Howard Dean on single-payer

Time Magazine offers up 10 Questions for Howard Dean, DNC chair:

As a former physician, what are your thoughts on the Democratic candidates' health-care plans vs. a single-payer system? Megan Prouty CARROLLTON, TEXAS

I think while someday we may end up with a single-payer system, it's clear that we're not going to do it all at once, so I think both candidates' health-care plans are a big step forward. Certainly compared to Senator [John] McCain, who represents a big step backward.

Clinton Won't Discuss Penalties

The NYTimes reports that in discussing her health care plan that includes forcing people to buy private health insurance:

When asked for a third time whether garnishing people’s wages was an option, Clinton told Stephanopoulos: "George, we will have an enforcement mechanism, whether it's that or it's some other mechanism through the tax system or automatic enrollments." She went on to say that enforcement of her mandate was less important than the fact that her plan requires all citizens to have coverage, while her rival, Senator Barack Obama of Illinois, would only require children to be covered, according to the article.

The issue of health care mandates has become a central topic in the Democratic primary contest because it represents "one of the few substantive differences" between Clinton and Obama, reports the Times. Clinton insists that the mandate is key to achieving universal coverage, while Obama argues that the "use of government subsidies to reduce the cost of insurance, would effectively guarantee coverage to anyone who wants it." Some Obama advisors pointed to Massachusetts, which recently implemented an insurance mandate, as an example of a state that has "failed to enroll nearly half of its uninsured despite imposing a modest first-year tax penalty of $219."

Colorado Democratic Party Platform on Health: Already Single-Payer

HCAC is working to get the words "single-payer" into the platform, but Colorado Dems do already have single-payer in the party platform. The bold, by the way, is in the original document.

HEALTH

In the United States, as a matter of social justice, we support a quality universal health care system not tied to employment, as a basic right of all citizens. The health of our citizens is essential to the health of our nation. We support:

• financing through one agency (public or quasi-public) that pays the medical providers for the care they deliver, including prescription drugs;
• patient choice of medical service providers and returning medical decisions to the patient and medical service provider;
• reduction of administrative cost and strong cost-containment programs involving input from those who use the system and which cause no significant harm;
• emphasis on prenatal and postnatal maternal care and complete health care for children;
• health care that is no longer tied to employer health insurance coverage;
• an emphasis on preventative health care including for those with disabilities and chronic illnesses;
• increased funding and accountability for mental health care; government funded providers should have users of services on their staff and governing boards;
• educating the public about scientifically sound policies regarding STDS/HIV/AIDS and comprehensive programs for their research, prevention, and treatment;
• increasing availability of hospice care, and home and community based services that address the needs of all, including people with all levels of disabilities of any age;
• providing for the long-term solvency of Medicare;
• increasing availability of shelters and programs for victims of domestic violence;
• federally-funded research and investigation involving stem cells for the purpose of seeking treatments and cures for heart disease, diabetes, cancer, diseases of the nervous system and renal failure; and
• use of medical cannabis prescribed for a patient by a physician.

About Hillary....

For a rousing denunciation of Clinton's healthcare "reform" plan, give John Nichols' a read. Nichols writes how it should be done.

...Clinton and the Democrats would have a far easier time selling “European-style socialized medicine” than what the senator from New York is peddling. And that does not even take into account the potential appeal of a uniquely American single-payer system that might intelligently combine the necessary efficiency of a publicly-funded and defined payment program for covering costs with the appealing prospect of allowing Americans to choose their own basic plans and doctors.

Steven Pearlstein of the "liberal" Washington Post, on the other hand, thinks Clinton's plan is the best of the bunch. Feasible, you know?

Newt Gingrich explains, via his interview on Hannity & Colmes, why incremental and "feasible" won't work.

COLMES: All right. Getting to Hillary Clinton's health care plan, this is not a government-run plan. In fact, you can keep the plan you have now.

GINGRICH: Alan, Alan...

