The Clinton Plan

Here it is in brief. You've got your individual mandate, you've got your pay-or-play for larger employers, you've got your subsidies, you've got your community rating, you've got your "choices offered in the Menu will provide benefits at least as good as the typical plan offered to Members of Congress," etc.

My record of political prognostication is terrible, but given that Clinton already has a sizable lead and that what Team Obama is telling Marc Ambinder doesn't sound very convincing, I feel like Clinton is drawing close to checkmating her opponents. I'll have to wait and see what more expertish people have to say about this proposal, but it certainly has the look and feel of a decently ambitious proposal (indeed, probably too ambitious to be enacted, but we'll have to see how the Senate looks after the election) in a way that really undercuts some of the main arguments that have been made (including by me) against her.

Comments

having done quite a bit of work on state-level health care reform, I've reluctantly come to the conclusion that employer & individual mandates + the option of buying into a public plan + better targeted subsidies for private coverage is probably the most realistic route to universal coverage.

A "Medicare for kids" approach is also appealing. But going directly to single payer just doesn't seem possible.

Posted by lemuel pitkin | September 17, 2007 12:16 PM

Re Matthew's comment "I feel like Clinton is drawing close to checkmating her opponents. I'll have to wait and see what more expertish people have to say about this proposal, but it certainly has the look and feel of a decently ambitious proposal (indeed, probably too ambitious to be enacted, but we'll have to see how the Senate looks after the election) in a way that really undercuts some of the main arguments that have been made (including by me) against her."
------------
Fuck Me. Sounds like Hillary has either given Matthew a blowjob or a consulting contract. Or maybe both.

Posted by Don Williams | September 17, 2007 12:29 PM

As long as it continues to tie health care to employment, its crap.

Posted by Spike | September 17, 2007 12:40 PM

Gah. Hillary. What did we liberals do to deserve this?

The worst part is that the average dem voter out there pretty much agrees with the progressive viewpoint, but they simply don't know that Hillary supported the war, that Obama and Edwards are more liberal then her, etc.

Posted by Chad Okere | September 17, 2007 12:40 PM

Hillary Care 2 -- or, your worst big governmetn nightmare come true. This does absolutely nothing to control costs, eliminate inefficiencies, but does add new bureaucracies and policing mechanisms. It takes the most cumbersome, inefficient health care system of any industrialized nation, and makes it more complicated, cumbersome, and wasteful. This assures that we will not have universal health care for at least another 8 years. (Not to mention that we'll still be occupying Iraq for another 8 years)

Posted by Alan in SF | September 17, 2007 12:54 PM

I'm not sure anything a Democrat does on the health care policy proposal front is going to actually influence primary voters beyond saying "I support universal healthcare," which is already a prerequisite for a Democrat who is running. Health care policy is so complex and boring that a lot of even well-informed people don't have the patience to go through policy proposals to choose who has the best one.

Posted by Reality Man | September 17, 2007 1:02 PM

So, where are the details? Can we look forward to MattY discussing the ways the plan won't work, or will the plan just be promoted here? Will this plan cover foreign citizens who are here illegally as well? If so, given how strongly the Dem leadership supports illegal immigration, won't that lead to problems? Will any "liberal" commentators even discuss that issue in depth, or will that at most be hand-waved away?

Posted by TLB | September 17, 2007 1:09 PM

The individual mandate scares me. The reason I don't have insurance is because it's expensive and doesn't seem to ever cover me for anything. In my life, I have always paid 100% of my medical costs regardless of whether I had insurance or not. So far, insurance has been a complete waste of money for me. And now I will be forced to buy it? You can count me out on that. I'd much rather pay cash for emergency services and have elective services performed in other countries where they are affordable. What's even worse about Hillary's plan is that the individual mandate will get support from the insurance companies, so it will pass. But the rest of the program won't. All this does is force me to participate in the most inefficient medical system known to man.

Posted by fostert | September 17, 2007 1:10 PM

LEads in national polls, or even in early states, mean nothing until the results in iowa come in. This is the age of national, constant media. It doesn't take more than 12 hours for anything to sink in anymore.

And yes, this is a terrible plan. all it does is mandate that people have to buy insurance. It doesn't even kind of pay for it, and it includes NOTHING that forces insurance companies to both cover everyone, and actually provide the coverage when the time comes. Just more pro-business bullshi from team Hillary.

