Sen. Clinton's Health Plan: A First Look

Sen. Hillary Clinton has offered an initial look at her plan for health care reform. It's not likely to change anyone's mind about her candidacy, or about health care reform, but at the overview level it's well-designed and thorough. Her plan is solidly in the center of Democratic proposals. It emphasizes mandated coverage, cost reduction measures, and the elimination of predatory insurance underwriting. At first review, it reinforces the sense that she and her staff are knowledgeable, highly competent, and incrementalist in their approach.

We'll look at the plan's details, and then quickly touch on the Republicans' (predictable) responses.

Sen. Clinton has abandoned the regional health alliances that were a hallmark of her 1994 proposal. That makes the Edwards plan, with its regionally-based Health Markets, more traditionally 'Clintonian' than Sen. Clinton's new proposal.

Here are the highlights of the Clinton plan, based on an initial review:

Like the Edwards plan and Mitt Romney's Massachusetts plan, mandates are the centerpiece of the Clinton program. Every American will be required to have health insurance. To offset this new requirement, the Clinton plan promises future cost savings to ensure affordability.

I'm not a fan of mandates, for reasons discussed here, although I understand the thought process behind them. There are fundamental issues of fairness that are easy to address in theory, using subsidies -- but most policymakers so far have failed handle premium and copayment structures in a way that does so effectively. I also suspect that Republicans will have a field day running against the mandate concept.

The Clinton plan -- like those of Edwards and Obama -- apparently offers a public insurance alternative, although details are sketchy at this point. The long-term impact of a public/private competitive model is potentially very significant: If private insurance companies can't compete on price and value, and if they're policed effectively enough to avoid their use of unfair underwriting advantages, they could potentially wither and die. That would leave the country with a de facto single-payer system -- one created by market forces. Yet there are many potential hurdles between a mixed system and a fair outcome.

Sen. Clinton's program is administered through the Federal Employee Health Benefit Program (FEHBP). She takes a page from John Kerry's playbook (and Ron Wyden's) by saying that this will provide "benefits at least as good as the typical plan offered to Members of Congress, which includes mental health parity and usually dental coverage." There will also apparently be also a public Medicare-like system, although details on that are sketchy at this point.

The problem is that, as Joe Paduda points out, many Americans can't afford the copayments and deductibles in the congressional health plan.

It will be difficult to light a fire under the political base with this plan, or for that matter with Edwards' or Obama's (although Edwards took the rhetorical lead today by promising to cancel coverage for the executive and legislative branches if health reform isn't enacted).

Sen. Clinton's plan appears to handle taxation issues in depth, and addresses the ongoing (and often neglected) issue of retiree health benefits. And Clinton has been ahead of the curve in addressing health IT issues.

Republican reaction was predictable:

"If you've seen the report this morning on the latest version of Hillarycare, you'll see that version 2.0 is not like to have any more success than 1.0," former Massachusetts Gov. Mitt Romney told reporters in New York. "Hillarycare continues to be bad medicine."

Yet, of all the candidates, Romney is the only one who has tried to enact health reform. As we've discussed before (here, here, here, and here), his record so far hasn't earned him any bragging rights. And Giuliani indulges in a typical attack of red-baiting, saying ""If you liked Michael Moore's Sicko, you're going to love HillaryCare 2.0. " That may not be a smart move, since a lot of people did like Sicko (a movie that condemned the "new Hillary").

As with any of the health proposals, the Clinton plan can't be fully assessed until more details are provided on knotty issues like premium calculations and benefit design. We'll be looking for more information, and will provide more details as we get them.

A Night Light
The Sentinel Effect: Healthcare Blog
Future-While-U-Wait
RJ Eskow at the Huffington Post

Comments

[sophson]

want to have good care for all americans at much less money than we pay now? single payer is the answer."socialized" NOT!.. SOCIAL secutity has been around for many years and is well accepted by everyone.. run health care with a system like the V.H.A..dont be critical of this suggestion until you. see how well V.H.A. works these days cut out high administrative costs( 30% at present) and negotiate for lower cost of all drugs.... 47 million or more will thank you!

[swkidder]

All substantive discussions about what to do with a totally broken healthcare system must wait until the middle of November 2008. A candidate for political office who is rash enough to tell the truth, i.e. that it's time to fire private insurance companies and rein in the pharmaceutical industry, creates a few hundred million dollar "Harry and Louise" moment for himself/herself.
Anyone with a functioning cortex understands that private insurance has failed in the task we gave them, i.e. managing the dollars this nation spends on healthcare. We need a single-payer, universal healthcare system. We're not going to get one anytime this year.
And, the medical model into which we've fallen is similarly "challenged" - single-ligand/single-receptor drugs and "fighting disease" in a philosophy that emphasizes going to war against one's own body have both hit the proverbial wall when applied to the single issue on which we spend 70% of our overall healthcare dollars - complex, chronic illnesses.
So let's not kid ourselves - don't sweat the details of anyone's "healthcare plan" - they're all irrelevant and nothing on the table yet is a sane response to fixing what's broken in the U.S. healthcare system.
But let's do so thinking, and some talking, and be ready to act 18 months from now?