COLMES: You can buy a new plan for profit. You can pick a plan from the menu of quality private insurance options. You can get the plan that Congress has. You can choose a public plan similar to Medicare.

So you've got a bunch of options here. It's not like it was, as you called "Hillary Care", back in 1994.

GINGRICH: Alan, it has a huge tax increase. It costs $110 billion a year more. It has government intruding all over the place. It cripples the insurance companies. It takes money away from executives. It has government interfering at all sorts of levels.

If you add up the total amount of red tape this is going to cause, I agree with you. This is not Hillary Care. So let's call this "Daughter of Hillary Care". OK? This is way beyond Hillary Care.

So. Clinton (and the rest of the Dems, except Dennis Kucinich) surrender — she goes along with keeping all the blood money for the insurance industry on the table.

Guess what? She loses again. Because it's too expensive.

Walter Shapiro at Salon seems to be talking about a different plan than Nichols, Pearlstein, or Gingrinch. He quotes from Clinton's ad about the plan: "it lets you keep your coverage if you like it [and] provides affordable choices if you don't." and suggests it will be harder to demonize this time.

(That malicious laughter is coming from Newt, who has already accepted the challenge.)

Shapiro writes,

Rather than being timid and incremental, her proposals are as ambitious as those offered by John Edwards, who was the first major Democrat to offer a plan for universal coverage. (Dennis Kucinich remains a voice in the wilderness with his call for a government-run single-payer plan.) Like Edwards, she would legally mandate that uninsured individuals obtain health coverage -- and would provide hefty subsidies for those who cannot afford it on their own. The Clinton and Edwards plans (along with a more narrowly drawn proposal advanced by Barack Obama) would be largely financed by rolling back the Bush era tax cuts for those earning more than $250,000....

Less than four months before the Iowa caucuses, there is scant evidence that Democrats will be mobilized to choose a candidate based on his or her healthcare position papers. All Democratic contenders agree on the goal of universal coverage for the 47 million without insurance -- and, Kucinich aside, their road maps for getting there only differ in the details.

"The candidates would do just as well to hold up blank reams of paper and say, 'This is my healthcare plan,'" joked pollster Andy Smith, the director of the Survey Center at the University of New Hampshire. "Healthcare has been consistently coming up as the second or third most important issue in the polls after the war. But are the voters following the debate over the nuances of policy? No."

The sorry part of this article is Shapiro describing Clinton's policy as "bold."

Bold it's not.

Single-payer = less global warming

Jonathan Tasini writes this entertaining piece at Huffington Post.Tasani quotes the New York Times: "In a break with the past, automobile manufacturers have agreed that some increase in fuel economy requirements is appropriate. But they vigorously oppose the Senate bill, complaining that its requirements are too rigid and not economically feasible." Tasani replies to that the same way I would (albeit more succinctly):

That is a lie. Fuel economy requirements are entirely economically feasible. Sure, if the industry -- along with the rest of the business community -- continues to put ideology ahead of economics, then, it will maintain it can't afford better fuel standards.

We are letting these executives get away with helping kill the planet AND deny people decent health care. And every person in America should be enraged because this is dumb economics, too (and, I will say, this as an aside: I am aghast that the Democratic candidates, with the exception of Dennis Kucinich -- I am not making a pitch for him -- are refusing to embrace single-payer even though the economics are clear and, instead, are all rolling out health care plans that keep the private insurance industry in the game.)

Sicko's even at Business Week

Sicko's even at Business Week — and with a positive review. Which is as it should be. Our healthcare system is bad for business.

"Anything—including a film—that can bring this issue into the public eye is good for the debate," says heart surgeon Dr. William Plested, president of the American Medical Assn. "So, I'm cheering on Michael Moore, even though I haven't seen the film."

Business Week has a nice trailer for the film there.

