Why Not Single Payer? Part 3: The Clinton/Obama/Edwards Individual Mandates Represent a Losing Political Strategy

Hillary Clinton is busy in Iowa bashing Barack Obama for offering a health care plan that doesn't punish uninsured people who won't pony up their own money out of their own pockets to buy their own health insurance. She points out (rightfully) that if, under Obama's plan, the Federal government doesn't force everyone to buy health insurance, millions of uninsured people may decide not to pay for their health insurance and remain uninsured--Thus, Hillary charges, Obama's plan fails to provide for Universal Health Insurance for all Americans.

Meanwhile, John Edwards criticizes Hillary's plan on the same grounds. Her plan is vague and elusive on the details, calling for a Federal Mandate, but not specifying what the penalty will be on uninsured citizens who ignore the Mandate. If there's no penalty, or the penalty is small (under Massachusett's Universal Mandate plan the penalty is currently $295 per year) then Hillary's plan doesn't guarantee Universal Health Insurance either. In addition, Hillary's plan does not cover 12-15 million illegal immigrants who will continue to flood emergency rooms, driving up premiums for everyone else. Even one of Hillary's principal health care advisers, MIT economic professor Jonathan Gruber, acknowledges that Hillary's plan will not include everybody, stating that "Any system that does not have a single payer will not have 100 percent coverage."

At least John Edwards has the political courage to put some teeth into his plan for the federal government to force the uninsured to buy their own health insurance: Citizens will have to provide proof of health insurance when they seek care or file their Federal tax returns. If they don't have health insurance, the Federal government will sign them up for a minimum basic plan and take the premiums out of their taxes or garnish their wages. However, Edwards, Obama, and Clinton all avoid spelling out what a minimum plan would cover, what the deductibles and co-pays would be, how much the premiums would cost, and how poor you will have to be for your premiums to be subsidized by the government.

The whole dust-up among Clinton, Obama and Edwards makes clear why Individual Mandate plans--far from being more politically pragmatic than Single Payer/"Medicare For All" plans--are likely to end up being as big a political disaster as Hillary's 1994 health reform fiasco.

When the Republican Presidential candidate starts attacking the Democratic nominee for trying to compel middle class Americans to buy health insurance that they can't afford, the Democrat's poll numbers may start to dive. "If you're a family making over $40,000 a year so you aren't poor enough for subsidies and you don't have health insurance, the Democrats will force you to sign up and keep your tax return or garnish your wages for thousands of dollars, since the average policy costs $10,000 for a family of four." This is what the Washington consultants think is smart, pragmatic politics for Democrats? The health care issue, which should be a big Democratic advantage on the '08 elections, could suddenly turn into liability.

Even if a Democrat wins the Presidency, when it comes time to get a specific proposal through Congress, it will become clear to the voters either that their plan only pretends to cover all the uninsured but doesn't, or it represents a massive backdoor tax on the uninsured middle class who will be forced by the Federal government to pony up thousands of dollars which they can't afford to buy their own individual insurance policies. The most affordable of these policies, which realistically will still cost thousands of dollars a year, will of necessity have high deductibles and co-pays. This will force policyholders to forego preventive care and delay going to the doctor until they are really sick and may need major and expensive care. It may even lead to their early death from conditions like breast and prostate cancer that could have been treated if diagnosed earlier. (For some of the other serious problems with Universal Mandate plans as social policy, see Part 2 of this series on the Huffington Post.

Getting major health care reform through Congress (particularly the Senate, with 60 votes needed to end a filibuster) will require a massive popular mobilization. If history proves anything, it's that Washington only enacts major social change if prodded by large scale social movements such as the union movement, the civil rights movement, and the anti-war movement. Without such movements, there would be no social security, no Civil Rights Act, and we might still be fighting in Vietnam. Why should progressives put such an effort into organizing a mass movement around Universal Mandate plans that will prove unpopular, will not really offer Universal Health Care, will put a huge financial burden on the uninsured middle class, and subsidize the private insurance industry? If we're going to organize the kind of massive mobilization that will be necessary to really change the health care system in America, then let's do it for a progressive plan that really works.

