits of the plans so that the premiums become affordable? The current anti-tax political environment makes the former highly unlikely.
AB 8 will result in an explosion of the fastest growing problem in health care today: underinsurance. Private plans with affordable premiums but inadequate coverage will create financial hardships for precisely those individuals who should be protected – those who need health care.
Most of us who continue to advocate for a single payer national health insurance program have also supported incremental improvements as temporary measures until we can achieve the reform that we really need. But the line must be drawn with AB 8. We need health care financing reform that enables patients to access the health care system without being exposed to financial hardship.
We need a universal risk pool that is equitably funded and efficiently administered so that funds can be redirected to the health care that we need. What we don’t need is false pride in having protected the private insurance industry at the cost of leaving millions of Californians without adequate coverage.
Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 14,000 members and chapters across the United States.