Hillary Learned the Wrong Lesson from 1994 Health Care Fiasco

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

Comments

[Kendo Nagasaki]

French people live longer than US citizens.

Must be the wine, I suppose.

It has nothing to do with that lazy 40 hour workweek, 6 week vacations and universal health care.

[Doofus]

'When the moon is in the Seventh House,
and Jupiter aligns with Mars, then peace will
guide the planets, and love will steer the stars...'

That would be The Dawning of America V2.0,
and Dennis Kucinich will be The Man.

In the meantime, there's Hillary Clinton.

[swkidder]

Bravo. I work in healthcare. There are some fairly well understood rules for how to reform a complex system that is as completely dysfunctional as healthcare in the United States. The trick is to identify one or two points at which that system is effectively "locked down," and then apply a pair of the proverbial legislative "bolt cutters." This then frees that system up to begin a process of organic self-correction.
Fixing healthcare in this country requires a lot more than just making sure that everyone has "insurance." Yes, we have a broken funding/entitlement model, and yes we have some room to improve the quality of the care we receive. Going deeper - which is what it will take to create any fundamental change - we must also address a care delivery model that is thoroughly trashed, and a medical model that is severely challenged.
And, if we can "solve" the funding/entitlement issue through legislation, and do so in a manner that frees up our medical model(s) and care delivery options to responsible innovation ... we can transform healthcare in this country.
There is a potential plan that does this, but it's certainly not any of those currently sitting on the table. On the other hand, to propose a viable plan that breaks the choke hold on the system currently enjoyed by the insurance and pharmaceutical industries ... would be political suicide in the 2008 electoral cycle. So I guess we're on hold until 2008?

[Janelynne]

I work in health care too, and i agree with your bolt cutting analogy. I think Hillary's plan goes to the heart of bolt cutting. The choke hold is profound, and involves our colleagues and neighbors who work in pharmaceuticals and insurance, and like it the way it is. It is no small trick to get ANY reform. But the very least we can do, the first step, is to legislate health care for all. We cannot let people die for lack of coverage. That isn't America. I like the American Cancer Society's approach: to spend its advertizing dollars calling for reform. The ACS says all its advances will not save lives if people can't get treatment. We need to make this a kitchen table issue. There is a lot of lost energy spent on bashing Hillary. We need to stay focused on health care for everyone. This is the kitchen table issue.

[Kendo Nagasaki]

All we need to do is expand Medicare to cover all citizens.

Its really that simple. Let's cut the BS.

Insurance companies could still compete if they wish.

[twosetz]

A good analogy for the basic problem with our healthcare system can observed by looking at the number of blog responses DeMoro received for her column (70). Now go to the Huffington Post homepage and you can sadly see that John Ridley's column about O.J. has received over 170. That's the whole problem in a nutshell. No one gives a tinkers damn about the welfare of others as long as their family and friends are secure and they can still get their fix of celebrity news. When the healthcare crisis becomes a front page, above the fold, story the tide may turn. But for now we seem to be content with O. J., Britney and Paris. I have a vested interest in this disscusion because I lost my insurance coverage due to a serious illness. I'm, however, not very optmistic there will be any significant progress made with any of the leading Dem. candidates in the White House. Maybe when the number of people who are uninsured surpass the number of people who are, we will take notice.

[bigbear]

Kucinich-Kucinich-Kucinich!!!

[Steve7]

All the proposed plans overreach and try to use the current delivery system. This means the current vested interests, physicians, hospitals, insurers, HMOs, and pharmas do not need to change but we do. Politics is reality and I suppose what is being proposed is necessary for the campaigns. We need simple and direct proposals that begin to change how the system works. Look at the Healthcare Access Card and Other People's Money posted on www.healthcaresoundoff.com and you will find a route that might lead to effective change.

