Better Health Care Questions

The ongoing debate over how many people would wind up without health insurance under Barack Obama's proposals is interesting, but by its nature it's bound to be inconclusive.

What I'd like to see a clearer explanation of from the Jon Cohns and Ezra Kleins and Paul Krugmans and so forth of the world is a more detailed account of who's supposed to worse off under Obama's plan. After all, I could unveil the following Matt Yglesias Health Care Plan -- let's make an individual mandate to buy health insurance at least as good as what congress gets -- and then run around town slamming Barack Obama as a foe of the uninsured for leaving millions without coverage. But that'd be dumb. My hypothetical plan is only a "universal health care plan" in a vacuous sense. It wouldn't do anything to actually help people who currently lack insurance.

Clinton's plan isn't like that. It does do things to help people buy insurance. As a general matter, though, the things it does are the same -- subsidies for those of modest means, regulations preventing insurance companies from discriminating against those with pre-existing conditions, etc. -- as the things Obama's plan does to help people buy insurance. In terms of specific details, neither campaign has released much in the way of specific details. And what's more, everyone acknowledges that any specific details the campaigns might release will likely be changed during the legislative process anyway. So what's the deal? Instead of guessing how many people might or might not buy insurance in Obamaland, I'd like to know what kind of people will wind up uninsured in Obamaland and how they'd be differently situated in Hillaryworld. In particularly, would they actually be better off in Hillaryworld? My sense is that mandate advocates are trying to obscure the fact that most of the people who wouldn't have comprehensive insurance after the proposed Obama reforms are people who'd be screwed-over by a mandate.

UPDATE: I should have added that these are people who arguably should be screwed over. The goal of national health care policy should be to support the needs of the poor and the sick, and the individual mandate is a clumsy way of doing that by making the prosperous and healthy cross-subsidize their insurance premiums.

Comments

Your update gets it right. The combination of reforming health insurance and leaving out a mandate is a good way to incentivize scofflaws. If you can't be denied coverage and it can't exclude pre-existing conditions, why not wait until you're sick to start paying bothersome premiums? Then when you're well, you can stop coverage to save extra money for that vacation you wanted.

Meanwhile, everyone else is paying off treatment.

Posted by AJ | December 5, 2007 11:29 AM

With few exceptions doesn't any plan or legislative initiative eventually result in screwing the poor, enriching the wealthy and mollifying the middle just enough to keep them thinking the powers-that-be aren't really all that terrible of a crowd?

Posted by steve duncan | December 5, 2007 11:31 AM

Matt: Not sure if you have seen it yet, but Sullivan links to an interesting analysis that does talk about those getting screwed over under a mandate:

http://andrewsullivan.theatlantic.com/the_daily_dish/2007/12/obamas-healthca.html

Posted by d | December 5, 2007 11:34 AM

Good questions indeed. I don't know much about the real detailed breakdowns of the mechanics of how the plans work, but there are some basic things that I want explained that I haven't heard much about from any of the candidates. What basic things do the plans do that achieve greater accessibility for healthcare? Does it subsidize employer expenses? My (not so great) insurance costs my employer nearly $500 per month because I live in Brooklyn, where my health is supposedly statistically "at risk" moreso than people who live in the suburbs. What a crock. But seriously, how can Hillary get decent healthcare to people working at jobs which are low-paying and undesirable enough to not offer benefits? Where is that several hundred dollars per month going to come from?

Costs have to be brought down. Theoretically, if costs are brought down, my employer should be able to pay me more, but how will any kind of related regulations deal with such an issue? Will employers which don't offer benefits pay some kind of penalty? What about Edwards' policy which could direct policy in the eventual direction of a single-payer system? He still has to explain how exactly the lower-income strata of the population is going to get that several hundred bucks per month to pay for insurance.

What are any of them going to do about denials of treatment / service? Refusals to treat pre-existing conditions? Insurance companies prolong having to deal with costs by doing these things. They spend a lot doing this, but save even more. If they are forced to stop these practices, which they should be, where will the money come from to cover that? Repealing Bush's tax cut won't be enough to pay for what this will cost in today's America! I can see it all being much more cost effective once the system is up and running, if the right reforms are made. But the cost of transitioning from the way business is done today to what the proposals want to achieve will be massive.

Posted by onceler | December 5, 2007 11:34 AM

A pleasant sophistical explanation of why America shouldn't have universal healthcare from Matthew.

Next up, can we have a pleasant sophistical explanation of why America should go to war with Iran, or why Social Security should be privatized?

Posted by Petey | December 5, 2007 11:44 AM

Can we have one plan, say like medicare that we can buy. I do not want to pay corporate executives and share holders for my health care.

Posted by cheflovesbeer | December 5, 2007 11:49 AM

Nice post, Matt. I also found the link to Sullivan (posted above by d) to be compelling.

I think Erza, Krugamn and some of the rest are getting lost in thinking that this is "the moment" that universal care has to be implemented because of the trends that seem to point to a big Democratic win next year. They think we have to go for the whole pie RIGHT NOW. The link from Sullivan's place makes several good points about why Obama's plan (which is clearly more incremental) isn't going to be as easy for conservatives to attack because Obama's plan doesn't force coverage; it merely makes it cheaper for those who can't currently afford it and those who don't want coverage don't have to get it. Easier sell.