God I fucking hate Democrats.

Posted by Soullite | September 17, 2007 1:15 PM

Alan in SF,

Federally run health care programs like medicare are far more efficient than privately run health insurance. Adminstrative costs for medicare are anywhere between 2% and 4%. Private insurance plans spend about 20% on adminstrative costs. Healthcare is a complex issue. The economics are even more complex. The best way to get to universal coverage is to try something ambitious and fix it along the way. Right now, insurance companies and big pharma hold way too much power over what is offered and at what price. Change the dynamics and you will change the pricing structure of both delivery of services and drug costs. The industries will fight it but at the end of the day, they will adjust to the realities as they have in every other industrialized country. Big Pharma will tell us they won't be able to do any more research but does anyone really believe that? Why do the same drugs produced by these companies sell for a lot less in Europe and Canada?

Posted by ny nick | September 17, 2007 1:18 PM

And yes, this is a terrible plan. all it does is mandate that people have to buy insurance. It doesn't even kind of pay for it, and it includes NOTHING that forces insurance companies to both cover everyone, and actually provide the coverage when the time comes. Just more pro-business bullshi from team Hillary.

Yeah, it does nothing, other than make Medicare accessible to everyone that wants it. How horrible!

Posted by Steve | September 17, 2007 1:21 PM

This would be an decent compromise between an Democratic Congress and a (rational) Republican president. But this is Hillary's opening offer?

Unless the Dems pick up a filibuster-proof majority in the Senate next year, whatever she proposes is going to be watered down the Republicans.

Posted by beowulf | September 17, 2007 1:25 PM

This would be an decent compromise between an Democratic Congress and a (rational) Republican president. But this is Hillary's opening offer?

Should we be surprised that she's starting out conceding half her territory in the name of pragmatism, and will hail the watered-down version as a great victory in the face of overwhelming opposition, even if it sucks?

Posted by latts | September 17, 2007 1:34 PM

It's time to go after her personally - by which I mean focus on her own views, and her own record. Focusing on policy just means whe will give a speech in which she appears to endorse your policy, thus blurring the real differences in the eyes of voters who don't really pay attention.

Her RECORD shows her to be far to eager to compromise. In fact, if elected, you can bet this plan wouldn't see Congress as anything other than a proposal. Then she'd sit down with the same lobbyists that destroyed her first effort and allow them to do exactly the same thing.

Posted by DrFrankLives | September 17, 2007 1:37 PM

The health care system is so broken at a fundamental level that we're headed toward single payer. Everyone agrees that de-linking employment from health care is the way to go. Four 50 years the tax-free status of employer-provided health care has stripped out most of the incentives that would otherwise keep costs in check.

At this point, there's no political will for ending that subsidy, but instead there's plenty of political momentum headed in the direction of further, massive health care subsidies in the form of a single-payer health care system.

Things are going to get much much much worse before they're ever going to get better. And the people who are going to get screwed the worst are the middle class who today who can just afford insurance, but who in a government mandated system are going to be barred from exercising that option because it'll be too costly. The rich will always find a way to pay for top notch health care. The poor always get screwed.

But, whatever man, as a lawyer I got mine, so see ya suckers.

Posted by Joe Strummer | September 17, 2007 1:39 PM

This is an obscene joke. We now all understand why the insurance companies donate to Hillary! This "plan" amoutns to a regressive tax to further subsidize the insurance industry, which is the very actor that ruins our system in the first place!! This will do nothing to address the adminsitrative waste in the system, or the obscene insurance company profiteering. This is a Republican plan. If Hillary's the Democratic nominee, its time to think about 3rd parties...

Posted by Father Figure | September 17, 2007 1:44 PM

..."drawing close to checkmating her opponents"

President Dean disagrees.

It's a cheap crack, but someone had to say it.

Posted by Klug | September 17, 2007 1:46 PM

It's overcomplicated and rewards the worst offenders in the current system. It's basically an agreement to pay off the Big Insurance goons on the assumption they won't burn down your house. Of course, they'll soon come back for more.

It's a Republican plan. It's the plan of someone in the pockets of the corporate puppeteers. Anyone see how Big Insurance stock prices reacted?

