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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"You Have the Option of Choice!"--Letter sent by Obama supporter.
I love that--the "option of choice"! How moronic. Thanks for quoting this.
I totally agree with you that the choice theme is utterly inappropriate. Grossly so. It's an appeal to greed and idiocy.
I disagree about your fiend--I think he was completely in line, and I'm sorry he felt the need to apologize. I'm guessing he did so partly because of all the rocket scientists who seriously believe he was comparing Obama and/or his fans to Nazis. Literacy in America--what a concept.
Just don't presume to tell me i have no choice. that in fact I must pay for an insurance swindlers wife's new tits, and if i do not i am breaking a brand new law.One set up by and for the parasites in the "Industry" (that produces nothing but money for themselves and ever declining medical competence and treatment for others) when I find them to be immoral and a protection racket rivaled by few in harming America by collectively and adversely influencing (buying off)congress and the Senate!
Hello there I am a statistic . I do not matter . My life does not matter . If they {health care racket} can't get filthy rich off of me they want me to not exist , to crawl off and die . I am disabled {not a choice} , but not before losing Job and Insurance {not a choice} and of course once diagnosed will never have coverage again {preexisting condition} not my choice . In closing I would like to thank , Richard Nixon , Ronald Reagan , The Dem. congress and senate during Clinton's first term and all you morons that voted for the parasites afore mentioned . Hillary was right 15 years ago and she is right now . And the capitulation wing of the dem. party will never get it right .
Hillary simply does less. Barack Obama and Hillary both purport to lower the costs of health insurance, but Obama provides a concrete 2500 dollar premium reduction. Hillary and Barack Obama both open up the Senate healthcare plan but Obama doesn't MANDATE it.
The subservient defense of Hillary's mandate only works if you IGNORE what Obama keeps saying about his plan. It's subsidized choice. The tapdance of Obama's mystical 12-million uninsured is repeatedly debunked but dragged out every other week to make a non-point.
Your post fails to explain how mandates are better than choice without a single-payer system. The only way mandates would make sense are if they are subsidized and the choice isn't, but the CHOICE IS SUBSIDIZED.
The real problem here seems to be frustration that Hillary's plan makes no sense and a reactionary attempt to invalidate the other plan without explaining it. (Or seemingly knowing what his plan is.)
So, if you are truly open-minded, consider this: under Obama's plan NO ONE IS DENIED. No one. It says so on his website, he said so in the debate. If you want coverage you'll get it.
QUESTIONS . . .
1) How do you enforce this MANDATORY insurance plan?
2) What agency will play the enforcement role?
3) What are the administrative costs associated with ENFORCEMENT?
4) What are the penalties for not choosing MANDATORY insurance?
5) Is the smarter candidate the one that seeks a hybrid and allows for an individual's right to opt in or out, or the one that builds an agency and an enforcement wing, assessing penalties on consumers already burdened with the paycheck-to-paycheck lifestyle that is the inheritance of our generation?
Just a thought.
"I don't understand why he thinks that people ... 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".
You talk about health care and health insurance as if they were the same thing. They are not. Learn the difference before you write on this subject again. I'm serious. Health "insurance" is an unnecessary and expensive obstacle to receiving health "care". The only thing worse than health insurance is mandatory health insurance. What is needed is single payer, universal health CARE. If you are having trouble getting your mind around it think of it as "Medicare for everybody" paid for by taxes. No insurance is necessary.
Unless you fully subsidize everyone's health care, a government mandate is worthless. How will Hillary enforce this? Under Hillary's plan, many people would rather pay a fine than buy health care.
"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 statement is false. I asked around most the people I know who happen to be "young to middle-aged". It seems that neither myself or the people I talked to know of anyone who can afford health insurance but elects not to get it!
You can make an argument on either side of this debate, but it seems to me that fundamentally we shouldn't take away someone's freedom not to participate. It just doesn't seem right to force people. It seems someone is always trying to take away our freedoms. Let's say someone's philosophy was that they never, under any circumstances wanted medical treatment. Say it was their religion. Should we make these people pay also? I can just see the delight of struggling people out there when you say, congratulations, we now have universal health care in the US, and then you add, you now owe us $1000 and if you don't pay it you'll be fined. Oh lucky me.
I asked another person below but maybe more people could answer it here:
The worry about not making insurance mandatory is that people who don't pay into it when they are healthy will then expect benefits from it later on when they're sick and therefore try to "ride for free." Like not wanting to pay into Social Security but then expecting Social Security checks after retirement.