Posted by Mike P | December 5, 2007 11:50 AM

As a general matter, though, the things it does are the same -- subsidies for those of modest means, regulations preventing insurance companies from discriminating against those with pre-existing conditions, etc. -- as the things Obama's plan does to help people buy insurance.

Right. HRC's and Obama's plans pretty much boil down to the same things, with the exception of the mandate. Is it a good idea or not?

I'm strongly leaning in favor of a mandate, and here's why. It's quite possible -- I suspect overwhelmingly likely -- that any major reform that gets enacted by a Democratic administration will face serious blowback from the insurance industry and from the right wing in general not long after it's passed. They'll lick their wounds for a few months, or for a year or two, plot their strategy, and then they'll attack.

So, let's imagine, in, say, 2011 or 2012, we've got a newly energized right wing pushing back on the issue of healthcare. Under Hillary's plan, they'll be pushing back in an environment where 100% universal health insurance is now a matter of law, and, theoretically, everybody should be covered. (In practice there will no doubt be a few people who haven't been coralled into the system, but, if we're serious about enforcement, this should be minimal).

Under Obamacare, we will not have arrived at 100% universal health insurance when this inevitable counterattack begins.

I think once Americans live under a UHC system, they won't want to give it back. That's why I say we should go after it, and quickly, as soon as it is feasible, by any means necessary. Even by the admitedly less than satisfactory method of individual mandates. I think if we're successful, then, when the shit hits the fan a year or two down the road, the debate will be framed something along the lines of "Republican proposals to retreat from UHC versus Democratic proposals for greater subsidies, or Medicare for anybody who wants it, etc." I likes our chances in such a debate. Second stage reform is really what gets me excited; I'd much rather we go into second stage reform trying to perfect UHC, instead of still trying to attain it.

But if we're under Obamacare two or three years down the road when such an attack occurs, the right will be trying to get us to retreat from, um, what, exactly?

Posted by Jasper | December 5, 2007 12:04 PM

Matt

You're thinking about this wrong. The problem isn't the number or type of people uninsured, the problem with the lack of a mandate in Obama's plan is that it has the potential to make the *entire* health insurance system collapse.

Essentially, the Obama plan (like the Edwards and Clinton plans) forces insurance companies to offer insurance to all comers at a common price.

Given this, nobody has any incentive to buy insurance *until they get sick*, at which point they dive into a plan. Under who wants to just buy insurance before getting sick will end up paying for all these free-riders.

This means that lack of a mandate screws *everybody* who decides to purchase insurance, as the whole point of insurance (pooling and cross-subsidization of risk) is undone.

the problem isn't the number of people uninsured per se - they can buy insurance anytime under the Obama plan (if they're too poor to afford even the community-rated prices, there are generous subsidies in the plan, same as Edwards and Clintons plans). The problem is that lack of a mandate makes providing insurance untenable.

Posted by josh bivens | December 5, 2007 12:09 PM

I think you need to break down poor and sick/ prosperous and healthy into all 4 categories.

Prosperous and healthy--fine today, and under both plans (premiums go up, risk goes down)

Poor and sick--badly off today, better off under both plans

Prosperous and sick--well off today, better off under both plans (premiums go down with community rating)

Poor and healthy--struggling today, much worse off under both plans (premiums are much higher).

And remember--"poor" here means household income under $30,000/person (NOT per worker)--the point at which expected cost of healthcare is less than 20% of income.

Posted by SamChevre | December 5, 2007 12:09 PM

So, does Matthew really believe AEI is a nonpartisan group?

Or does Matthew just not give a shit about universal healthcare?

My money is on the latter explanation.

Posted by Petey | December 5, 2007 12:12 PM

"by making the prosperous and healthy cross-subsidize their insurance premiums.

I'm confused why we should believe the mandate would hit up "prosperous" people.

Wouldn't a big chunk of people hit by a mandate be unemployed/have crappy jobs? I've not had insurance nor the ability to pay for it without going into increased debt at times, but I was never poor enough that I would have qualified for Medicaid/or other public assistance. I pretty sure I used to be a prime target for mandates.

Also agree with what cheflovesbeer said.

Posted by Christopher Colaninno | December 5, 2007 12:13 PM

Poor and healthy--struggling today, much worse off under both plans (premiums are much higher).

SamChevre: Is this pre or post subsidy?

Posted by Jasper | December 5, 2007 12:16 PM

"The problem is that lack of a mandate makes providing insurance untenable."

You've confused Matthew with someone who actually cares about universal healthcare.

This is just about primary election games for him.

Posted by Petey | December 5, 2007 12:16 PM

"The goal of national health care policy should be to support the needs of the poor and the sick"

Why do you have such hostility to universal government programs, Matthew?

You've expressed your hostility to universal college aid programs many times in the past, and now you've repeatedly expressed your hostility to a universal healthcare program.

Given that you've also expressed your belief that non-universal programs are politically vulnerable, I'm a bit at a loss to explain your attitude, other than that you just don't give a damn about the folks who would get helped by universal programs.

There are plenty of folks in the GOP who believe that making Social Security non-universal would be the wedge to destroy the program. But I'm always a bit confused as to why folks who claim to be Democrats are opposed to universal programs.

Posted by Petey | December 5, 2007 12:22 PM

Let's be honest: universal health care doesn't mean the government compelling people to buy health care. Universal health care is given to everyone automatically.