Posted by pseudonymous in nc | September 17, 2007 2:19 PM

One of the major reasons why there hasn’t been any system-wide health care reform has been the unwillingness of idealistic progressives to get behind any realistic non-ideal plan. I think we're past the point where we can object to serious health care proposals because a better solution is conceivable. Let’s take some time to consider this plan before we start name calling. History has shown that systematic health care reform is NOT inevitable; we could easily end up with no reform for a generation. Progressives have been letting reform opportunities pass by for 60 years holding out for something better; let’s think before we do it again.

Posted by JK | September 17, 2007 2:26 PM

As long as it continues to tie health care to employment, its crap.

I grudgingly agree, but I'd rather have 99.9 % "crap" coverage than 85% coverage (which is still crap anyways). For America's millions of uninsured people, a crappy system that allows them and their kids to see a doctor is infinitely better than no system at all.

And the thing is, in what parallel universe does any legislation producing universal coverage by demolishing the status quo get passed? Why is this so hard to understand?

Once the camel's nose of universal coverage has passsed under the tent, Americans will never let it go. Can you imagine Britons or Finns or Australians allowing their society to lapse into American Dickensianism?

Anyway, at that point we can go in for some serious restructuring.

Posted by Jasper | September 17, 2007 2:29 PM

Getting a big margin in the House is still important too; I count Marshall, Cramer, Barrow, and Boyd as not voting for anything, and I imagine there are another dozen plus that I don't know about who won't vote for anything with a big tax increase.

The fact that it's truly universal is a big plus. Still, Iraq-related mendacity strikes me as a good reason not to vote for Clinton at this point.

Also we have no indication of where in the priority list this super-awesome health care plan goes. At times, she's said the goal is universality "by the end of her second term", at other times it's been her "highest priority", etc.

Posted by Nicholas Beaudrot | September 17, 2007 2:33 PM

"Progressives have been letting reform opportunities pass by for 60 years holding out for something better; let’s think before we do it again."

That's absurd. "Reform opportunities" per se are not good. The actor that needs "reform" is the insurance industry, and this plan is a massive giveaway to the health care insurers. Democrats have destroyed their popularity by listening to self-interested neo-liberals and accepting regressive measures, instead of sticking to their guns and fighting for what they believe in. This ties in with the "eleavtor pitch" debate.

Health insurance companies are one of the juiciest political targets we've ever had! Instead of targeting a campaign against them, this plan ties us to them for perpetuity!! This plan sweetens the pot for capture, while imposing a regressive tax on the middle class and the young? As a moderately "young person," I can tell you that an expensive individual mandate plan will ruin the Democrats for an entire generation. This plan is a better advertisement for campaign finance reform than it is for Senator Clinton.

Posted by Father Figure | September 17, 2007 2:39 PM

Nicholas Beaudrot brings up a good point. I remember going to a Kerry event in '04 and he checked off every liberal issue, but I had little sense what his priorities would be. With Hillary it goes further, what is she willing to fight for.

I know Matt has a rather defeatist attitude on Universal Healthcare, but if the President isn't willing to make it into a political issue, it is already defeated. Edwards is making the case that he will make it a front and center political battle, if Hillary plans to sweet talk her plan through backroom deals she might as well not have proposed anything.

Posted by AJ | September 17, 2007 2:44 PM

It seems to me that what she says she'll do is pretty irrelevant here. So is what she actually wants to do. So long as she's serious about her foreign policy, she'll be too tied down dealing with that to marshal the support and money she needs to carry out her domestic priorities. We're not going to get a "Great Society" from H. Clinton.

Posted by Chris | September 17, 2007 3:11 PM

"Insurance and Drug Companies: insurance companies will end discrimination based on pre-existing conditions or expectations of illness and ensure high value for every premium dollar; while drug companies will offer fair prices and accurate information."

IOW, insurance companies would be legally prohibited from charging actuarially sound rates? Why even bother with the insurance companies, if you're going to outlaw the very basis of how they are supposed to function?

Look, it's just a fact that some people, AIDS patients, for instance, or even overweight couch potatos, cost a hell of a lot more than others. If you can't charge 'em more, where's the extra money come from? Seriously? From the people who diet and exercise and use condoms, I suppose. So much for encouraging responsible behavior...
outside her plan.