Can we reform the system? Or are the cynics right, and it's "unfeasible"? If that's the case, we're in the decline and fall of our democracy. Here's a comment from a recent Washington Post back and forth with Steven Pearlstein:

If you look at wealth inequality from an historical point of view, you will see that countries with a vast difference in the percent of wealth held by the upper 1 percent (say) as compared with the lower 90 percent (say) soon go down the tubes. The reason is that wealth translates into political power, and soon the country is making decisions that benefit the top 1 percent and not the country as a whole. This is discussed in detail in Kevin Phillips' "Wealth and Democracy." Since this is a feedback situation, it tends to happen and has at least started to happen several times in our history. The strength of America has been that just when the trend starts to enter the strong feedback stage, something has happened that redistributes the wealth. The rise of unions and FDR are two such examples. What we have to worry about is that the trend of wealth piling up in the top 1 percent or 0.1 percent is increasing and we see the country taking positions that benefit only the Rich. Two examples are taxing dividends and capital gains at a lower rate and the attempt to abolish the estate tax. I am sure you can come up with many more such examples.

Time to redistribute, wouldn't you say? Or are we too "free market" to save the country?

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.

Why?

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."

Morality: Two or Five Foundations?

I just linked from Onegoodmove.org to this New Yorker clip with cultural psychologist Jonathan Haidt talking about the difference between conservative and liberal moralities.

Not only is Haidt nice to watch — funny, entertaining, smart (oh, and handsome) — he's got some great insights here that explain some things that I became aware of while working for the Catholic Church. Haidt describes how liberals have primarily a two-foundational morality based on protecting the weak from harm and on fairness. Both of those values are intrinsic to a social species with vulnerable young and nursing mothers, and which has reciprocal social interactions that are damaged by cheating.

Those moralities are our American, Enlightenment values, and reflect the definition of morality that psychologists go by and that of a tolerant, diverse society.

However, traditional societies, as exemplified by Islamic society and fundamentalist, conservative and rural societies, have five foundations to their morality that liberals miss out on. Their additional moral foundations are based on:
• in-group thinking, that is, loyalty;
• authority, that is, respect; and
• purity, that is, temperance.

Haidt refers to studies that show religious and conservative people to be happier, and he explains that like this: "As society gets more modern and more free, the depression rate goes up and people get lost… if you simply measure how happy people are... conservatives are happier... and a lot of the reason for this is because conservatives participate in denser, more binding social structures. We think we want freedom but if you get freedom beyond a certain point it’s actually bad for you..."

Talking about the three Democratic candidates, Haidt says that Ds have spent way too long thinking that people will vote for the person with the best policies. He cites Malcolm Gladwell's book Blink, on rapid cognition — which happens in the blink of an eye, and how a lot of choices that we liberals believe we should be thinking through actually happen on that basis.

Haidt judges that Hillary isn't a natural at speaking to people in a way that inspires awe and makes people feel elevated — although she's getting better. He sees Edwards and Obama as naturals, with Edwards operating from that liberal, two-foundation morality and Obama able to also reach the five-foundation crowd.

The entire talk lasts a while but is completely worth the time.

Haidt left out the odd libertarian version of conservatism, which pretty much leaves out kindness, fairness, authority, and temperance, and leaves only in-group, with the in-group being basically just that one person or family and Ayn Rand — and she's dead.

He offered this analysis so liberals could understand where conservatives are coming from — in particular on gay rights and abortion. It also explains a lot about the Iraq war (authority and in-group values). It does not explain, however, the deadly American distrust of government that has played into the hands of those who have for so long successfully denied Americans the universal healthcare that is a right of citizenship in every other industrialized nation on earth.

At least we've got universal primary and secondary education. Keeps the kids off the streets.

Obama & single-payer

Barack Obama in New Hampshire has mostly been in huge venues — but Ron Brownstein of the LA Times writes that Obama "heard impassioned and sometimes wrenching pleas for a single-payer health care system at a forum limited to 100 people in Portsmouth on Tuesday afternoon."

Dozens of papers ran stories on Obama in Iowa, and his reluctance to spell out his position on healthcare reform. In Iowa, he told an audience that "We shouldn't just put more money into a system that isn't efficient." At another event he said,

Money saved by converting health record keeping into an electronic rather than paper process, early detection of chronic illnesses, and child wellness programs could help finance coverage for the uninsured, he said.

