Note to Barack Obama: Choice is the Problem, Not the Fix in Health Insurance
I hesitate to write about health care issues at this moment as a colleague of mine is embroiled in a controversy regarding his comments about health insurance policy ads being released by the Obama campaign.
I don't want to go into the controversy or to try and speak on behalf of or defend my colleague other than to say that I very much disagree with the tenor and content of his reported comments on a Clinton campaign conference call. (Len Nichols does offer a statement here on this subject)
That said, I do want to raise an issue about the "choice" question that Senator Obama raised last night in the debate.
And like Senator Obama, I have an open mind on this as well as I don't understand why he thinks that people who are not well off financially would be better off "choosing" not to have health care if in fact he, like Clinton, plans to subsidize the provision of that health insurance.
From my reading of the problem in comprehensive health insurance, "choice" is the problem -- not the fix.
Someone on the road with him should ask Senator Obama if he thinks we should give the elderly the "choice" of being in Medicare.
I received a note this morning from an Obama foot soldier (this may be from a self-appointed follower of Obama rather than an official campaign representative -- I'm not sure) that was sent to me and a good number of other publications and editors. This individual wrote:
Barack Obama's Health Care is the Same Universal Health Care offered by Hillary and Edwards, but with one Major Difference: You Have the Option of Choice!
We as a nation have to decide, do we want to be forced to pay for universal medical insurance, like we are mandated to pay for auto insurance now? Or would we rather have the option of CHOICE -- to be able to decide whether or not we want to buy our medical coverage when we think the time is right?Barack Obama's plan thoughtfully does not want to put another mandated cost, like auto insurance, on the backs of the people, especially the young, who already have college costs to contend with. However, the coverage is always there for you, if and when you need it. That is our decision and our choice!
This emphasis on choice by Obama and his followers seems misplaced to me. I don't think he fuly understands why the American health care system is struggling today.
One of the reasons that the health insurance system is failing is that some healthy, young to middle-aged people with the resources to buy insurance are electing not to -- or in your words, their "choice" is not to participate in any insurance at all.
This creates the problem. Choice means that many who are healthy and don't have insurance don't kick into a system that would help subsidize the less well-off economically and those who may be ill. Thus, insurers want to cherry-pick among those they want in their portfolios and want to avoid covering those at the lower end of the spectrum.
Including the non-participants in a comprehensive program would make everyone's costs decline on average, but you need full participation.
Barack Obama is trying to do an honorable thing by putting a plan forward that would cover more Americans -- but he needs to listen to his own words offered in last night's debate. He said that he's not always right and will listen to others. I think he may be wrong on this front -- and his embrace of "choice' may not only inhibit provision of health insurance for the poor but also for others in our society because his system would propogate adverse selection.
I may be wrong as well and have an open mind -- and don't feel as passionately about this as apparently others do. I'd welcome informed comment and thoughtful commentary below on both sides of this question -- and personally, I feel regret for the unfortunate imagery that a colleague of mine used in this policy conversation -- but I don't want to speak for him. He'll do that himself.
But just intellectually and practically on the subject of choice and health insurance, choice seems to me to be part of the problem, not the fix.
-- Steve Clemons publishes the popular political blog, The Washington Note
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Should someone who doesn't "believe in" the way health is treated in America be forced to pay for it? For example, many immigrants from the East choose their traditional Chinese medicine over the "treat the symptoms not the cause" approach of our medical system. They see their own doctors, get preventative measures treatments and usually don't develop chronic disease states, like diabetes and heart disease, which drain the medical system and fill the pockets of pharmaceutical companies. That is one of the rationales that choice is a right that should be upheld - unless the national health care program supports any treatment chosen by the payee (which, of course, isn't realistic). There are many cancer patients who don't think chemotherapy or radiation is the way they want to treat their condition - and they rather take "alternative" treatments that are expensive but not covered by the current protocol. As a Canadian, I love having universal health care - and after witnessing how friends south of the border have been bankrupted by the astonishing cost of what is considered standard care, I hope you do have the opportunity to have this privelege in the near future; however, I also live amongst a very diverse population who approach health and illness differently, and I can appreciate the need to respect and appreciate this right of choice.