That being said, no candidate offers "universal health care"--though I wish one would. I think all three plans make sense. I support Obama's because I cannot see any Congress passing Clinton's or Edward's. How will Democrats sell this to people who are wary of the government? I cannot see a Presidential candidate that says to the public, "You have to buy health insurance when you get a library card or we will garnish your wages," as being a very popular--or successful--one.

Posted by Jared | December 5, 2007 12:22 PM

You've confused Matthew with someone who actually cares about universal healthcare.

This is just about primary election games for him.

Wouldn't a healthcare program that has (a) all the positive attributes of "universal healthcare" and (b) the same or fewer negative attributes actually be preferable to "universal healthcare"?

Is the first word more important than the second?

Posted by southpaw | December 5, 2007 12:25 PM

Sully's link is a more compelling argument than Krugman's.

The best argument for a mandate is that a subsidy without a mandate doesn't really do anything to address the issue of rising health care costs. It only partially addresses the free rider problem and it doesn't provide the bulk purchasing power of a single payer system. The end result is we spent more on health care while leaving all the structural inefficiencies in place.

On the other hand, the people who get screwed by a mandate are going to mostly be lower middle class folks who don't quite qualify for government assistance. Obama's plan is both more progressive and politically feasible than Clinton's, while nonetheless being less effective.

The answer, my friends, is still blowing in the wind. The wind is speaking French.

Posted by LaFollette Progressive | December 5, 2007 12:27 PM

The difference be Matthew and Klein is that Matthew doesn't really support the plans from either Edwards, Clinton or Obama. In other words he believes that Dems should either not do health care reform or shoot for single payer. If that is your position Obama is probably your candidate, because he will probably just expand S-CHIP and focus on other issues. Clinton and Edwards on the other hand are dead serious about their plans and will try to enact them. Now obviously Clinton and Edwards are spinning their plans. Individual Mandates are good policy if you also help poor people afford coverage, but politically the best way to sell individual mandates is to say "cover everybody." The real reason for mandates is that young people who don't buy insurance are free riders and everybody else is left with the tab.

Posted by Craig | December 5, 2007 12:28 PM

I cannot see a Presidential candidate that says to the public, "You have to buy health insurance when you get a library card or we will garnish your wages," as being a very popular--or successful--one.

What you need to remember is most people already have insurance coverage. In fact, only about 15% of the public lacks it. So, the unpopularity of mandates will be blunted by the fact that they don't apply to a particularly large percentage of the electorate.

Moreover, mandates play to most Americans' sense of fair play: we don't, after all, allow young, healthy, uninsured people to die on the street from injuries sustained in a car accident. Quite rightly, they'll get treatment. It's only fair, therefore, that such people be required to contribute to the system.

And remember, there's nothing in the constitution that prevents a Democratic congress (ideally one with deeper majorities) from pushing the White House from the left, in order to make the plan as palatable as possible to the public when it comes to affordability and subsidies. Sure, your average 20-something is going to have something to bitch about if he/she is required to find an extra $400 bucks a month from his/her budget. But if the requirement is only an extra, say, $120 per month -- because of generous subsidies -- color me skeptical they'll get much sympathy from the average citizen.

Posted by Jasper | December 5, 2007 12:31 PM

"That being said, no candidate offers "universal health care"

If you want to define "universal healthcare" as meaning something different than "universal healthcare", then you have a point.

But here on planet Earth, you're either dishonest or mistaken.

Many of the candidates have offered universal healthcare plans - Dennis Kucinich, John Edwards, and Hillary Clinton, to name three. Barack Obama has a plan that, while better than the status quo, doesn't bring healthcare coverage to all Americans, and thus is not universal healthcare.

"Let's be honest"

Yes. Let's be honest.

It's really weird how a fairly large number of Obama supporters seem to respond to Obama not having the backbone to offer a universal healthcare plan by either lying or by pretending that universal healthcare is bad.

Posted by Petey | December 5, 2007 12:31 PM

I don't know too much about this subject but I was under the impression that we already have a program, Medicaid, designed to provide insurance to people who cannot afford it. Can someone fill me in on its shortcomings. Are the elligibility rules too stringent? Is the coverage not wide enough? Is it too difficult to access?

Posted by John | December 5, 2007 12:36 PM

"Is the first word more important than the second?"

In terms of constructing government programs in general, yes.

In terms of the specifics of healthcare legislation, yes.

-----

Look, I understand that there are plenty of folks in America who are opposed to universal healthcare. It's just that prior to this past summer, almost all of those folks were outside of the Democratic Party.

Posted by Petey | December 5, 2007 12:38 PM

It is not The Plan that matters, it is the coattails. Elect a heavily Democratic Congress, and all things are possible.

In this respect, the right questions to ask are about how the candidates might lead the Party in claiming territory in Red States. Each of the three leading candidates have an answer of sorts, to this question, but the liberal blogosphere, in its idealism, is not much interested.

Mrs. Clinton has chosen to make herself the candidate of the plutocracy, the Democrat with whom business can do business, and surrounded herself with Mark Penn et alia. There is, in her return to the 90's association with her husband, some faint memory of the DLC plan to re-claim the middle, a middle long since ceded by the Republicans. Mr. Edwards combines a concern for the poor with a southern drawl and polls, which show some evidence that he would be good for the Democrats in the South. Obama promises us a new kind of politics, a new tone, etc., based on his rhetorical powers.