Posted by Brett Bellmore | September 17, 2007 3:27 PM

Nick -- You got me wrong. I'm totally for a federally run plan, totally against a federally-run bureaucracy presiding over a bizarre quilt of private insurance, employer plans, various classes of uncovered individuals, small businesses, etc. Preserving the private insurance/employer provided model is Hillary's first principal. We need to adopt the European/Canadian approach, not make our own system even more complicated.

Posted by Alan in SF | September 17, 2007 3:32 PM

"If you can't charge 'em more, where's the extra money come from?"

Brett, that's how insurance works. The premiums of those that don't end up using it pay for those who do. Insurance companies can keep rates higher (or exclude you entirely) by setting up risk pools as small as they can make them (1000 5-person companies treated as 1000 5-person pools instead of one pool of 5000 people). Single-payer would (ideally) create one big pool with the obvious benefit.

Posted by BlueStreak | September 17, 2007 3:58 PM

The actor that needs "reform" is the insurance industry, and this plan is a massive giveaway to the health care insurers.

I think you're vastly underestimating the impact of this plan on insurance companies. The new rules regarding pre-existing conditions, for example, would rewrite an awful lot of business models.

Posted by Steve | September 17, 2007 4:06 PM

As a starting point, this is far better than Hillary's Soviet-style approach of the early 90's, but Brett Bellmore highlights the scary paragraph. To me, the scarier part of that paragraph is the implicit threat against the drug companies. The pharmaceutical sector is one of the real jewels of American industry, one that, regrettably, the rest of the world has been getting a free ride on for years.

The price controls in other industrialized countries cause our drug prices to be artificially higher than they would be otherwise; a "fair" approach would seek to remedy that by getting those countries to pay their "fair share" (to borrow a Dem phrase). If Hillary instead sought to apply Canadian-style price controls here, what incentive would so many large and small drug companies have to invest billions and decades in primary research and drug development? American companies wouldn't be the only ones effected; this would also effect foreign drug companies that rely on American sales to recoup their R&D costs.

Posted by Fred | September 17, 2007 4:11 PM

Bluestreak, that's not "insurance", that's just a government benefit plan administered by companies that formerly offered insurance. Incorporating actuarial data into the rate setting is a fundamental element of "insurance", and if you omit it, replacing it with legally compelling everyone to be part of a single pool with uniform rates, it's not "insurance" anymore.

Frankly, if we're going to do that, I'd rather we left the insurance companies out of it, they're not contributing anything except the pretense that it's not socialized medicine.

Posted by Brett Bellmore | September 17, 2007 4:17 PM

The problem of un-insureds isn't rocket science: there are folks like fostert and myself who don't have health insurance for one reason or another (either because they are relatively young and healthy, they don't want to pay for it, they are temporarily between jobs, etc.), and there are those who are too poor to afford it, or have two many pre-existing conditions to qualify for it.

A mandate (even if just for a high-deductible, catastrophic policy) makes sense for me, fostert, and the rest of the first group. With us joining the risk pools, insurance companies ought to be able to make a little more money and slow the increase in average premiums. For those who are too poor, there is Medicaid. For those who make too much to qualify for Medicaid, Hillary's idea of limiting their premiums to a certain percentage of their incomes is reasonable (assuming the government will subsidize the difference). For those with pre-existing conditions, the best approach is to have insurance companies bid on insuring them for government-subsidized fees, and then let the government write the checks.

Also, if consumers are allowed to shop for insurance across state lines, as implied by Hillary's outline, this will lower insurance costs and lower administrative costs, as insurance companies wouldn't have to set-up subsidiaries in every state where they want to offer insurance. There's an obvious states' rights issue here, but since states rely on federal aid for Medicaid, this is probably negotiable.

Posted by Fred | September 17, 2007 4:25 PM

This proposal by Hillary is intentially designed to fail. She is offering a plan that will never be enacted. She knows this. It is pure bullshit.

If she really truly wanted to help Americans with health care she would advocate medicare for all. It would be wildly popular with the public and even with the intense opposition of conservatives it could be enacted in stages.

