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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RJ Eskow at the Huffington Post

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Comments

[Dap]

Dear Brother RJ,

Thanks again for keeping us informed on this issue. One thing is sure, bringing a viable plan to the table is not going to be easy, especially with all the competing interests.

Agape.

[avergejoe]

This is just bush's medicare prescription plan extended.
Take care of the business first, then the pt.

[avergejoe]

Or trikle down (piss on) health care.

[Singha]

"Tinkle Down" heath care.
Cleaver

[gillespie]

She so far surpasses her challengers in terms of competence that this really ought not be a contest, but so much of the Democratic Party (I am a Democrat) is bent on this or that obsession and prone to follow irresponsible rhetoric right of over a cliff that it will be close; still, the biggest adult in the bunch (HRC) will likely prevail in the end, prompting more screeching from the unhinged fringe.

[Independent voter]

Biggest adult in the bunch? What metric are you using - ego, greed, lust for power at any cost, sleaze?

I hope your post was in jest.

[ebbtide]

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.

err, yes

I read it. I still don't see it as anything she will do to impliment it,. So I agree. It is all now just big talk. And goverment will see to it that those who cannot afford health care and are going broke, using half a pill instead of the prescribed dosage to save their money for food--err, isn't that what Medicare was supposed to cover?

Come on. This is the great Clinton health care revelation. It says nothing to me at all, so far. In fact it is confusing and no one around seems to be around to explain it. Says something aboutg this great "unveiling".

[jumperpin]

Details aside, and yes that's a big aside, Dem's health plans all reflect political reality.

The jiu-jitsu of "mandatory insurance" is a great way to handle otherwise overwhelming special interests. They prob'ly know it. But their predictable pursuit of short-term gain will ultimately kill their golden goose as the efficiency of expanded Medicare (single payer) clobbers its private counterparts.

[lastams]

There are two things that should be obvious here;
One is that ANY for profit healthcare system is going to put profits above service.
More income, less service equals more profit …period.
Two is that PFIZER INC., AMERICA'S HEALTH INSURANCE PLANS PAC,
THE BLUE CROSS BLUE SHIELD ASSOCIATION POLITICAL ACTION COMMITTEE,
Or the AFLAC INCORPORATED POLITICAL ACTION COMMITTEE,
haven’t given massive “donations” to the Clinton campaign because they expect her to cut their profits.
Barney Frank likes to joke that, “Politicians are the only human beings in the world who are expected to take thousands of dollars from perfect strangers on important matters and not be affected by it.”
How naive do we have to believe that Ms. Clinton will put our interests above K-street’s, when K-street is footing the bill.

[Independent voter]

More smoke and mirrors from the queen of the flim-flam.

Mandating that people buy their own health insurance is not quite my idea of universal health care - anymore than forcing people to buy their own homes is an end to welfare.

If you buy this bullshit, I have a cave in Afghanistan for sale - needs a little paint, but it could make a cozy home for the right couple. Actually, it would make a real nice place for the Clitons.

[MrLiberal53]

Did you watch the O'Reilly factor before or after you posted?

[Stoyver]

Predictably, Hillarys plan sucks up to insurance corporations. Insurance corporations are a no-value-addded drain on our healthcare system. It is goulish that insuance corporations (investors) make a "killing" off the misery of ill human beings. Whats next, investors making money off war?

[linkunlovr]

Clinton is unveiled as the tool of the insurance lobby. Bought and paid for.She wants to force everyone to give money to the insurance companies and she has thegall to call that universal health care!Dennis Kucinich is the ONLY candidate for true universal not for profit health care with no insurance companies involved draining dollars from health care expenditures. But Hillary and all other "top Tier" candidates owned by lobbyists are the only ones the corporate media will cover. What a surprise! But the internet gives people a chance to hear the truth and the truth can set us free. Kucinich for President.

[pmfelipe]

The problem is even the Democratic leadershipis afraid of Kucinich. He is the only one who represents true change. The others represents a window dressed status quo that looks like change.