The real question is not about health care policy plans, but about political strategies, and the implications of those strategies for policy.

Is Mrs. Clinton realistic about her willingness to concede the power of the plutocracy? Would there be a policy space open to reform, or would her good intentions fall victim to her Faustian bargain? Is Obama the leader and symbol of a better America, or so much hot air? Would Edwards know what to do, to marshal political power? Would the Southern drawl undermine the Republican Southern strategy?

These political questions trump the policy wonkery.

Posted by Bruce Wilder | December 5, 2007 12:40 PM

Jasper:

$120 is a lot of money to me. I'm flat broke.

Secondly, I don't think it will matter that it won't directly affect a lot of people directly. Just as it didn't in the early 90's.

Petey:

I may be mistaken but, I've always been under the impression that "universal health care" (as in Canada and Europe) meant health care provided, without charge, by the govt. directly to the public. Which candidate proposes this? Clinton and Edwards, I thought, just tell people they have to buy health care.

I completely understand criticisms of Obama's plan, but I think it's unfair to attribute it any failings to a lack of backbone. Maybe he is trying to actually achieve something? Is that so wrong?

Posted by Jared | December 5, 2007 12:41 PM

"The ongoing debate over how many people would wind up without health insurance under Barack Obama's proposals is interesting, but by its nature it's bound to be inconclusive."

It's "bound to be inconclusive" if you don't give a shit about universal healthcare and don't give a shit about telling the truth.

For those folks out there playing with a full deck, the "ongoing debate" has been concluded quite a while ago.

Posted by Petey | December 5, 2007 12:43 PM

It's really weird how a fairly large number of Obama supporters seem to respond to Obama not having the backbone to offer a universal healthcare plan by either lying or by pretending that universal healthcare is bad.

Well said, Petey. It's truly sad that those of us who otherwise would welcome the prospect of Obama's getting the nomination have to abandon the long-held progressive goal of UHC. Here's an idea: instead of forcing us to do so, why don't all you Obamites push your candidate to bolster his UHC bonafides? Lots of you mention that single payer is really the way to go if you want UHC (as opposed to evil mandates), so, how 'bout it? Get Obama to come out with a speech saying, in addition to the reforms he's thus far proposed, he's now convinced upon further analysis that it would make sense for the government to provide Medicare to anybody who prefers it over private insurance, perhaps financed by, say, means-tested premiums deducted from payroll (no more than 5% of wages) and a carbon tax. Believe me, I'd like to be able to support your guy.

Posted by Jasper | December 5, 2007 12:44 PM

re: I should have added that these are people who arguably should be screwed over.

This is taken from the post Sully admired:

Krugman also insists that Clinton’s plan makes more economic sense. He says that forcing young, healthy workers to buy insurance they don’t think they need will subsidize insurance for others, making “universal coverage” affordable.

But that analysis is hopelessly simplistic. Who are those young, healthy workers likely to be? White-collar and other highly paid workers won’t refuse to buy insurance; its cost amounts to a small portion of their pay. Nor will older workers and workers with families, who need insurance more and know it. So the people most likely to “self-insure” are young, single blue-collar workers (including the poor and near-poor), for whom the cost of insurance is a substantial part of their earnings.

Forcing these people to buy insurance they don’t want will have two adverse effects. Politically, it will drive young, single, healthy workers away from the Democratic party. It will put the so-called “Reagan Democrats” back in the arms of the Republicans, precisely when Democrats need them to consolidate their status as a majority party. For someone supposedly astute at politics, that’s a downright stupid thing to do.

Economically, Clinton’s mandate will turn the health-care system into a regressive tax. Imposing extra costs on young, single, healthy, low-paid workers in order to finance others’ health care will put part of the burden on those who can least afford it.

Probably right - this is a longer version of the "Poor and healthy--struggling today, much worse off under both plans (premiums are much higher).

And remember--"poor" here means household income under $30,000/person (NOT per worker)--the point at which expected cost of healthcare is less than 20% of income." insight provided above."

But screw the working near-poor! They probably deserve it!

Posted by Tom Maguire | December 5, 2007 12:49 PM

"I may be mistaken but, I've always been under the impression that "universal health care" (as in Canada and Europe) meant health care provided, without charge, by the govt. directly to the public."

You are indeed mistaken. You are describing "single payer" here.

"Universal healthcare" refers to a system where all citizens are included. "Single payer" is a subset of "universal healthcare", but a system can be "universal healthcare" without also being "single payer".

The Kucinich, Edwards, and Clinton plans are all "universal healthcare" since they bring everyone into the system. The Obama plan is not.

Posted by Petey | December 5, 2007 12:49 PM

"Economically, Clinton’s mandate will turn the health-care system into a regressive tax. Imposing extra costs on young, single, healthy, low-paid workers in order to finance others’ health care will put part of the burden on those who can least afford it."

Tell lies much, Tom Maguire?

I can't speak for the Clinton plan, other than it's largely copied from the Edwards plan, which I do know a bit about.

The Edwards plan has $120 billion / yr of subsidies to make sure the burden does not fall on those who can least afford it.

Subsidies in the Edwards plan are provided on a sliding scale up to $100,000 / yr of income, with the poor and near poor getting their insurance for free.