"We can save huge amounts of money and put that money into providing basic health insurance or subsidies to purchase health insurance for those who don't have it," Obama told about 400 supporters and Democratic activists in Fort Dodge. "We can create universal health care in this country."

... Obama has said he is open to raising income tax rates on wealthier Americans to pay for domestic priorities, including transportation, education and health care.

... Obama hinted during his later stops Thursday that his plan would likely include government assistance for some uninsured to enroll in insurance programs such as those offered to federal employees.

In another story, Obama was quoted as saying "if he was starting from zero, he would likely support a single-payer system, similar to the government-run program in Canada. But he's leery of taking such a step because the United States already has a complex and established system of employer-based health coverage."

Gore for single-payer

Al Gore is right about global warming. He's a smart man. He's right about healthcare too:

"I think we've reached a point where the entire health care system is in impending crisis," Gore said. "I have reluctantly come to the conclusion that we should begin drafting a single-payer national health insurance plan."

Challenging the Dems

That was then, this is now, but Steven Colbert continues to fiercely, relentlessly support a still-unappreciative Bush.

I missed Colbert's television explanation of Bush's health plan, but it translates well to print: "It’s so simple. Most people who can’t afford health insurance also are too poor to owe taxes. But if you give them a deduction from the taxes they don’t owe, they can use the money they’re not getting back from what they haven’t given to buy the health care they can’t afford."

Exactly. Cornell professor Robert Frank used the Colbert explanation as his lede in the NYT, following it up with a great challenge for the Democratic candidates to stop being sissies and come out for single-payer healthcare:

As health economists have long known, market incentives induce private insurers to spend vast sums to avoid people who may actually require health care. This problem is mitigated (though not eliminated) by employer-provided group policies. Because Mr. Bush’s proposal would steer people toward individual policies, it would actually strengthen the incentive to shun unhealthy people. Such people can now keep their insurance by not changing jobs. But no private company would want them as individual policyholders at a price anyone could afford.

That Mr. Bush’s proposal will not shrink the ranks of the uninsured is not its most serious problem. Far more troubling is its embrace of a system under which we spend more than twice as much on health care, on average, as the 21 countries in which life expectancy exceeds ours. American costs are so high in part because the reliance on private insurance multiplies administrative expenses, currently about 31 percent of total outlays...

If the single-payer system embraced by virtually all other developed countries is clearly the best solution, why doesn’t the United States adopt it? Some analysts concede its merits, but characterize it as either unaffordable or politically unrealistic. But why should a policy that promises better results for less money be considered a nonstarter?

There are two obstacles, which could both be overcome by intelligent political leadership. One is that the single-payer system would require additional tax revenue. In the current climate, that’s a tough political hurdle, to be sure. Yet how complicated would it be to explain to voters that because the single-payer plan would reduce costs substantially, every additional tax dollar would be offset by an even larger reduction in private insurance spending? Given that such a system is so much cheaper over all, calling it unaffordable makes no sense.

The second obstacle is opposition from private insurers, who would be understandably reluctant to abandon multibillion-dollar annual profit streams. Those who stand to lose from policy changes always battle harder than those who stand to gain — an asymmetry that is exaggerated when losses would be concentrated and gains diffuse. So, yes, the insurance industry would bitterly resist...

[F]orceful advocacy of the single-payer approach offers a golden opportunity for any serious presidential candidate. Voters are fed up with rising insurance costs and dwindling coverage...

Critics of the single-payer plan have long railed against the specter of socialized medicine, suggesting that it means being treated by government functionaries. Yet people who have experienced single-payer coverage firsthand seem unconcerned. When one of my sons needed surgery for a broken arm during a sabbatical in Paris, for example, the medical system we encountered was just as professional as the American one and far less bureaucratic. And in France, which spends half as much on health care as the United States and has more doctors and hospital beds per capita, everyone is covered.