Start with lowering medicare eligibility to age 55 or 60. This would drop the expense of private health care dramatically and at the same time make American employers more comptetive globally.

As medicare continues to prove itself as the most rational solution it can be extended further to more of the population until everyone is covered.

Posted by ken | September 17, 2007 5:10 PM

"A mandate (even if just for a high-deductible, catastrophic policy) makes sense for me, fostert, and the rest of the first group."

I agree with this in general, and I don't really mind joining the risk pool. But if I am required to buy in, then the insurance company should be required to cover me, regardless of my pre-existing conditions. What worries me is that only the individual mandate will get through Congress, and I will still have to pay 100% of my medical costs in addition to the insurance premium. Unless the guarantee of coverage is passed first (it'll never happen), I can't support the mandate.

Posted by fostert | September 17, 2007 5:25 PM

fyi: Here is a quickie analysis of Hillary's plan from Don McCanne's at Physicians for a National Health Program:

http://pnhp.org

Hillary Clinton’s proposal "preserves existing health insurance," and includes the responsibility of individuals "to get and keep insurance" through the current private insurance market, or through a "Health Choices Menu" of private FEHBP-type plans, or through a Medicare-type public program.

Thus her proposal is an individual mandate to purchase private insurance that is no longer affordable for average-income individuals, or to purchase a public plan that will be even more expensive because of adverse selection.

To make the plans affordable for individuals, she would use a combination of refundable tax credits and a cap on premiums at a percentage of income. Assuming that the plans would provide adequate benefits and adequate protection against financial hardship, the increased spending through the tax system would be exponentially more than the estimates in her plan. And most of the proposed savings to pay for these increases are largely nebulous, and some of those measures would actually increase costs.

Further, the administrative complexities of refundable tax credits and means-tested premium caps would still leave many without coverage. Coverage will never be universal unless it is truly automatic for everyone.

If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.

Many will try to contrast the differences in the Clinton, Obama and Edwards proposals, but they are all basically the same. In spite of their rhetoric, they have each made the protection and enhancement of the private insurance plans a higher priority than patients."

I would only disagree with Don insofar as saying that Obama's plan is significantly even less than this, and Edwards a bit less bad.

A pleasant surprise that Hillary's is offering something this "bold"... and not a surprise that it is more subsidy and support for the private for profit insurers that have given so much to her campaign.

Once again, time to point out that Medicare overhead of 3-4% versus the private for profits overhead of 15-20% is $350 billion not going to health care, but going to an unneeded middleman. Plus further savings by not having the paperwork involved in determining and rejecting eligibility if everyone is eligible, and all the many other reasons single payer is the way to go to provide Universality & Comprhensive coverage & Cost-control.

Posted by dr.steveb | September 17, 2007 5:29 PM

Having the government require that people buy health insurance is about as effective as having the government require people tithe at church.

It is bullshit. Clinton knows it is bullshit. She is offering this plan in order to escape serious debate on the only practical solution to the problem which is simply to extend medicare to everyone.

Posted by ken | September 17, 2007 5:34 PM

Re: The new rules regarding pre-existing conditions, for example, would rewrite an awful lot of business models.

The new rules are exactly how large group policies function today: the insurer charges the same premium for everyone in the group. There is no individual risk-rating. If they can insure everyone at Microsoft or GM (and their depeedents) in that manner why not the entire country?

Re: Incorporating actuarial data into the rate setting is a fundamental element of "insurance

See my comment above on group rates. There is no individual risk rating in the vast majority of health insurance policies today. To the extent that this done it is done at the group level, not the suscriber level. This simply mandates an already common practice be made universal. Where's the problem?

Posted by JonF | September 17, 2007 5:37 PM

The American debate about health care is mostly about the wrong thing, and this is a beautiful illustration. Very few people actually want health insurance. What they want is to know that their medical expenses will be covered. The insistence on individual mandates is basically secular puritanism at work, anchored in a fear that if something is "just" paid for through taxes, it won't have been earned with enough worry or suffering. But the American people are not, by and large, crying out for more cryptic decisions that they'll have to make without being able to get reliable straight answers about the consequences, another expense they'll have to budget for, and like that. They want themselves and their families to have access to good care when they need it, and they're telling pollsters and politicians they're willing to pay more in taxes for it. Maybe someone in a position to propose policy will eventually listen.