But you just keep telling your little lies about how universal healthcare will hurt the poor and the near poor, Tom Maguire.

Posted by Petey | December 5, 2007 12:56 PM

"On the other hand, the people who get screwed by a mandate are going to mostly be lower middle class folks who don't quite qualify for government assistance."

Folks earning more than $100,000 a year are "lower middle class", LaFollette Progressive?

Posted by Petey | December 5, 2007 12:59 PM

Petey, how do you respond to the argument that "universal mandate" doesn't mean "universal healthcare", since many people will choose to ignore the mandate (just as they do the mandate to buy auto insurance)? This is what the (pro-Obama) NY Times article pointed out.

Posted by Al | December 5, 2007 1:01 PM

"Petey, how do you respond to the argument that "universal mandate" doesn't mean "universal healthcare", since many people will choose to ignore the mandate"

By pointing out that John Edwards has outlined details of how automatic enrollment would function under his plan. At the end of the day, almost everyone won't be able to "choose" to avoid being enrolled.

If you live in the Montana wilderness like the unabomber with no contact with society, you'll be able to avoid automatic enrollment. But under the Edwards plan, healthcare coverage would approach 100% quite rapidly.

Posted by Petey | December 5, 2007 1:07 PM

"The best argument for a mandate is that a subsidy without a mandate doesn't really do anything to address the issue of rising health care costs."

LaFollette Progressive I agree with you about your conclusion, but how would a mandate address this issue of rising health care costs?

1) Even if it effectively cross subsidize health care costs wouldn't that be neutral to overall costs? People with insurance would get cheaper insurance because other people paid into the system. Where is the overall cost control?

2) It seems to me for mandates to reduce health care costs for current customers that you would need an efficient market in the healthcare industry, ie would need to know that if a health insurance company just pocketed the extra revenue then people would leave to find other insurance often enough that they would lose money. Around DC there are only few non/gov providers and I don't think it's very easy for most companies to just up and leave.

Posted by Christopher Colaninno | December 5, 2007 1:10 PM

>the individual mandate is a clumsy way of
>doing that by making the prosperous and
>healthy cross-subsidize their insurance premiums.

Well, it does more than that. It prevents free-riding by the healthy. Otherwise, I could avoid insuring myself until I get badly sick and only join in after I become a bad risk. This makes the system financially untenable, because the whole point of insurance is to spread risk.

The only way to prevent this (beyond the mandate or the Medicare-for-all approaches) is by disallowing coverage for preexisting conditions, but that's brutal.

Alternatively, you could moderate the mandate; if you were to circumscribe the mandate only to catastrophic coverage, you'd probably prevent the most expensive sort of free-riding.

Posted by Ivan | December 5, 2007 1:37 PM

By pointing out that John Edwards has outlined details of how automatic enrollment would function under his plan.

Oh, right, the wage garnishing thing. That seems to me to be a lot closer to "universal" than the non-specific Clinton plan, which doesn't seem to me to be universal at all.

Posted by Al | December 5, 2007 1:38 PM

"Subsidies in the Edwards plan are provided on a sliding scale up to $100,000/yr of income"

Subsidies to people with incomes of $90,000. What a great idea!

Posted by ostap | December 5, 2007 1:49 PM

"That seems to me to be a lot closer to "universal" than the non-specific Clinton plan, which doesn't seem to me to be universal at all."

Clinton hasn't been willing to specify how her plan works in terms of the mandate, so who knows how it'd end up functioning in the real world?

"Oh, right, the wage garnishing thing."

No. Automatic enrollment is a separate issue than payment.

Automatic enrollment just means that when you have contact with the government or the healthcare system, you get automatically enrolled for healthcare coverage if you don't already have it.

Posted by Petey | December 5, 2007 1:52 PM

"Subsidies to people with incomes of $90,000. What a great idea!"

Yup. It is a great idea. The same way that paying Social Security even to people making $90,000 is a great idea.

Programs for the poor are poor programs. Universal programs are strong programs.

This is why most liberals really like Social Security and universal healthcare, and why most Cato types really don't.

Posted by Petey | December 5, 2007 1:56 PM

Sick Al is lying, because Sick Al is incapable of not lying.

Posted by Jennifer | December 5, 2007 1:58 PM

Automatic enrollment is a separate issue than payment.

Only on the most superficial level. After all, the issue isn't getting people to accept healthcare when given to them; it is getting people to pay for it.

Posted by Al | December 5, 2007 2:00 PM

Subsidies to people with incomes of $90,000. What a great idea!

I know a guy now earning in the low 100s, who, a couple of years ago, had a monthly COBRA payment in the $2,000/month range while he was waiting for coverage to kick in when he switched jobs (he was supporting a spouse and two children). For somebody earning a mere 90k -- let's generously call it 65k net -- a $2,000 monthly premium eats something like 40% of take home. That doesn't leave much for extras like housing and food.

Sadly, the insanities of the US healthcare system mean that yes, even people making pretty good money have trouble affording health insurance.

Posted by Jasper | December 5, 2007 2:02 PM

"Only on the most superficial level. After all, the issue isn't getting people to accept healthcare when given to them"

You might want to pay attention to this entire thread. The whole problem with the Obama plan is precisely that it won't enroll people in healthcare coverage automatically.

