30 May 2007

Obama plays it safe

Obama came out with his healthcare plan yesterday — and it wasn't single-payer.

Counterpunch's Corporate Crime Reporter explained why back in February:
The majority of the American people want a single-payer health care system ­ Medicare for all.

The majority of doctors want it. A good chunk of hospital CEOs want it. But what they want doesn't appear to matter.


Because a single-payer health care plan would mean the death of the private health insurance industry and reduced profits for the pharmaceutical industry.

Presidential candidates John Edwards, Barack Obama, Hillary Clinton, and Mitt Romney and California Governor Arnold Schwarzenegger talk a lot about universal health care.

But not one of them advocates for single-payer ­ because single-payer too directly confronts the big corporate interests profiting off the miserable health care system we are currently saddled with.
Take a look at that entire Counterpunch article, which interviews Dr. Steffie Woolhandler of PNHP.

Back to the present, Edwards estimates his plan would cost $90 billion to $120 billion; Obama figures $50-$65 billion for his. (A nice chunk of protection cash either way for the various powerful insurance families. The Gambinos themselves couldn't have done better.) Obama's plan, like Edwards, includes unspecified employer contributions, cost-saving measures, and specifically coverage for all children. Edwards' plan mandates that individuals have insurance; Obama's doesn't.

Speaking of the families, in particular the bosses, this wouldn't be a complete win. Both Edwards and Obama would pay the insurance families in part by getting rid of some of Bush's tax cuts for the wealthy.

As for the other candidates, Senator Christopher Dodd, who sold out to the insurance industry back in the 1990s, and Governor Bill Richardson also like mandates. Alaska Mike Gravel likes vouchers — which could be single-payer. Sen. Joseph Biden is the most timid. He'd insure children — an increasing number of them orphans and paupers as parents have a harder and harder time covering themselves. Sen. Hillary Clinton also talks a lot about children. She hasn't shown us her cards yet, but she has promised to reduce the power of insurance companies and to computerize medical records — a good start.

Rep. Dennis Kucinich is of course unabashedly for single-payer. He'd pay for it with income and payroll taxes, and a tax on stock and bond transactions.

Kevin Drum doesn't think much of Obama's plan. "Obama's voting record shows him to be, possibly, the most liberal of the three main Democratic candidates. But his record also shows him to be a very cautious liberal. This is not necessarily a bad thing: the time he's spent in the trenches doing community organizing and then as a state legislator seems to have taught him that there are no easy answers; that political coalitions are hard to build; and that real progress often requires a slow but steady approach. He may even be right about that. Certainly I'm no revolutionary myself. Still, sometimes audacity requires audacity. Hope isn't always enough."

Ezra Klein explains the plan, which includes a new regulatory agency called the National health Insurance Exchange — which would both regulate the insurance industry and administer a new public insurance program:
...That's a big deal — one of the real tests of seriousness for the new plans is whether they create a public insurance program, and Obama's does. Unlike Edwards' and Jacob Hacker's plans, he doesn't use Medicare as the basis for the program, but instead creates an entirely new public insurer.

Here's the catch: The Obama plan does not set the public and private plans in competition with each other, as the Edwards plan does. Rather, the best way to think of it is as a two-track plan. The first track extends the new public program to the self-employed, small businesses, and the uninsured. In other words, the public plan is open to those who are currently disadvantaged in the insurance market — it is not a new insurance market unto itself. That said, if it proves popular and effective, it would be trivial to expand it in the future, letting all businesses, or all individuals, buy in.

The second track is a restructured insurance market. Participating insurers ... will have to offer minimum benefits, spend a certain portion of their budget on patient care (rather than profits and advertising), be barred from discriminating on health history, and be forced to justify large premium increases. Employers will have to either pay into this market, or pay into the national plan.

...The Obama campaign's decision to omit a mandate is a puzzling one, both from a policy perspective -- you want the largest possible risk pool -- and a political one. His plan, unlike others, is not truly universal, it's simply possibly universal.
RJ Eskow predictably puts down criticism of incremental plans that funnel tax money to the private insurance market:
Rose Ann De Moro, for example, has done terrific work as leader of the California Nurses Association. But she drips with contempt for anything less than immediate single-payer reform. Barack Obama is "rearranging deck chairs on the Titanic," she writes. Really? Someone who receives coverage for the first time under the Obama plan, or who gets better care, might feel more like they'd been rescued from a shipwreck. The John Edwards plan, which forces private insurers to compete with a public program, would lead inevitably to single payer unless private insurers could offer something else that some part of the public might want. Nevertheless, to Ms. De Moro the Edwards plan is a "soggy mix and match."

"Edwards does deserve some credit for proposing that at least one plan in each health market be a public program based on Medicare," she writes. "But, if a public program, as he implies, is more likely to assure affordable alternatives to the private insurance model, why get off in Chicago when your plane is going to New York?" Here's why: If the plane doesn't have enough fuel to get to New York, you stop off in Chicago. If some passengers want to get off there, that's fine too. But Ms. De Moro, like other single-payer absolutists, gives this aspect of the Edwards plan only a passing glance before dismissing him by saying he "should go back to being a populist."
Eskow claims he'd switch our system in a heartbeat for Britain's — but, since that won't work, he's for the incremental steps. Which is a bit of a self-fulfilling prophesy...

MSNBC rounds up of mainstream coverage of Obama's announcement. Here is the quote there from the LAT: "Like the other top Democratic presidential contenders, he rejects the left's growing support for a government-run, single-payer healthcare system. Instead, he proposes to reinforce the existing system, under which the vast majority of Americans receive coverage either through their employers or through government programs such as Medicare and Medicaid."

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