Insurance is not the answer. Insurance is one means to the end, but it turns out not to work very well with health. It's time for a different means to the real answer.

Posted by Bruce Baugh | September 17, 2007 5:45 PM

Brett Bellmore's point about actuarially sound rates makes a lot of sense. Its true that under any reasonable insurance system, sick people should pay higher rates (just as old people pay higher life insurance premiums than young people). Once you decide that insurers can't make riskier policyholders pay a higher rate, then its not an insurance system, its a social welfare system and it should be funded as such. Especially since "individual mandates" means that its not a voluntary payment. If the government makes you to write a check, its a tax-- whether the check is made out to the US Treasury or Blue Cross.

An insurance premium is payable at a actuarially sound rate regardless of the policyholders income. On the other hand, income taxes are assessed on a progressive basis.

Requiring everyone to pay the same premium is an example of the most regressive form of taxation, a poll tax, "a tax of a uniform, fixed amount per individual (as opposed to a percentage of income)". If you recall, Thatcher got bounced in 1990 because of her local council poll tax.
http://en.wikipedia.org/wiki/Poll_tax

If health coverage is a public good (and I believe it is) then it should be taxed as a percentage of income-- if not by progressive income tax, then at the very least by expanding the flat rate Medicare payroll tax. And if its not a public good, then the conservatives are correct that its wrong for the government to force insurers to set below market premiums or to force citizens to pay it.

Leave it to Hillary to propose a health plan that helps the insurance companies and screws the poor. The insane part is that the electorate thinks she's the most liberal candidate going.

Posted by beowulf | September 17, 2007 5:46 PM

Three questions:

1. How do you enforce the mandate? States have a hard time enforcing the mandated car insurance and they have particular pressure points (registration and driver's license renewals). What are the equivalents in the medical field?

2. How are the tax credits supposed to help with the cost of premiums in care when they will not be received until March or April of the following year? Or how about those that don't pay taxes?

3. With the mandated coverage, will it work like mandated private insurance (i.e., you get bare bones coverage)? If so, what good does that do for the individuals required to purchase it?

Posted by Keith | September 17, 2007 5:53 PM

"Having the government require that people buy health insurance is about as effective as having the government require people tithe at church."

"1. How do you enforce the mandate?"

1) Increase the employee portion of the payroll tax by one or two percent and call it an uninsured surcharge. Refund this money back to taxpayers when they file their taxes if they provide proof of having health insurance coverage over the previous year. If the filer is eligible for any "refundable tax credits" (e.g., government grants), such as the EITC or child tax credit, withhold a portion of these as well if they don't provide proof of insurance coverage.

2) Crackdown on illegal immigration, which is probably responsible for about a 25%-33% of our uninsured population.

Posted by Fred | September 17, 2007 6:24 PM

That "e.g." should have been an "i.e.". Desculpe.

Posted by Fred | September 17, 2007 6:27 PM

One comment for those who want to expand Medicare. The portion of the payroll tax designed to cover Medicare in its current form only covers about half the costs of Medicare. So the Medicare tax would essentially have to double just to fully cover the current cost of Medicare. The reason why Medicare seems like such a good deal may be because you're not really paying its true cost.

Posted by Fred | September 17, 2007 6:39 PM

So where does the other half of Medicare costs come from? Medicare recipients do pay premiums, obviously it doesn't cover the full amount of its cost or there wouldn't be a Medicare payroll tax.

Those Medicare premiums too are a poll tax. But since Medicare recipients are also Social Security recipients, it works out the same as if seniors didn't have Medicare premiums and Social Security checks (and taxes) were reduced by an equal amount. It all comes out in the wash.

Posted by beowulf | September 17, 2007 6:51 PM

"If the filer is eligible for any "refundable tax credits" (e.g., government grants), such as the EITC or child tax credit, withhold a portion of these as well if they don't provide proof of insurance coverage."

Boy, what a progressive plan. I bet it'll be a treat to sell this plan to the poor and the middle classes. They'll love the thought of entrenching health insurance companies by creating perpetually inelastic demand for their product.

Posted by Father Figure | September 17, 2007 7:00 PM

I do agree with Fred's point about illegal immigration. Its a huge cost driver from everything from health care to education to law enforcement. We have enough poverty without importing more.