You can't have universal healthcare if you're not willing to enroll everyone automatically. That's the exact issue at hand here.

Posted by Petey | December 5, 2007 2:12 PM

What I'd like to see is more discussion of the differences, on health care, between the leading Democrats as a group, and the leading Republicans as a group.

Ditto for pretty much every major issue of the day: global warming, Iraq, terrorism, immigration, you name it. With only occasional exceptions, you'll find the Democrats' proposals all clustered together over here, and the GOP's proposals all clustered together way the hell over there.

The press could do no greater service in educating the American public politically than by making them aware that this gap is all but universal: that none of the GOP candidates occupies some place near the center, but rather that they're all way the heck out there.

Posted by low-tech cyclist | December 5, 2007 2:20 PM

I don't think so, Petey. Imagine a system which enforced payment for health care but didn't enroll people automatically - for example, one that did what Edwards plans to do to make people pay (up to and including wage garnishing). I don't think you'd have a lot of people who wouldn't be enrolled - once people were paying the money, filling out some papers to become enrolled isn't that big a deal.

The issue is payment.

Posted by Al | December 5, 2007 2:22 PM

"The issue is payment."

The issue between the Republicans and Democrats may indeed be payment, since the Republicans don't want to budget out the money for subsidies. But that's most definitely not the issue at hand inside the Democratic primaries.

The issue at hand here is precisely that the Obama plan won't force folks into the system if they choose to avoid healthcare coverage. The issue at hand here really is enrollment.

If you're a healthy person making $70,000 per year, it would be perfectly rational to avoid healthcare coverage under the Obama plan, since the government subsidies won't make it free for you at that level of income, and since you'll be able to enroll at some point in the future if you end up getting sick.

This has incredibly negative policy implications for the Obama plan, in that it will starve the system of resources.

It also has incredibly negative political implications for the Obama plan, since it will make the healthcare system into a plan for the poor and sick, rather than a universal plan that will have the political support of a universal system like Social Security.

There's a reason Cato types keep trying to convert Social Security into a voluntary system like Obama's healthcare plan, y'know...

Posted by Petey | December 5, 2007 2:33 PM

I agree with you about your conclusion, but how would a mandate address this issue of rising health care costs?

A mandate (or a universal public insurer) eliminates the free rider problem. Much of the waste in our current system relates to uninsured people landing themselves with medical bills they can't pay. Hospitals eat some of these costs and thereby shift the costs onto the people who DO have insurance.

"Folks earning more than $100,000 a year are "lower middle class", LaFollette Progressive?"

I don't recall saying anything about JE's plan, Petey. My understanding is that Clinton is not planning to cut off the benefits at a level anywhere near that high. I also doubt that anyone, even Edwards, could push a mandate plan through the Senate without setting the bar lower.

Of course, it is entirely possible nowadays for households that make more than $100K to be financially struggling, if they live in a major urban area with a mortgage and large amounts of debt, or if they are self-employed with a highly variable income. And these are indeed the people who will be hit by JE's plan. But no, I would not describe them as "lower middle class."

Posted by LaFollette Progressive | December 5, 2007 2:47 PM

It also has incredibly negative political implications for the Obama plan, since it will make the healthcare system into a plan for the poor and sick, rather than a universal plan that will have the political support of a universal system like Social Security.

I think this is an extremely accurate assessment of the Obama plan vis a vis a genuine universal health care program modeled on social security, which is what I support. I don't think it's germane to a comparison of Obama's plan to a mandated private insurance scheme with limited subsidies. I'm not sure why anyone thinks an unfunded mandate to purchase the same crappy private insurance people didn't want to buy in the first place would be enduringly popular. All of these plans will be popular with everyone who receives a check from the government and unpopular with everyone else.

Let me say again that I don't like any of the health care plans on offer by the Democratic candidates, but I think all of them are preferable to the status quo. This attempt to draw a bright line between Clinton's or Edwards' plan and Obama's is a waste of time. These are all half-measures that are better than nothing. They all have advantages and drawbacks from a progressive standpoint.

Posted by LaFollette Progressive | December 5, 2007 3:06 PM

"I also doubt that anyone, even Edwards, could push a mandate plan through the Senate without setting the bar lower."

Higher subsidies make the plan more politically appealing, not less.

It'd be harder to pass a universal plan that cut off subsidies at $50k than it would be to pass a plan that cut off subsidies at $100k, since the more generous plan would be more palatable to folks near the median income level, and thus to the average voter.

A plan that socked it to households who make $50k would be the one that would be impossible to get through the Senate with people paying attention. Not to mention that it would go against everything that Edwards stands for.

And Edwards has already shown where he gets the $120 billion per year to pay for the subsidies. Clinton, as usual, won't specify.

"Of course, it is entirely possible nowadays for households that make more than $100K to be financially struggling, if they live in a major urban area with a mortgage and large amounts of debt, or if they are self-employed with a highly variable income. And these are indeed the people who will be hit by JE's plan."

The demographics of the uninsured today are overwhelmingly that of the poor and the near poor. Most folks earning $100k + already have coverage, and thus won't be affected by automatic enrollment.

And if we're worrying about the impact of forcing small numbers of currently uninsured financially strapped $100k + earners into the healthcare system, we should also be also be worried about what happens to currently uninsured financially strapped $100k + earners who get sick. Under the current system, they then have pre-existing conditions and can't get insurance. Under the Obama plan, they'll be able to buy in once they get sick, making everyone else pay for their free ride while healthy.

