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.
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Screw her. Mandated health coverage is a windfall for the insurance companies and a massive strain on the people who already can't afford insurance. This is a typical rich person's solution: clueless, arrogant and completely out of touch with the people who need help. Hillary Clinton's plan stinks. Just SCREW HER.
Hillary's "plan" is to require everybody to buy insurance from the people who are putting up the money so she can buy the white house.
The village idiot can see through this.
The pharma and insurance companies are backing Cliton for a reason folks - and this is the payoff - forced customers.
What I want to know, is what are any or all of these candidates going to do to increase supply of medical delivery systems of all sorts (doctors, hospital beds, medical equipment, etc.) to drive down prices while still maintaining an effective, high standard health system?
Don't kid yourself- like any country that has it, it is expensive in the end. In Canada about 15% of ones income goes to it- just so you know.
When you buy any kind of "insurance" you put your money on a bet that you are going to experience and be rewarded for dying young, getting maimed, or having an accident, disaster, disease, flood, fire, etc. while the insurers holding your policies gamble that those things will NOT happen to you. So who's been winning the wager? Who's laughing all the way to the bank? If you manage to have a disease/disaster and are compensated for some of it, have you won???
I will NOT buy any form of "disease insurance" whether mandated or not--and if you've read my first paragraph and have half a wit you already understand why: I'm EXPECTING to stay healthy! I am not an accident--my life is not an accident! There are no accidents!--we create our individual and collective experience with our expectations and that is not an accident!
So what penalty is proposed for non-conformists to the Clinton/Ed
I applaud the passion of most of you guys, but so many are missing the point. There is not one health care plan in the whole primary process that matters. Not one! I do not care what plan Obama has, or Clinton has, or Romney has. I do not care that Dennis K. supports single payer. As a matter of fact I do not care what any of their plans are for any issue. When will we realize that The President Of The United States is not supposed to be some idea machine. Plans are made and passed in congress. It is the duty of the President to show leadership in this process, and facilitate it however possible to the benefit of the people. Why oh why do we keep giving such authority to the the executive branch, assuming all their ideas will instantly be law once they take office. Any plan they have will immediately be torn to shreds in congress no matter what support they have. Deals are made there not in primaries. We need a uniter that can forge deals, not an idea man. If you want inventive people look for them in the legislative branch where it actually matters.
Any healthcare plan that does not disconnect healthcare from employment is unworkable as far as I'm concerned. And the notion that people should be forced to buy healthcare when these same people can't afford it now seems preposterous on the face if it. I can't imagine how the government or the market can prevent gouging when they haven't been able to accomplish it thus far (except in the VA). Neither can I imagine a successful two-tiered system with the haves owning private policies while the rest with government insurance since it is bound to create inequities with some doctors opting out of the latter in favor of the former. What politicians are trying to do is fight logic and the inevitable. The only system that makes any sense is a single payer system. Such a system must include everyone without exceptions and everyone should pay for it directly through a tax.
The thing I don't get about healthcare being market based is how does someone shop around for the best "cost efficient" provider when they are lying unconcious in an ambulance?
Most people don't even know what tests their doctors are ordering so how can they possibly shop around to find the best price for that test. Do you know the code for a comprehensive panel? You will need to shop around for prices. Does anyone on this site have any idea of the complexities of medical coding and billing? I do, because I work for an insurance company and if I could only tell you the stories I have seen. I just had a doctor bill me with a CPT code for an 80 minute office visit when he only saw me for 10 minutes. If I didn't recognize the code he would have never been caught overcharging me about $200.00.
Who, without working in the industry or having a medical degree is going to know this stuff??
I don't see anyone answering these questions.
I'd prefer to cut to the chase and nationalize healthcare. Yeah. That is not going to happen until people see a public plan side by side with the private healthcare "system", so poisoned is the debate. So the private providers will fight the Clinton, Obama, Edwards plans as hard as they would fight outright socialized medicine, because they know they can't compete on price or quality and still take home enough to pay for the Rolls Royce.
Still, taking a page from the Rove/Bush playbook, incrementalism, is probably the best hope of getting moderate Republicans to cave in to allowing the side by side comparison. A manditory insurance plan will be to health what the NCLB was not to education, because the goals are diametric opposites. Bush was trying to destroy public education and healthcare reform, any reform, is trying to create public healthcare.
The biggest problem I have is with the tax break widget. Of the people who do not have health insurance, to how many will a tax break matter?
I have to say I'm underwhelmed. In fact, I like Romney's plan better. His plan has problems, but he has actually done it, while Clinton's plan is all talk. It looks to me like the Democrats by being too calculating and by accepting half-measures have given another one of their key issues to the Republicans.
Clinton's 'plan' is a cut n' paste of Massachusetts with a tiny tewak here or there.
I have been tracking the MA plan for a Gov.'s committee in my state.
Romney's system in MA only workd for those who are at of below 300% of Federal Poverty Level. ($30,000+ for 1 person.) For those people, it is subsidized premiums with the state picking up the bill and they enroll with a limited few priivate insurers.
Those who are over that level in income and (1) have a fmaily or (2) are over 40 can not afford even the plans negotiated by the state with supposedly lower premiums than sold in the open market.
Thanks for the additional details. I agree that Romney's plan isn't perfect but at least he did it, with a lot of help from Democrats including Senator Kennedy, I understand. It seems to me that premium costs and coverage of middle income people are problems with Clinton's plan, too.