We live in challenging times. Does a candidate who couldn’t persuade voters to embrace the single-payer approach deserve to be president?

Bravo. Are you listening, Hillary?

Obama? You there?

Time to be counted

There's a lot of guesswork going on about which Democrats are willing to go further than the Rs towards a sustainable healthcare system. That means single-payer — at least in the reality-based world that is based on evidence and past performance.

The three major Democratic candidates are all for covering children and expanding coverage, but neither Barack Obama nor Hillary Clinton will speak in terms of single-payer. John Edwards goes a bit further. His plan includes a public program that would compete with private insurance. Paul Krugman thinks this is a workable avenue to single-payer. A number of other smart observers, on the other hand, think that it would not affect cost-shifting and could not contain costs.

Progressives long ago lost anything but a pragmatic kind of tolerance for Hillary Clinton — much of it based on nostalgia for Bill. That's despite his neo-liberal policies, and rightly so. Anyone still saying that Ds and Rs are the same has not been paying attention for the past six years. We were happier then.

But Obama. Have you heard the man speak? He'll make your heart sense hope and goodness. Obama's not just a competent speaker. He is eloquent in a way that makes you believe it really is morning in America again — an honest, eyes-open sunny day rather than that old Reaganesque "no sacrifices needed, greed is good!" miasma that passed for a sunrise back in the '80s.

On healthcare policy, however, Obama's coming up short.

David Sirota interviewed him last summer, and wrote this:

Obama is all about the art of the possible within the system. “This is a classic conflict within the left: Are you a revolutionary or are you a reformist?” Obama said. “I am less concerned with the labels that are placed on me in terms of what kind of leader I am, and I am more interested in results…. I think within the institutional structures we have, we can significantly improve the life chances of ordinary Americans.” I asked him to give me some specific examples of what he meant. Is a proposal to convert America’s healthcare system to one in which the government is the single payer for all services revolutionary or reformist? “Anything that Canada does can’t be entirely revolutionary–it’s Canada,” Obama joked. “When I drive through Toronto, it doesn’t look like a bunch of Maoists.” Even so, Obama said that although he “would not shy away from a debate about single-payer,” right now he is “not convinced that it is the best way to achieve universal healthcare.”

The Black Agenda Report:

By June 2003, when Obama was a candidate for his current job in the Illinois Democrat primary, we were impolite enough to ask him a direct question about whether he'd support single payer legislation if elected to the U.S. Senate. We asked him: "Do you favor the adoption of a single payer system of universal health care to extend the availability of quality health care to all persons in this country? Will you in the Senate introduce or sponsor legislation toward that end?" Obama's answer was:

"I favor universal health care for all Americans, and intend to introduce or sponsor legislation toward that end in the U.S. Senate, just as I have at the state level."

Already Obama's position on health care had markedly deteriorated. By the following year, Obama was newly elected to the U.S. Senate, and in an interview with BAR's Glen Ford he was asked whether he planned to sponsor the kind of single payer legislation he'd been identified with as a state senator.

Glen Ford: "Are you going to introduce single payer legislation?"

Barack Obama: "No, I am not. Which isn't to say that I'm not interested in the conversation about moving in a direction that expands affordability and accessibility. But my point is that, along that spectrum there are many points that people may arrive at, all of whom affirm the notion that we have a health care crisis that hits our communities much harder than anybody's, but it's everybody's crisis, and we've got to have an agenda in terms of both general health care issues as well as issues like AIDS that are ravaging the African American community."

Obama is at least as distant from single-payer as is Clinton or Edwards.

John Dean and Wesley Clark, on the other hand, have explicitly come out in favor of single-payer. As did Gore in 2002.

Ezra covers Edwards

Ezra Klein gives John Edwards' health plan a good grade in this crib sheet at the Prospect.

Here's how it works: On first blush, the plan is much like the Wyden initiative, though it puts the onus of the responsibility for funding health coverage on employers... The employers can satisfy that responsibility by either providing comprehensive care, or helping employees purchase from a menu of insurance options provided by newly formed, state-run "Health Markets."

