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

Comments

[LiberalMathProfessor]

I can see the merits of both Clemons' and altohone's cautions, which appear competitive, while I side with the idea that if we are stuck with cruel insurance companies, let's make it "communistic" and all kick into the kitty. Nevertheless, I don't know enough to be able to contribute to the substance, but I will say that Obama's use of "choice" disturbs me since that word has been used by RoveBush for many years as they set us up for impoverished aid programs and the lies of "the ownership society" crap. Just tell someone that if they buy your thing or idea, that among the best of the benefits is that they get "choice" along with it, then they'll buy it, whether it is good or not. An interesting bit of advice comes from a fellow named Mander, when cautioning us about so-called "technological advances" as they are about to make it to market. The advertiser­s/vendors/­marketeers will say "Get this thing, it will benefit you." Mander says NO, don't ask "How will this benefit me?" Ask the following question instead: "Who will this benefit MOST, and to what end?" As wise consumers, we might want to question the benefits of "choice" per se, and determine if there are real choices, and if so, who benefits most by our being presented with them, by acquiring them. I just don't trust that language, "choice." Is Obama just trying to attract attention and support with a false hope, that hope instilled by the idea that, "Hey, I can have some of that great commodity called Choice!" ) Or maybe he just means what he says.

[BillZBubb]

You've hit on the problem with all the plans being offered by our "change" candidates. Obama's is by far the weakest for the reason you point out. Some change. The poor and near poor will "choose" to do without insurance just like they "choose" to now--they won't be able to afford it. It's baloney.

Someone for real, meaningful, and beneficial change would be pushing single payer. It's time for the US to join the first world.

[tricynical]

I'm curious, Steve, what would happen if health insurance were mandatory and you refused to pay the premium? Would you be thrown in jail? Have your salary attached?
There are some people who would have to make a choice between feeding their families or buying health insurance. If you take that choice away, then their kids starve, right?

[ProudLiberalDan]

Thank you for pointing this out. I am one of those who is passionate about this issue.

We will only get to the single-payer health care system we need and deserve if we go through a transitionary stage of mandates.

Obama health care plan supports mandates for children, so he's not against mandates.

Health care IS the weak link in Obama's policy platform and is why this Kucinich, then Edwards supporter is not supporting him in the primary.

Backing out of mandates for adults seems purely opportunistic, and damages the cause of universal health care.

Paul Krugman is right.

[CatherineAtlanta]

Very good points, all around, Mr Clemons. I wish Senator Obama would see that, like his idea that the wealthiest among us should pay higher taxes, the healthiest among us should participate in health insurance. Just as we all pay for schools (even those, like me, who have never had children) because we all benefit from an educated population. We all benefit from a healthy society, as well. Senator Obama seems to get this concept but hasn't carried it to the logical conclusion.

[altohone]

Must disagree with you Steve.

You are defending the profit driven insurance industry and framing the debate inaccurately.

Young people are ALLREADY subsidizing everyone on any government program with their taxes.

The healthy joining the insurance pool is likely to increase the insurers profits. As far as I know, it is government not private insurance companies who subsidize "the less well-off economically and those who may be ill". Your description is flat wrong.

Your assertion that everyone's involvement would decrease costs is also not true.

Not only are private insurers not obligated to reduce premiums when their costs are reduced, neither are costs linked to numbers of users as the average 80% increase in premiums in the last three years despite low inflation indicates, and a whole lot of currently untreated health problems would grow the number of visits.

What you say would be true in a single payer system.

Hillary's plan is not single payer, so everything you have argued does not apply.


Our Republic does not have a history of forced participation in private profit schemes.

People can choose to build in hurricane zones, flood zones, fire areas, etc. and choose not to insure their house.

Nobody else is harmed if the worst happens and they are wiped out. Their fellow citizens may or may not choose to help them rebuild, though help with necessities is standard.

With car insurance, drivers risk not only their own property, but also the property and lives of others... cars can be weapons. Mandatory insurance makes sense. People can choose not to drive if they don't like it.

Health insurance is not like car insurance.
Nobody can sue you for millions for dying on their lawn, but if you drive up on their lawn and run them over, you will really need insurance.

You asked for comment, and I hope you consider what I've said and recognize that mandates as part of our current mixed govt./priv­ate system are simply a boon to an industry that is gouging us while sucking at care.

[DrPaulProteus]

This isn't difficult. Why don't they have a plan where Americans are just covered by virtue of being an American taxpayer, whether they "choose" to be or not? Like, you get sick, you show up at someplace with doctors, and they fucking help you (whatever that entails) and send you home without a bill. Done.

I suppose you could choose to decline help if you wanted to.

Do any of these health care plans involve things like chiropractic, accupuncture and other types of care that some people are legitimately helped by? Or are they mainly about prescription drug plans?

[eddiestardust]

The real problem is that of cost. Cost in that premiums continue to go up and the cost of prescriptions and doctors visits continue to go up as well.

These costs have NOT come down for anyone including those who do have health insurance.

In effect, we all write a big blank check out to all these industries­...

Heatlh Insurers, doctors, hospitals and Pharmaceuticals.

And they keep coming back asking for more and no one says no.

Is it any wonder that healthcare is a growing industry because every time we pay for a prescription or a higher premium, we are growing that industry, not to mention the excessive greed of CEO's.

[ReasonIsMyReligion]

Choice shmoice.

Can you choose not to get sick, choose not to walk into an ER for basic care?

Can you choose not to have the fire department respond if your home is ablaze?

This is a red herring.

Whether the best health care solution for the nation has choice in it or not, I am not one to judge. But as a slogan, it is refuted by EVERY OTHER INDUSTRIALIZED COUNTRY.

[Santayana2008]

Want the truth..go here...

http://www.chicagotribune.com/news/local/chi-070403obama-ballot,0,1843097.story?page=1
Obama Knows His Way Around A BallotSome say his ability to play political hardball goes back to his first campaign
By David Jackson and Ray Long | Tribune staff reporters6:48 PM CDT, April 3, 2007
The day after New Year's 1996, operatives for Barack Obama filed into a barren hearing room of the Chicago Board of Election Commissioners.
There they began the tedious process of challenging hundreds of signatures on the nominating petitions of state Sen. Alice Palmer, the longtime progressive activist from the city's South Side. And they kept challenging petitions until every one of Obama's four Democratic primary rivals was forced off the ballot.