[VoteOrDie]

Anyone willing to touch that 3rd rail deserves credit. Having said that, we need Univeral Health care period. But what do you do with the private hospitals and insurance companies? They are huge employers and contribute to the tax base. How do you break them up, absorb them, you can't just pretend they don't exist. Being a small business owner I watched my insurance co. raise my rates 3 fold last year. A company I started w/20 years ago when I started my business. I asked if there were other insurers, they never got around to it and I ended up w/another insurer for 1/3 the cost. Lazy, figured they had me all these years I'd just stay.
Just like Bush's unchecked dictatorship, insurance co. are the 800lb gorrilla in the room, that is being ignored and left to rape and pillage.

[Doofus]

Fact is, practically everyone involved in Big Medicine is making lots of money.
No doubt, nurses less than doctors, technicians less than nurses. But lots of people are doing well financially off of healthcare. Funny story - managers
must be paid even more than doctors, else they 'don't get no respect'.

Every part of the cost equation is expensive,
labor and 'materials', etc.

That would be why 'insurance costs' are going up.

'Single-payer' would radically change the equation,
and *everybody* involved in the 'delivery system'
would be effected, including all those who profit
from it, and have the political power that comes from wealth & profit.

So, how do you think this is going to turn out?

[Spoons]

HR-676 (co-sponsored by Kucinich) provides for a one-time buy-out of for-profit health insurers and providers at great rates. From that point on American healthcare consumers and providers get to keep and use the gravy train for the Good of the Whole rather than the Corporate Welfare of the Few. Whether you like Dennis or not, we have to all agree that he has not sold out the "we the people" concept "of the people, by the people, for the people".

[malcolm37b]

I heard that auto makers spend more for health care now than for steel. Also their health care costs add $2000. or so to the cost of manufacturing a car. Surely they are large enough to form their own clearing house (Read insurance company) to pay medical claims for their workers/retirees, eliminating that expensive middle man, existing providers. This should be like a mini gov't provider, and lower costs to a reasonable level, but I think they have shifted production to Canada and Mexico due to lower costs, instead.

[Rabbin]

The problem with getting health care reforms in action is the Conservative point of view, that any reform would take away from the economic philosophies of capitalism in favor of socialism!
Consider this comparison: in the very Conservative Soviet Union before it fell to the pressures of spending too much of their wealth defending itself from the western ideologies and fears we'd attack them. Their most imperfect form of Socialism economically fell. Which was that the State owned everything including its people! In America we let ownership belong to individuals or do we? Socialistic forms of economy and governments those whom are at the head of government live far above common working citizens. Here those in positions to be the heads of both Private and Public Industry live far above the common working citizens of its respective nations. That being fact we must realize that our wonderful Conservative America is made up of many little nations not called States but Corporations. So in reality then there is little difference from an ECOMOMIC stand point. It just means our Capitalistic form of economics fight harder over the philosophies between being liberal or conservative.
The bottom line in regards to health care is our Capitalistic form of economics has allowed us to create the best technology in the world to treat health problems the down side is due to human greed it has priced itself completely out of the pockets of most all of our society. So don't get sick for today it will bankrupt both you and the nation! For we are nation who has allowed its greed to make us immoral above all people!
Hilary and all others see the truth and accept we must control the greed of all people both the rich and the poor! But we must also find a better way to take care of the sick. TRUST IN GOD first!

[Kendo Nagasaki]

God exists only in your mind.

There is no god "out there"

I'ts all in you head.

Question: are the Christian God and Allah the same entity ? How about Yahweh ?

[lookingAhead]

Hillary's plan is nothing but a big give away to the insurance companies is any one surprised. The MSM is suggesting that their is no big differences between Hillary, Obama and Edwards plans. WRONG With her plan the insurance companies are still profiting off the sick and dying. Why did it take so long to come out with this plan? to appease the right wing. Sorry Hillary your plan sucks more than Monica.