As of now, the plan doesn't explain how much employers must provide towards health market coverage, but it's a safe bet to assume that it's somewhat less than the total cost of health care, and so the incentive will be for employers to encourage their employees to purchase from the HMs. And that's where things get interesting. The HMs will offer a menu of private options that are totally community rated. The plan "will require insurers to keep plans open to everyone and charge fair premiums, regardless of preexisting conditions, medical history, age, job, and other characteristics." These days, though, community rating is a common enough.

Where the Edwards' plan takes a big step forward is in mandating, along with the private options, that HMs offer "at least one plan [that] would be a public program based upon Medicare." And the intent is explicit: "Health Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."

At his own site, Klein writes that the media coverage of John Edwards' health plan was bad — snarkily compared to Hillary's 1994 plan in the NYT and just given a mushy "it's a tree" description in WaPo: "Reading their coverage, you'd be hard-pressed to distinguish the plan from any other proposal ever offered," opines Klein.

Klein thinks Edwards' plan is a big step forward, because it will allow the public and private sectors to compete with each other. If that were to be the case, I'd feel better about this plan, even though it does seem to be a long way around to the right solution. However, why would the powerful medical insurance lobby ever allow the public sector to compete on a level playing field? Medicare would have to be adequately funded for that, and all the private sector would need to do is ensure that the people signed on to the public program were subsidizing people who couldn't afford insurance and voila — the public subscribers be getting a raw deal. There would also be the same stigma as riding the city bus in Denver.

Can't afford a car, eh?

Maggie Mahar, author of Money Driven Medicine (2006), writes, in a response to Klein at The Prospect:

We don't have the best healthcare system in the world — patient satisfaction is lower in the U.S. and hospital errors are higher — as are mortality rates for many diseases. End-of-life care in the U.S. is both extraordinarily expensive and cruel.

Yet we spend far more than any other country on health care ($2 trillion, of which about $600 billion is wasted) and that bill has been rising by 6% to 10% a year--more than twice as fast as wages or GDP.

By accepting runaway healthcare inflation we are caving in to the corporate interests now running our health care system: Big Pharma, device-makers, for-profit hospitals and lobbies created by some of the highest-paid specialists who do the largest number of unnecessary sometimes unproven procedures.

These are powerful interests, but unless we face them down, healthcare reform will simply mean universal access to unnecessary, sometimes unwanted care at a price that we cannot afford.

This is not a one-time waste of money (like Iraq)--it is a continuous, ever-escalating expense. We have to get a handle on cost if we have any hope for healthcare reform.

I would love to see the Edwards plan empower the public insurer (Medicare) to use its enormous clout to negotiate serious discounts on drugs and devices. Medicare also needs to stop paying doctors and hospitals for volume (fee-for-service).

On March 1, the Medicare Payment Advisory Commission (MedPac) will be releasing a report March 1 that talks about waste in the system--and alternatives to paying doctors for volume. It will be interesting reading.

John Edwards: huh?

It's not enough to go on, but here's what Edwards said this morning on Meet the Press about healthcare.

He'd raise taxes, chiefly on the wealthy, to pay for expanded healthcare under a plan costing $90 billion to $120 billion a year. Details coming tomorrow.

It would expand Medicaid, the federal program administered by states for low-income families. It would offer subsidies for the uninsured. It would ask employers to play a bigger role — evidently they'd either have to cover their employees or buy into "what we're calling health markets."

This makes more sense if Edwards were saying that employees were going to play a bigger role — because it is also a Democratic goal to decouple our health system from employers. Furthermore, Edwards evidently talked about national "health markets."

One choice available in the markets would be "the government plan, so people who like the idea of a single-payer health insurance plan, that is actually one of the alternatives," he said.

Doesn't that sound like employees, rather than employers?

More importantly, this story says nothing about the role of private insurance. Is Edwards talking about something like Eskow is (below), and I'm just not as reflexively hostile to it because he didn't use the word "voucher" or "to pay for private insurance"?