Folks, the corporations have "allowed" Obama and Clinton to proceed because neither is threatening their profits. Since all Honest candidates have already been excluded, everything from now on will be game fluff to win the election.
Obama and Clinton, cannot propose eliminating the health insurance companies for fear of what all that health insurance money could do to them. That goes for any and all other, perceived anti-corporatist proposals.
Don't expect to get what you vote for.
I'm going to vote democratic and hope for the best.
It appears that Obama copied most all of the plans created by Edwards and Clinton but wanted to include a salable difference. Choice is a catchy word, although it is in effect meaningless in these terms.
He says he is avoiding making healthcare insurance mandantory. Does he also want to discard the mandantory feature of Social Security? If not, he is being less than consistent. If so, he is on the side of the Republicans who want to privatize it.
Actually, the only proposal that makes sense is to go for a single-payer system. I would be handled through Medicare (Medicare-for-All) and be paid for the way Social Security is paid for.
cognito ergo populistae
Let's be very clear about this. Obama is not opposed to mandates. He proposes them for children. For those hypocritically asking about "punishment", one could ask Obama what the "punishment" will be for not having coverage for one's children.
Edwards had this right. There shouldn't be punishment. If someone doesn't have insurance, they would just be automatically enrolled in the government insurance plan.
Mandates are a part of life. Everyone participates in social security, everyone pays taxes. If you don't have auto insurance it is illegal to drive.
For those whining about Edwards/Clinton's mandates, asking about the "punishment", I suppose it could be the same as Obama's "punishment" for not having insurance for children.
The reason Massachusetts program is problematic is that there are insufficient subsidies for poor people and there is not a government not-for-profit plan forcing costs to be lower among private plans.
It's a phony argument anyway. We need single-payer health care and only a universal program where basic health care is a right and responsibility will takes us there, while Obama's plan leaves health care as a privilige.
Edwards/Clinton plan is better as a transition.
The intensity of this dispute is odd. HRC proposes a system with mandates, but no enforcement mechanism specified. BO proposes one with choice, but with various possible penalties against those who 'game the system'. Is this the sort of subtle difference over which to have a knock-down fight?
In the long run, the system will have to be inclusive, but in practice neither version would be initially. HRC's version might get a few more people signed up, and thus please the insurance companies, but maybe at a huge political cost in riling up some of the libertarian-minded American public. BO's version would be more in tune with American populism, but might draw even more fire from the industry and wouldn't officially proclaim (however hypocritically) the goal of universal coverage.
How about for now we fight about something else- like how many $2 trillion wars we can afford to stumble into.
This comment does not address the question asked here but really should be mentioned whenever universal health-care is discussed:
I would like to know how much money is paid to all health-care insurance company employees.
Add that to;
How much money is paid to the shareholders of all health-care insurance companies as profit or return on their investment.
Add those numbers together and ask;
Why does so much money get between the patient and the doctor?
That is why health-care cost so much today.
Single payer plans look awfully good when these numbers are included in the conversation.
or....
If one opts-out of paying for health-care insurance they must carry a card that tells the hospital to not resuscitate this patient, let them die, because they voluntarily chose not to have medical coverage..
It is clear that at this late date, and 16 years after Hillary's aborted health care reform plan, that no single politician, or single economist (peace, Paul Krugman) has all the answers on health care. The one equitable system -- universal govt. healthcare paid through taxes -- has been so demonized by conservatives as socialized medicine, that passage of UHC is virtually impossible.
The problem is a social one -- Americans, unlike some other nations -- have yet to learn and accept that we are all each other's keepers and that ensuring health care for everyone is not politics but something everyone deserves in the most prosperous country in the history of mankind.