HR 676, the "Medicare For All" bill introduced in Congress by Rep. John Conyers, already has 78 congressional co-sponsors. It would cover all Americans from birth until death for all medically necessary treatments and drugs, as well as preventive care. As with Medicare, people can chose their own doctor and determine the best course of care in conjunction with him or her. The 30% of the health care dollar--over $400 billion this year--that goes to pay administrative costs of insurance companies, doctors, and hospitals, as well as insurance company marketing cost, executive salaries and profits, would be reduced to less than 5%, which alone would be enough to cover all of the uninsured. Medicare For All would be paid for by taxes, but would cost most Americans less in the aggregate than they are already paying in premiums, deductibles, co-pays, and forgone wages that are used for employer-provided health care. Unlike Clinton's, Edward's and Obama's plans, it would be truly universal.

A mass movement has already begun to organize around Medicare-For-All. HR 676 has been endorsed by over 235 union organizations in 40 states, including 60 Central Labor Councils, as well as many citizens and religious organization. In California, SB 849, which would have provided for a single payer system for the State's 37 million citizens, passed both houses of the California Legislature, only to be vetoed by Gov. Schwarzennegger. It was backed by over 400 organizations and unions including the League of Women Voters, the Consumers Union, the California Catholic Conference, the California Nurses Association, the California Teachers Association, AFSCME and the SEIU, and numerous cities and counties. Many other states are building large coalitions favoring Medicare For All.

With a mass mobilization still in its infant stages, several polls show that a majority of Americans are ready to support Medicare For All. A CBS News poll on September 14-16, 2007 asked, "Which do you think would be better for the country: having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers, or keeping the current system where many people get their insurance from private employers and some have no insurance?" 55% chose "One Program For All" (up from 47% in February, 2007) and 29% chose the "Current System" (down from 38% in February). (Back in January, 2007, according to an NBC News/Wall Street Journal Poll, 53% said they would be willing to pay higher taxes so that everyone can have health insurance, while 40% disagreed.)

So why are the leading Democratic candidates afraid to support Medicare For All and are instead offering up inferior, and politically less viable, proposals for Universal Mandates? When it comes to health care, Andrew Sullivan's recent description of Hillary Clinton, unfortunately seems to apply to Barack Obama and John Edwards as well. "Her liberalism is warped by what you might call a Political Post-Traumatic Stress Syndrome. Reagan spooked people on the left, especially those, like Clinton, who were interested primarily in winning power. She has internalized what most Democrats of her generation have internalized: They suspect that the majority is not with them, and so some quotient of discretion, fear or plain deception is required to advance their objectives".

As the above polls suggest, the Democratic candidates need not be so fearful when it comes to Health Care. Even if they are, progressives do not need to follow them in their fear and timidity. Only a progressive grassroots movement has the power to help a Democratic President get meaningful health care reform through Congress, given the millions of dollars in campaign contributions and the arm twisting of corporate lobbyists that will be mobilized against real reform by the insurance and drug industries and other corporate special interests.

So here's the deal for our Democratic frontrunners: Run on your Universal Mandate plans if you must. You've probably gotten yourself so locked into them that it's hard to change course in the middle of a political campaign. At least you'll keep health care reform on the political front burner. We'll even give you money and work on your campaign, because the country and the planet cannot afford another 4 years of a Republican in the White House.

But if you're elected President, we're not going to lend the force of our progressive movement to supporting your Universal Mandate plans. We'll be organizing millions of people behind Single Payer Health Care/Medicare-For-All, the only type of plan that can actually guarantee quality, Universal Health Care to all Americans.