Could you have a single-payer plan, paid for by everyone's taxes, and then people who were — ah! — reflexively hostile to it could buy their own insurance?

That might work. It would be like public schools, where there's a basic public good for everyone, and then those who have $10,000, $20,000 or whatever to toss to the winds could buy private insurance. Along with Phillips Exeter.

Something for Bush's base.

Medicare cuts

The NYT reports that "President Bush will ask Congress in his budget next week to squeeze more than $70 billion of savings from Medicare and Medicaid over the next five years, administration officials and health care lobbyists said Thursday."

Mr. Bush is also expected to propose changes in the Children’s Health Insurance Program to sharpen its focus on low-income families. The changes could reduce federal payments to states that cover children with family incomes exceeding twice the poverty level. Under federal guidelines, a family of four is considered poor if its annual income is less than $20,650.

What should our response be?

Marilyn Clement, national coordinator of Healthcare-now writes, "if we allow the debate to go on in the beltway this year around trying to keep Bush from cutting $70 billion dollars from Medicare or other incremental cuts or $35 billion or a few bucks less and focus all of our time on trying to keep him from cutting dollars from Medicare and the CHIPS program for children rather than getting to the central debate, then the current (new) Congress will have lost its momentum and be subject to rebuke and likely defeat by the voters in 2008 who voted for real comprehensive change in 2006, not incremental reforms."

Just say no, congress.

Clements urges everyone to call or write Pelosi and other congressional leaders, as well as our own congresspeople, to urge support for HR 676, the improved Medicare for All bill — and to call our senators to ask them to create a complementary bill in the Senate.

Wes Clark is for single-payer

Wes Clark gets it.
He says after studying the issue, he doesn't see how we can achieve our healthcare goals without going to a single-payer system.
The real question is how can anyone, after studying the issue, not agree?

Social insurance & progress

Catch this story before it disappears behind the NYT firewall. It's yet more evidence that not all economists are evil...

Dani Rodrik, a trade economist at the Kennedy School of Government at Harvard and author of Has Globalization Gone Too Far? believes that social insurance and free trade must go hand in hand — "a concept entrenched in Europe but not in the United States." In Economist Wants Business and Social Aims To Be in Sync, Louis Uchitelle writes that as a practical matter, Rodrik says that

Washington must counteract the damage from America’s trade policies more than it has in the past. It is a message that is resonating not just with populists in both parties, who have long been skeptical of the benefits of globalization, but increasingly with mainstream policy thinkers, many of them associated with former President Bill Clinton...

“The people who talk incessantly about trade and its importance,” Mr. Rodrik said, “do so without recognizing the importance of the social insurance agenda as part and parcel of that process.”

Evidently a new research group funded by Robert Rubin, President Bill (We were happier then) Clinton's Treasury secretary, is putting together proposals to influence the D's party platform. Jacob Hacker, who wrote The Great Risk Shift: The Assault on American Jobs, Families, Health Care, and Retirement--And How You Can Fight Back, is part of the Hamilton Institute, giving it credibility in the healthcare field.

“My argument is that we need to have a new social contract,” said Jacob Hacker, a political scientist at Yale who is working on a plan for health insurance modeled on Medicare and a program to provide subsidized 401(k) accounts. “This new social contract won’t be as extensive as those in Europe,” he added, “but it will move a lot of the responsibility for providing economic security off the backs of employers.”

Uchitelle then turns back to globalization, in particular why China has succeeded so spectacularly (government interference with the sacred free market.

Rodrik is now consulting with governments, offering them a lot more than the single solution than Peruvian economist Hernando de Soto keeps repeating. De Soto's answer to poverty is making sure the poor have legal title to their property.

I'm not aware of de Soto's solutions working anyplace — although they sure sound great.

Rodrik should get the U.S. contract. And it's gotten to that point. The free-market worshippers have taken us to where we need to get in line with the developing countries to find someone to tell us that we need to take care of our most valuable resource — our people — as well as to take care of business.