Is Clinton's story going to be, the Republicans implemented health care reform a year ago, if elected she'll do the same thing? I don't see how she's going to run on that, why vote for a Democrat if she's just copying the Republicans?
What do I think? I think it sucks. This "plan" is a gimme to the insurance companies she is so in bed with.
In her "plan" she would still have large companies providing health coverage to their employees. Why is this a bad idea? Because it lowers the amount of money they have to invest into R and D. We as a country are LESS able to compete with other counties because so much of the profits are being used on health care and retirement benefits. Her "plan" does not address this. Indeed, it seems to make it worse.
Worse because it requires people to buy their own insurance through "tax breaks". Fine and dandy if you earn enough to pay taxed, but lousy if you don't. Do you really think that those among us will get the same health care if they don't buy their own? I don't. There is no financial incentive to do so.
What is needed is to pit two large lobbies against each other for there to be reform. Strange as it might sound, it might be for the best to convince the business lobby that profits would increase if thsy didn't have to pay all these costs out of pocket.
I'm not fool enough to think it would happen or that it would work. It is, however, worth a try. Hillary's "plan" is a give away to her contributors.
The answer to your question just requires a little bit of critical thinking. There is a reason businesses don't want socialized medicine even if it would save them money. The reason? Because the executives and upper management that have the VIP plans with everything 100% covered and paid for will no longer have their coverage subsidized by the employees at the bottom.
In addition to that, if the government is footing the bill then the data in the medical records of their employees becomes the property of the government and when the government sees how many "Exxon" employees have cancer and other serious illnesses then they may end up going after them to recover costs. There are many companies out there that have very sick employees and they are doing everything in their power to make sure the public doesn't know about it. Think about those mine workers and wonder just how safe working conditions really are for millions of people in this country.
We need a national health care plan that does not include the insurance industry.
Hillary is in the pockets of the health insurance companies.
We should listen to Kucinich, those health insurance CEOs are ripping off the people now, imagine how much more they will after the government DEMANDS that we buy insurance from those companies.
Our car companies and other manufacturers in this country are at a disadvantage if the burden of health care is just on them. We Americans are fools, look at all the other industrial countries, they have good health coverage, despite what those people who want you to believe otherwise.
Ever notice, those who don't want everybody to have health coverage, already have it!
All of Europe also have 4-5 weeks paid vacations, by law!
Those European countries should hate American, because we are cheap labor compared to them, and we talk about those cheap illegal people undermining our country, not to mention that cheap labor in the third world countries where most of out good paying jobs are going.
Like I said Americans are fools!
They even elected Bill Clinton , who gave us those treaties that cost the middle class millions of good paying jobs and Cheney's speech-a-day pet monkey Twice,....
"the Clinton plan can't be fully assessed until more details are provided on knotty issues like premium calculations and benefit design"
I think it can be fully assessed in that it does nothing more than direct more of people's money to the same private insurers that currently go out of their way to deny coverage when it's needed. In fact, it actually requires that everyone pay money to private insurers. They must love this plan.
Sen. Clinton announced right off the bat that this is not government-run health care, as if that's naturally a bad thing. It's not. Ask the rest of the industrialed world.
I'm so disappointed in her. This is a shameful attempt to actually fool Democratic primary voters by using the term "universal coverage." This makes it even easier for me to put my primary support behind Sen. Edwards.
How about eliminating predatory lawyers that drive up insurance costs? You won’t hear any liberal candidate approach that subject. Truth is it’s that’s the root of the problem. If we enacted tort reform and term limits our country would be a better place. Get rid of the blood-sucking lawyers and career politicians and we all beneift.
Medical malpractice claims are less than 1% of all medical costs.
Oh yeah, 1% of medical costs explains the billions in insurance company profits, Uh huh,,,,
Better to reduce the net take-home physician incomes to levels comparable to other industrialized countries.
What? Are you an incompetent physician whose malpractice insurer cringes every time you renew your coverage?
No. Are you a neo-Marxist who wants to socialize our medical industry? Yea, lets turn it all over to you feel good liberals just like our public education system you’ve controlled for decades. The one that produces graduates that can’t read a comic book, balance a check book, and mistake Greenland for Russia on a map.
Personally, I don’t want to have to wait 3 months for an appendectomy like our sad socialist neighbors to the north.
Stupid is as stupid does. You are what you say, and that includes being stupid. How about medical malpractice insurance costs? No mention of that stupid.
2nd try for kasa:
No. Are you a neo-Marxist who wants to socialize our medical industry? Yea, lets turn it all over to you feel good liberals just like our public education system you’ve controlled for decades. The one that produces graduates that can’t read a comic book, balance a check book, and mistake Greenland for Russia on a map.
Personally, I don’t want to have to wait 3 months for an appendectomy like our sad socialist neighbors to the north.
Stupid is as stupid does.
It seems to me that the details are not important at this moment, in Hillary's, Obama's or any other Dem plan. The Democratic Party is committed to implementing universal health care and will work together to make that happen. Parts of all the plans will be injected into any final plan, and then congress would have to pass it, so more tweaking will be done.
Kudos to all the Democratic presidential hopefuls for putting time and energy into our fight for affordable health care for all Americans.
Yet again, the Democrats are listening to Americans on Main Street while Republicans listen only to the ones on Wall Street.
Boadicea honey, we need truth seekers not cheerleaders. One of these days you will be sooooooooooo let down.
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