Mandates suck until you consider the alternatives. (A point I think you already appreciate.)

Posted by Petey | December 5, 2007 3:08 PM

"I'm not sure why anyone thinks an unfunded mandate to purchase the same crappy private insurance people didn't want to buy in the first place would be enduringly popular."

The Edwards plan has a public component. Folks will be able to buy into a public plan rather than a private plan if they choose.

Politically, you can't move immediately into a single-payer plan since that would involve telling the 85% of Americans who already have coverage that Their Life Will Change By Government Fiat, which is hard to do.

You enact a universal system that works, ala the Edwards plan, provide a public healthcare choice that most uninsured folks and some already privately insured folks will immediately choose, ala the Edwards plan, and allow more folks to gradually move into the public healthcare choice, ala the Edwards plan. Soon, you've got something very similar to single-payer, with a luxury private insurance option for those real disposable income. This is essentially what France has.

"This attempt to draw a bright line between Clinton's or Edwards' plan and Obama's is a waste of time."

I'm not sure you've considered this fully enough.

The problems with the Obama plan are manyfold, but the perverse incentives it will create for folks to voluntarily avoid coverage is near the top of the list.

And in addition, once you bargain away universality, the politics of the program start to fall apart. It's no longer a program for everyone - it becomes a program for the poor. And we ought to understand exactly what that means politically, both in the short-term and the long-term.

Universality really matters, both for the policy and the politics.

Posted by Petey | December 5, 2007 3:25 PM

"I'm not sure why anyone thinks an unfunded mandate..."

And you're off your rocker if you think the Edwards mandate is unfunded.

Posted by Petey | December 5, 2007 3:27 PM

"Higher subsidies make the plan more politically appealing, not less."

Yes and no. Higher subsidies are easier to block in the legislative process because they require higher spending, which entails higher taxes. As you say, once higher subsidies are established, they become harder to get rid of. But the logistics of creating big government programs and protecting them from cuts are entirely different.

I credit Edwards for actually budgeting his plan with real numbers. It speaks to his relative strengths as a candidate. But such campaign plans rarely survive contact with Congress.

And you're off your rocker if you think the Edwards mandate is unfunded.

It's unfunded from the perspective of someone who is mandated to buy insurance but doesn't qualify for the funds.

Posted by LaFollette Progressive | December 5, 2007 3:40 PM

"Higher subsidies are easier to block in the legislative process because they require higher spending, which entails higher taxes."

The higher taxes come entirely from repealing the Bush tax cuts on folks making $200k + per year, which were never particularly popular.

Edwards is the only candidate smart enough to tie that money directly to healthcare reform.

And I will repeat that passing healthcare legislation that socked $50k income families with an unsubsidized mandate is the one that would be politically unpalatable. Easing the burden on the median voter is a political plus in getting the legislation passed, not a political minus.

"But such campaign plans rarely survive contact with Congress."

Except when they do. A fair amount of what Bush ran on in 2000, from his tax cuts for the wealthy to his sleazy corporatized Medicate prescription drug benefit passed Congress in much the same form that he proposed them during the campaign.

Running and winning on a plan for action can be quite useful once it comes time for legislative consideration.

Posted by Petey | December 5, 2007 3:52 PM

Petey,

The higher taxes come entirely from repealing the Bush tax cuts on folks making $200k + per year, which were never particularly popular.

Even assuming Edwards could successfully repeal those tax cuts, he has no idea how much revenue such a policy would produce, or how much he would have to spend on subsidizing health insurance in order to achieve universal coverage, which is one reason why his health care plan numbers are so laughable.

The last time a Democratic president raised taxes on the rich (Clinton in 1993) it led to a huge political loss for his party at the next midterm election.

Any mandate that ordinary Americans worry will compel them to spend a substantial amount of money on health insurance they do not think they can afford, or do not want to buy even if they can afford it, is likely to be a huge political liability.

Posted by Mixner | December 5, 2007 4:33 PM

Petey,

Universality really matters, both for the policy and the politics.

No it doesn't. There is little evidence that universality would do much either to improve health or reduce the economic risk from illness.

Posted by Mixner | December 5, 2007 4:38 PM

"Any mandate that ordinary Americans worry will compel them to spend a substantial amount of money on health insurance they do not think they can afford, or do not want to buy even if they can afford it, is likely to be a huge political liability."

Your crowd said the same thing about Social Security in 1935, Mixner. Your crowd said making folks have to pay for pensions if they didn't want to would be a huge political liability.

Your crowd was wrong about the political popularity of Social Security in 1935, and your crowd is wrong about the political popularity of universal healthcare in 2007.

Posted by Petey | December 5, 2007 4:38 PM

Petey,

Your crowd said the same thing about Social Security in 1935, Mixner.

Social security was passed in the wake of the Great Depression and visible abject poverty among the elderly. No remotely comparable economic and social conditions apply today. Social Security is also funded by a payroll tax, not a mandate on individuals to purchase something with their own money.

But if you really, really think a mandate is a political winner, go for it. I can't wait for the Republicans (or Obama) to set Harry and Louise on it.

Posted by Mixner | December 5, 2007 4:50 PM

Even assuming Edwards could successfully repeal those tax cuts, he has no idea how much revenue such a policy would produce...