End of Part 3
Coming in Part 4: How Universal Mandates Originated in Republican and Corporate Democratic Think Tanks

Comments

[iijones]

Edwards 'presents' himself as representing the poor! HA! If he truly WANTED the votes of the 'poor,' he'd back HR 676---WHO IS ADVISING THESE PEOPLE??? He actually HAD a SHOT--and is blowing it by barking at opponents and neglecting the voters! They are all floating in t----et bowls!
HR 676 HAS 84 (NOT 78) COSPONSORS!
Why arent the unions, small businesses, and chambers of commerce for HR 676? It'd take the pressure off business to not have to provide insurance. OH, could it be ---due to the fact that most members of Chambers of Commerce are local insurance agents?
HR 676
HR 676-HEALTHCARE FOR ALL--WE ARE WATCHING.
Unfortunately, the 'media' isn't!

[jlohman]

There are a number of health care resources at http://MoneyedPoliticians.net

[robchapman]

The difficulty I have with Single payor as a health insurance policy for America, can be summed up in one statement.

Single payor adresses only health insurance coverage.

There is scant evidence that merely providing health insurance to the entire population would benefit the health care system.

The retort from the single payor proponents that single payor is medicare for everyone, opens up the issue of the shortcomings of medicare.

Medicare has a private insurance component, medicare has arbitrary gaps of coverage,e.g., the donut in the drug coverage, and medicare requires a spend down in the case of the chronically ill that bankrupts them.

It is unlikely that the revenue stream available through tax dollars will ever be sufficient to fix the problems mentioned above in medicare.

Single payor provides no proposal for the capital and human resources investment needed to cover another 43 million uninsured and another 50 or so million underinsured.



It is inconceibable that tax dollars will ever generate a revenue stream sufficient to provide the necessary funds to make the capital and human resources investment to cover the new people who come undercare as a result of universal coverage, either.

Clinton, Edwards and Obama are moving the right direction in charting plans for a public-private partnership in health care.

It might be politically incorrect, but it is the way to get the job done.

[jlohman]

We indeed have a system where the insurance bureaucracy drains 31% of healthcare costs without ever laying a hand on the patient, and this waste should be transferred to a single-payer system.

But worse, we have a corrupt political system where politicians not only share in the $100 million the industry gives in campaign contributions, they can have enormous investments in the insurance and pharmaceutical industries.

In any other country we call it "crooked politicians." The bottom line: get the private money out of the political system and healthcare will be fixed overnight. So will everything else be. Taxes, pork, subsidies, etc.

[elmjcil]

Bush expanded Medicare all right. Non-negotiation of prices for drugs is a very big ripoff for the American people but a boom for big Pharm.

[ProfessorDuh]

Go into any convenience store and look on the counter. There you will see a couple of cans with kids' photos taped on them, and a message begging that you give your spare change for some family that has been bankrupted by their child's deadly illness.
That's called the "greatest health care system in the world."
What a sick goddamn joke.

[Lazslo]

Or, why not just stop the war, take half of the defense budget (which will still leave the U.S. with the biggest defense budget on the planet), eliminate corporate welfare and use all that money to give everyone free healthcare? Need more money? Why not start with the billions being spent by politicians to get elected? I'll bet Hillary's campaign funds alone could house, feed, clothe, provide healthcare and schooling to several thousand people.

[larry278]

It looks like aging has left me more dense than I was when I was younger & Harry Truman tried to get us universal health care. I don't get the arguments about the virtues & faults of the Edwards or Obama schemes versus Hillarycare. Does anyone care to 'over' simplify the differences?

[23000Days]

For those of you who think there are perilous social or financial costs to true unversal healthcare, first watch SICKO, then consider this: If doctors were paid incentively to convince patients to stop smoking or to lose weight, many of society's health ills would be removed, thereby reducing the cost of the program. To twist a phrase, prevention costs an ounce while cure costs a pound.
Secondly, there's no other way the poor and uninsured can be exposed to preventive medicine.
We are all products of our environment, one way or another. To change the US toward preventive healthcare, we must first provide that environment.
Consider just one aspect of that change: Healthier food grown because people aren't buying the old fat-hormone-pesticide products any more. Better yet, healthier fast food!

A future with a healthier population is a worthy goal, regardless of how much it scares the pharmaceutical industry (people using Less drugs - God forbid!), and the insurance pirates.
Anyone who gives you ANY excuse why universal health care will not work, has a hidden agenda that is not in the best interests of the public.