Posted by beowulf | September 17, 2007 7:02 PM

"So where does the other half of Medicare costs come from?"

It comes from a combination of other tax revenues and borrowing.

Posted by Fred | September 17, 2007 7:40 PM

The public hates insurance companies. We have to fight them to get medical expenses paid. We have to fight them to get pre-approval for necessary treatment and we have to beg them to see a specialist. And doctors find the billing so problematic they have to hire specialists to deal just with the insurance companies.

And Hillary thinks she is going to win support by 'requiring' that we pay premiums to companies that do not want to provide us with anything for it?

Medicare on the other hand pays doctors promptly without the paperwork or hassle required by insurance companies. And it is so popular that politicians dare not touch it.

So why is Hillary requring that we waste money on insurance companies instead of spending that money directly for medical care?

Posted by ken | September 17, 2007 7:49 PM

Do Democrats really think that all the problems with health care in this country are going to be magically fixed by sinking billions of dollars of consumer money and government subsidies into insurance companies?

If Hillary was serious about "First to do no harm", she wouldn't be running.

Posted by Duane | September 17, 2007 9:09 PM

Contrary to those that object to the fact that this plan (may) not allow for actuarially sound rates, this is probably a good thing. The idea that "sick people should pay more for health insurance" really undermines the idea of "insurance." You're insuraning yourself against getting sick, if you allow insurance companies to dump people (or effectively do so by charging them their new expected corts) then you allow the insurance companies to avoid having to fulfil the intend of the contract.

Also the idea that "moral hazard" is going to be a significant problem seems unfounded. While it's true that universal health insurance might slightly decrease one's motivation to not get AIDS because you won't have to foot the bill, you will still have a significant motivation to avoid getting AIDS. There will always be some moral hazard in any insurance system, any serious economist would agree that this is a minor example of moral hazard and does not undermine the benefits of insurance.

Posted by JK | September 17, 2007 9:19 PM

(S)hillary's plan in a nutshell: take the world's most costly, inefficient system and make it mandatory. How brilliant!

Posted by kafka | September 17, 2007 9:30 PM

Another brilliant stroke by Hillary. The country in the widest sense, which means the business community as well as the rest of us, knows the present system is unsustainable and want something done about it. Just how effective her proposal is can be judged by the screams of rage from all the usual suspects on the right. This is a very marketable proposal relative to anything on offer from Republicans all of whose proposals amount to some variant on tax cuts and then you are on your own. Romney's critique is perhaps the funniest since this plan bears a lot of similarities to one he championed in MA. Now of course it's the devils work. I actually like all these over the top responses from the right because they are so transparent. Hillary hasn't just checkmated her Democratic primary opponents she's also checkmated all the Republicans in the general. I can't wait to hear Rudy explaining why his plan is better than hers.

Posted by John | September 18, 2007 6:09 PM

I currently have insurance, which I pay about $300 per month, through my employer. It is a well known name, but I cannot go to any doctor I want.(I have to stay in-network).

I tried the out of network options, but if you go to a doctor who charges $250, evil insurance company says, "oh the usual and customary rate for that service is $100." So they just pay 70% of the $100, and I'm left paying the extra $150 to the doctor, plus my monthly health insurance.

And, even though on evil insurance company's website, they have a list of 200 doctors, in a certain specialty, good luck calling and getting an appointment. When you tell them you have insurance, there are no openings. If you offer to pay cash, suddenly there are openings. The insurance companies pay doctors so little, doctors can only afford a certain number of "insurance patients".

There are also doctors so sought after that they don't bother with insurance comanies. They take no insurance. They don't want to deal with the insurance companies because they're a hassle. You pay cash, check, or credit card or don't go.

I like what Hillary is trying to do, and if you read the article about Bill in the new Atlantic, you see he's quite good at "getting the demand, going to the supplier, and negotiating the best terms" Basically, Hillary will be bringing the insurance companies tons of customers and will be able to negotiate better prices. Same thing Bill did with the getting the HIV medicines at low cost. Very innovative thinking.

Hillary can get people to have insurance, but what's the point if the doctors don't accept insurance?

Posted by CD | September 19, 2007 3:07 AM