[Jonahson]

Free health care doesn't need to be completely free. You can take the British model for giving health care to everyone in their country. As for those still living in the past who things paying for every thing proves means you are not a socialist so who is stopping them?
As the population gets bigger each year while land and opportunity get scarce there will be more and more people who may not be able to pay for their medical insurance without making a big dent in their savings.To some it is no longer a joke; if the disease don't kill you the medical bill will.

[lottopol]

The issue is that medicine and capitalism mixes as badly as socialism and agriculture. If we did not regulate electricity, rates woould be be ten times what they are now because of the inelaticity of demand. Medicine is is the exact opposite of the "consumer sovereignty" that Adam Smith wrote about. The "seller" the doctor, tells you how much you need and what the price is. Whether is is a single payer system like Canada or a multi payer syesem like Germany eventually we will have a monopsony system that involves a "single buyer" who sets prices, like medicare today. If doctors' incomes rise a 3% more than the rest of the population indefinity eventually we will be spendingh 100% of GDP on health care.

[susanlno]

I wasn't at all surprised to hear that Senator Clinton is pushing "mandated coverage."

That means that, instead of my current situation of simply having no medical insurance, I would have to pay through the nose for "coverage" that would never allow me to get "care."

Like most of the political pros--all of whom are wealthy, though they swear that having less money than Bill Gates makes them middle-class, and all of whom are insured at taxpayer expense--Hillary has, whether intentionally or not, failed to draw the distinction between "health coverage" and "health care," a distinction that matters more than ever because the insurance companies have made sure that the two are completely opposed to each other.

The solution is so heartbreakingly simple that I already know it will not be enacted in my lifetime: A single-payer system is the only possible answer. Health care should not be a for-profit business.

No more blood for health insurance.

[Spoons]

It's looking like Hillary's blog on her misguided healthcare plan site won't post anything that's not cheerleading her brilliance. I asked if she would negotiate civil rights with the Ku Klux Klan, or National Security policies with terrorists. Does anyone think there were any uninsured (representing those who have been discriminated against by the health insurers) at her table? Does anyone find this interesting...or frightening?

[asnet]

When is a plan not a plan?

When there is no plan.
What there is are three fragments .... a newspaper ad, an outline and a "summary."

[asnet]

correction: When there are three fragments.

[DrSRKeister]

One tends to be a bit cynical about any health care plan that includes the insurance industry which currently accounts for some 30% of the health care dollar in profits, advertising, etc.

House bill 676 provides for universal health care underwritten by a public insurance entity free of the averice of the insurance industry and meddling by politicians receiving baksheesh from the HMOs and pharmaceutical companies. House bill 676 is backed by 15,000 physicians and numerous unions and academic organizations.

[Kendo Nagasaki]

Doctors who work for the UK National Health Scheme are paid an average salary of $200,000 per annum for working a five day, 40 hour week.

Insurance companies get zilch.

So socialism sucks, right?

[Kendo Nagasaki]

If you want Universal Health Care you are a Communist and a traitor to capitalism and probably a terrorist supporter and you should leave the USA because its OK just as it is. So there.

[Kendo Nagasaki]

I'd much rather have my health care in the hands of someone who has the duty to weasel out of every payment than a socialized system that takes care of me first and asks questions later. I'd much rather line the pockets of an insurance company than give a doctor his due. I'd much rather pay too much for prescription drugs because the drug companies are writing the copyright laws.

Capitalism rules and socialism sucks.

[Kendo Nagasaki]

Hillary Billery Shillery's Health Care Plan is another INSURANCE SCAM.

All we need to do is extend MEDICARE to EVERYONE.

[eliotone]

The following is from yesterday's on-line The Nation:

"The Clinton plan maintains the current system of for-profit, insurance-industry defined health care delivery. The only real change is that, in return for minimal requirements regarding coverage of those with preexisting conditions, the government would pump hundreds of billions in federal dollars into the accounts of some of the country's wealthiest corporations. The plan's tax credit scheme would buy some more coverage for low-income families, which is good, but it would do so at a cost so immense that, ultimately, Clinton's plan will be as tough a sell as the failed 1993 "Hillarycare" proposal.

"America is ready for health care reform.

"But it is not ready for more bureaucracy, more expense and more revenue for insurance companies."

[Kungfublood]

"Every American will be required to have health insurance." F.U. Hilliary -I REFUSE TO ABROGATE MY RIGHTS AS GUARANTEED ME UNDER THE CONSTITUTION OF THE UNITED STATES I will not be forced to act in a way I find immoral and reprehensible I refuse to support a gang of blood sucking leaches unless and until you mandate Music lessons and martial arts lessons for all so I can live like the kings of the insurance companies!

[Steve7]

Each plan has components that bear examination. We have a "first dollar" mentality when it comes to purchasing health services. Go to www.healthcaresoundoff.com and look at the post about Other People's Money. There, however, is a great idea on that site called the Healthcare Access Card and it could be a good solution for the short term and possibly the long term. www.healthcaresoundoff.com is the only site that currently has a good forum to discuss issues and with luck will be able to contribute to the discussion and find solutions.