[xrayman]

Once again:

This is a political red herring non-issue. Republicans will not let a universal healthcare program make it through congress. This issue has been on the dockets for over 30 years and is no closer now than it ever was. It wasn't Hillary's fault that universal health care failed in the 90s. Ted Kennedy and others have been fighting the good fight much longer.

This is an election cycle issue that will fade as fast as Bush's Social Security Privatization. Pay no attention to the man behind the curtain. Neither Clinton, nor Obama, nor Edwards will enact universal health care. It's time has not come.

[research]

Excellent "Political Post-Traumatic Stress Syndrome"! Exactly! HRC is still living in republican controlled mind set. Of course the media is still GOP, but 75% of Americans are not.

We spend twice per person what the rest of the modern world spends, for our infierior health care!

Our health care system is 37th in the world and our lifespans are 29th.

Medicare for All!

Kucinich!

[benjaminblue]

So, if a person is unemployed and has no income except, perhaps, unemployment benefits (which are taxed), how is that person supposed to stay healthy if he or she is required to spend the rest of his or her savings/minimal unemployment benefits on health care rather than, for instance, food?

It's a vicious cycle; the poor person without work cannot afford to pay both taxes and mandated health care coverage costs while trying to purchase adequate sustenance, pay for dry cleaning of an interview outfit, afford transportation, shell out more for printing resumes and access an Internet connection, etc. while seeking a new job.

Stop stealing from the poor to pad the pockets of the well-to-do.

[cloudy]

I agree with this columnist, both that single-payer is the way to go, and that, strategically, focusing on a movement rather than on the candidates' various plans is the right course.

Two further points: first, it would be much easier to get Congress to pass some kind of broad statement of mandate for a single-payer system of coverage, including statements about cost-control etc. and then setting up some kind of Commission of experts to draw up a or some plans consistent with the general guidelines. This might help get around the problems politically of 93-4, which this columnist plausibly suggests would happen again if any of the major candidates' plans come before Congress.

Second point -- if this political calculation is right, the plan with the best chance of passing, of the major Democratic candidates, is Obama's, even if some people, with UNIVERSAL ACCESS to coverage guaranteed, will opt out of actually buying coverage for themselves or the adults in their household.
I think that the claim of Obama's plan leaving out 15 million, and the suggestion that he is 'mudslinging' (essentially sleazy) to not only propose a plan initially without a mandate for all adults to buy coverage, but to actually have the impudence to argue that his plan is better! I think that too many liberals fail to take Krugman to task for this really uncalled-for broadside, although Eskow's column on Huffpo did clarify some important issues.

[KeysDan]

It seems to me, that with a Democratic president, and a Democratic Congress strengthened in numbers, we will have only one chance to change the health care system (and none at all with Republicans). This requires that all political efforts be marshalled toward the best plan possible-- medicare for all. All proposals will be intensly attacked for mandates, costs and, of course, socialized medicine. Truth will be lost in the shuffle. If it looks like "something" must pass, opponents will go with the weakest proposal and work to weaken it even further, to assure failure. The Obama plan is already a compromise, with the apparent hope that universality can be sneaked into town, only to be modified later with mandates similar to the Edwards and Clinton plans. However, all these approaches are old hat. The health care experts are becoming politicians, rather than formulating the best plans and letting the candidates provide the leadership necessary for passage.

[drricklippin]

The huge "elephant sitting in the middle of health care room" is how to reduce runaway costs which threaten our entire economy-especially what GAO head David Walker calls the economic tsunami of 77 million boomers hitting Medicare. (Everything else is secondary including mandates vs. non-mandates)

So I agree that"what people sign up to is as important as how they get signed up".

Reducing costs however is very dangerously close to denying "treatment" so politicians are very circumspect when talking about it.

As for me, I believe both individual(health behaviors)and institutional(public health) prevention is our only way out of this fiscal crisis.

Prevention musy be implented incrementally and always with compassion

Dr. Rick Lippin
http://medicalcrises.blogspt.com