The shocking thing is that though caring for others is a Judeo-Christian principle, in a country that is supposedly Judeo-Christian, we cannot accept this as basic justice.
For shame, America.
Steve, as a respected journalist, if you do not know if the mail you got was from the Obama campaign or just a supporter, why treat it as if it were and official statement of Obama's?
If you wanted to, as a well-known journalist, you can surely get this info from the horse's mouth so to speak, from the Obama campaign itself.
Steve,
You could parallel the fact that the Clintons were in Arkansas when our state adopted mandatory liability insurance for car owners.
Arkansas did lead the way, and enjoys one of the higher minimum ceilings of compensation for basic coverage as a result of their efforts.
Many states will pay out anywhere from two thirds to half of what the state's design for basic coverage will.
The last time Hillary tried to tackle this
her proposals were used to help lead a Republican take over in Congress. Crippling
the Clinton years into massive inquiries and
eventually leading to Bill lying under oath and to the American Public.
Deja Vu all over again
I suppose I might be considered one of those middle-aged people who can afford health insurance and chooses not to buy it. My major reason for not owning health insurance is that most plans don't cover the kinds of treatments I want. I have to pay for those out of pocket myself. So why, on top of those payments, would I pay for health insurance that doesn't give me what I want anyway? I can't afford my doctors of choice (who aren't covered by insurance plans) AND health insurance, so I choose that which is most important to me: health care of choice -- rather than being forced to accept a treatment plan I disagree with as defined by the limitations of my insurance policy.
What you do not seem to get is that you are already paying for it . Auto insurance subsidizes hospital costs in most states , everything you buy if employer has ins for employees cost is built in {bread milk beer ...} health care costs are tax deductible {personal and corporate} so we all pay more in taxes to subsidize everyone with health insurance . Health Auto Home Insurance is and always has been a ponzi scheme .
As a British citizen residing in Australia,i fail to understand American fear of a universal healthsystem payed for out of taxes.I have to tell
Americans that it works very well here and in the Uk no person ever goes broke trying to pay medical bills as i understand occurs in US.
Although i understand that the private health funds fear the loss of a very lucrative market and no doubt they donate large sums of money to candidates who oppose a universal system.
Hillary has promised the health insurance industry that she will pass a law requiring every single American to buy health insurance. Do you know the value of that? To the health insurance companies? They do. They've already quantified it, and are probably making arrangements for a special series of jets to haul the money out of the U.S.
If Hillary Clinton really wanted to help Americans get health CARE, she would come up with a plan to provide health CARE. Telling people to buy insurance is not a solution. It just means that every single American is being screwed by the insurance companies, rather than only some of the country.
Obama legitimately acknowledges that not all people will buy insurance. What is it about that admission that is causing such consternation in the Clinton camp? Go down to skid row. Do you really think people on skid row will buy health insurance?
Let's look at minimum wage workers, $5.50/hour
Obama is right. People don't have insurance because they can't afford it. The insurance companies contribute nothing to health care. They just steal money and put it in their pocket, then deny coverage. We need to get rid of them and go instead to a single payor system.
Let the strength of the federal government negotiate on behalf of all Americans for fee schedules for treatment. If we got rid of the health insurance industry, the money saved on that alone would be enough to pay for health care for all Americans.
The main issue is cost of insurance and co-
pays. When you join a "group" insurance plan
you pay less. It's usually taken out of your
pre-tax pay. When you pay for "private"
insurance you pay everything, and usually more
because the insurance companies negotiate lower
prices for their members.
I don't have insurance because I can't afford
the lowest price of $360 a month for private
insurance. Therefore I have maxed out credit
cards due to a broken wrist, and now have more
bills to pay.
If medical insurance isn't affordable enough
to encourage people to want it, then people
will opt out. Young people think they don't
need it. Older people can't afford it. If you
are lucky, you are in-between and get a deal
from your employer. Until you get laid off,
or something happens with your health.
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