[realistic2008]

One can argue, debate, discuss the pros and cons of the Clinton's health care proposal which I am sure many people have regreted did not support it, particularly those whose medical bills, lack of insurance,etc. have been affected by the atrocious, indefensable costs of one of the most important obligations of any government,to protect the health of its people.
That said, there is one principle which should fix this debacle, hospital care should not be a business venture nor they should profit from the misery of humanity. Profiting to alliviate pain and suffering is an oximoron of the canons of medicine.
The richest country in the world can't sit iddle and let people who have worked hard of their lifes to suffer and die penniless and without some degree of dignity.

[considerotherspecies]

As a single woman over 70 who has worked, and am still working, as an independent freelancer, Senator Clinton's plan does nothing to help me. Now I must pay to subsidize insurance companies and doctors who don't need my money. In fact, I cannot get the healthcare I could use because Medicare doesn't pay for it and this new proposed plan does nothing to help. We're still underprotected for Preventive care and Complementary and Alternative medicine. There is nothing better for my arthritis than acupuncture, massage, physical therapy, stress reduction, a gym -- and Medicare plans don't cover this and Hillary's new mess doesn't seem to either.

[Kendo Nagasaki]

HillaryScareCare is another step forward in a Police State. She is the stealth Republican candidate because the official line up are aun unelectible bunch of ghouls. Next she would privatize Social Security so that Wall Street vampires can suck your bank account dry.

In Britain they have had universal health care since around 1940. There are no co-pays, deductibles or denials of service. You still get it if you are unemployed. There are also private insurance plans for those that want it and can afford it. Let the capitalists compete - not have a monopoly.

No one in Britain goes bankrupt from medical bills. Which system would you rather have ?

[Lane]

So Kendo, how do you effect change and make this happen for us in the U.S.? Universal healthcare for all is the answer, why can't we take a cue from the countries that have a successful system?

[Spoons]

We must convince the "critical mass" of Americans who are healthy, wealthy, work for governments or large corporations to help us. If more of those people "got it" we could get it done. They're afraid of the unknown, but in reality should be MORE afraid of what they're helping perpetrate now. One month's health insurance premiums donated to PNHP, Healthcare Now or Kucinich might do it. If we keep feeding the health insurance industry at these rates relentlessly, and they keep electing our candidates for us, we may not be able to stop them eventually from running roughshod over us all, instead of only over one of every six of us. 16% of 100% of Americans have no health coverage, but if you don't count Americans already covered under some federal (not state or local) government plan (Medicare, Medicaid, VA or federal employees), alomst 30% of the rest are totally uninsured. The wealthiest will always have access to the best care; don't have a problem with that.

[Spoons]

Thank you SO much. I went to Hillary's website where everyone is invited to comment on this issue. I asked, "Would you sit down with the KKK to negotiate Civil Rights? Invite terrorists to barter our national security? Negotiating healthcare for Americans with profit-driven health insurers is worse". Plus I reminded her of the (at least) six nine-elevens worth of us they have rationed to Ground Zero who consequently die every year while insurers are allowed to continue denying ever more desperately-needed care and gorging on our healthcare dollars, the millions of Americans they have denied and caused to be bankrupted, the hundreds of thousands they deny who are "only" left unnecessarily disabled, not to mention the tens of millions of Americans they leave terrorized daily. Al Qaeda can only hope and pray for such successful wreaking of havoc upon us. Does anyone think even one uninsured American was on her panel to represent those of us who have been discriminated against by this amoral monster? I told her that if she can convince Americans that feeding the beast that is the problem is the solution, then I feel positive about her ability to convince Americans of the truth as well (because I believe she knows what the truth is, and the truth would then be on her side). She could be the heroine who saves Medicare, Social Security and gets our nation back on sound financial footing, if she chooses to be that (instead of this). Go to her site and look at the responses. NO negatives are allowed to be published, which is almost scarier than her misguided healthcare non-solution. Once before she put real reform back at least 16 years; now she wants to help overcharge and deny another generation access to reliable healthcare. The financial and physical health of our nation depends upon defeating her and other false prophets like her.