Yet Social Security is a government-only program. Clinton and Obama are going to provide health insurance through the private sector. If you have insurance you like, you stay with it. If you can't afford it, the government gives you money (or a tax credit?) to make up the difference. But it's still private insurance you're buying with the profits going to the private company.
So it's not like paying into one big pool and everybody needs to contribute because the benefits will be distributed among all of us. The program is paid for by rolling back the Bush tax cuts and these other ways Clinton and Obama said they would save in government spending to make room in the budget.
That means, if you pay taxes, you might be paying into this system (especially if you're wealthy). But you're not taking advantage of the system but not buying health insurance. The premiums you would be paying if you had a plan would be going to the private companies not the government.
What I might be missing is how this would affect the way companies determine premiums-- 15 million people staying out of the plan might drive them up, or lead to inflation, or higher interest rates . . .
Maybe I just need to buy Alan Greenspan's book.
Choice has already been eliminated by cost. Mandates are preposterous. They layer enforcement as an additional cost on top of already enormous profits. Mass. is already finding the flaws in mandates only approach to healthcare. Forcing people to buy it only adds more cash which is offset by added administration. The public loses.
Attack the problem at the source, the profits. Take this opportunity to lay it out for the health industry. Either cut prices or perish at the hands of an outraged public.
The key to Obama's plan is not choice. The key is lower costs through transparent negotiations. For instance, will non-profit hospitals be comfortable with the public knowing their hospital bill will be marked up 150 - 400 percent over costs? The reason they get away with it at all is that non-profits books are not open to the public. Changing that little loophole in public oversight would go a long way just by itself.
To be perfectly honest (since one-time thoughtful advocate of universal health care, now Clinton attack dog Paul Krugman of the New York Times won't be reading this) I don't think Obama wanted to come up with a specific plan.
He did because it would be so outlandish not to. "Change" can only go so far. Let's not be too different.
Because these plans are entirely *hypothetical*. The president doesn't make the laws. Hillary, who usually doesn't show an excessive amount of maternal energy, treats her plan like its her baby. Don't mess with it. It's perfect.
Well, Congress is going to take that thing apart, twist it a thousand ways, and mangle it beyond recognition. And that's before it goes to committee.
Obama wants to sit down with patient advocates, doctors, citizens, and that health care industry rep can sit down there at the end (behind the other guy, and quiet please) and come up with a good plan that people actually want. Not bequeathed on us by the infallible one, Hillary Rodham Clinton.
Obama wants to go to Congress and figure out what Ted Kennedy thinks is best, and the Republicans too (send them to Iraq? come again?). He wants to talk to people, and more importantly, *listen* to people.
If Hillary goes stomping into Washington thinking she has all the answers she is going to see a backlash the would make 1994's fiasco look like last night's love in/debate.
The specifics aren't important-- electing a Democrat who can get it done is what's important.
Sadly for the Clintons, their criticisms against their opponent will be on nuances in health care. One would have hoped they could flex some foreign policy muscle, but alas, due to their colossal failure in supporting the Iraq war and their lack of judgment in trusting Bush with an authorization to use force, they must resort to kitchen table issues. Good luck using those against the Republicans in a time of war and terrorism.
If I understood Obama right, then someone could choose not to have insurance until they need it, and then perhaps pay back premiums. As I said on another thread, this would be like giving someone death benefits and then charging back premiums after the fact. -- what the hell kind of "insurance" is that?
So much more to this converstation - one out of dozens of issues that our media and the candidates will not discuss in front of the public. Under the chapter title of: Yes Virgina, you too can have your very own Walter Reed Hospital to visit soon -- and you thought standing in line at the government run foodstamp office was discouraging:
A Sept 26, 2007 Q & A with students at UC Berkeley.. by former Clinton Labor Sec. Reich, now on staff at UC Berkeley -- the theme of the talk seemed to be: "can a politician be honest and be elected..."
I found his comments at about the 9 minute mark on his health care ideas
.."you young people are going to have to pay more." applause (always amazes me why liberals clap and cheer when the news is either bad or not humorous). "And we're not going to have to decide not to take care of old people... and you kids are not going to live to be any older (live as long?) as your parents." i.e., socialized medicine in America will lower life expectancy, and cost more.
Well, that's was a no brainer - but at least in a small group of students, Reich is willing to be honest.
It will cost much more, and will provide much less high end medical care. The trade off is the rest of the world will suffer as well, as they won't be able to come and utilize some of the best medical care in the world.
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