He has no idea? That strikes me as a bit of an overstatement, to say the least. As far as I know, the methodology in use by, say, the CBO, while not perfect, is reasonably sound.

Posted by Jasper | December 5, 2007 4:51 PM

"I can't wait for the Republicans (or Obama) to set Harry and Louise on it."

Our side has learned from 1993-94, Mixner.

Your crowd won in '93-94 because you went up on TV while we had no infrastructure to get up on TV outside of the formal campaign period. Things have changed.

We also have a much better plan politically than we did back then.

Your crowd isn't going to like the next 8 years, Mixner. You might want to review histories of the FDR period to get a feel for what it's going to be like to be so marginalized.

Posted by Petey | December 5, 2007 4:58 PM

Jasper,
As far as I know, the methodology in use by, say, the CBO, while not perfect, is reasonably sound.

It is? Show me the history of CBO predicted revenues from tax cuts, followed by actual revenues.

Petey,
Our side has learned from 1993-94, Mixner. Your crowd won in '93-94 because you went up on TV while we had no infrastructure to get up on TV outside of the formal campaign period. Things have changed. We also have a much better plan politically than we did back then.

That's right, Petey. It was all just a failure of marketing. I guess you have to tell yourself that.

Posted by Mixner | December 5, 2007 5:24 PM

I think that Krugman has been very clear and that the two of you agree completely.

In his Nov 30 op-ed column he clearly said that the people who would not buy insurance under Obama's plan are freeloaders who would improperly benefit. In particular, he explains how Obama's plan would make it much more attractive to live uninsured making the freeloading problem much more important than it is now.

"As a practical matter, letting people opt out if they don’t feel like buying insurance would make insurance substantially more expensive for everyone else.

Here’s why: under the Obama plan, as it now stands, healthy people could choose not to buy insurance — then sign up for it if they developed health problems later. Insurance companies couldn’t turn them away, because Mr. Obama’s plan, like those of his rivals, requires that insurers offer the same policy to everyone.

As a result, people who did the right thing and bought insurance when they were healthy would end up subsidizing those who didn’t sign up for insurance until or unless they needed medical care.

In other words, when Mr. Obama declares that “the reason people don’t have health insurance isn’t because they don’t want it, it’s because they can’t afford it,” he’s saying something that is mostly true now — but wouldn’t be true under his plan."

Posted by Robert Waldmann | December 5, 2007 5:37 PM

It is? Show me the history of CBO predicted revenues from tax cuts, followed by actual revenues.

Mixner: I deem it unlikely that a credible, major party candidate for national office would just make up numbers without resorting to the opinions of experts. But tell you what, since you made the original claim that Edwards has "no idea how much revenue such a policy would produce," why don't you produce a link to back that up? My preference, if you're taking research orders, would be a citation from a non-partisan source demonstrating the implausibility of Edwards's revenue projections with respect to the aforementioend tax cut repeal. Deal? Then I'll look into the CBO issue for ya.

Posted by Jasper | December 5, 2007 7:25 PM

I think the whole mandate issue is a red herring. Obama has said he would be willing to consider a mandate after costs are down and the country has made an effort to enroll people through outreach or auto-enrollment, if a substantial portion of people who are able to pay decline to do so. The difference among the top three Democrats is one of process and priorities. Obama believes bringing down cost must in fairness come before any mandate; he hasn't rejected a mandate completely.

The much harder question is how you get cost down without rationing care. None of the candidates is talking about it, and that's why I think the whole mandate question is a red herring.

Few random thoughts:

It has occurred to me -- although of course it's not something Obama has ever said -- that in leaving mandates on the table he has left himself a major negotiating chip for bargaining with insurance companies. He's essentially said he won't support a mandate unless people don't sign up AND cost comes down. Clinton and Edwards have already ceded that negotiating chip to the health insurance industry. Just my thought.

The candidates want companies to insure pre-existing conditions, and I don't understand how this would ever work. What's the incentive to set up a great facility for the treatment of, say, breast cancer, if every breast cancer patient in town would then switch to your plan?

I also don't understand how Edwards would subsidize up to $100,000 income. That's like 95% of the country, isn't it? It sounds really unrealistic to me.

There's a NY Times article today bolstering the Obama side of the mandate arguement at
http://www.nytimes.com/2007/12/05/us/politics/05truth.html
and a Krugman blog entry disagreeing with the article at
http://krugman.blogs.nytimes.com/2007/12/05/nonpartisan-aei/

Posted by Rachel | December 5, 2007 7:45 PM

I think the whole mandate issue is a red herring. Obama has said he would be willing to consider a mandate after costs are down and the country has made an effort to enroll people through outreach or auto-enrollment, if a substantial portion of people who are able to pay decline to do so. The difference among the top three Democrats is one of process and priorities. Obama believes bringing down cost must in fairness come before any mandate; he hasn't rejected a mandate completely.

The much harder question is how you get cost down without rationing care. None of the candidates is talking about it, and that's why I think the whole mandate question is a red herring.

Few random thoughts:

It has occurred to me -- although of course it's not something Obama has ever said -- that in leaving mandates on the table he has left himself a major negotiating chip for bargaining with insurance companies. He's essentially said he won't support a mandate unless people don't sign up AND cost comes down. Clinton and Edwards have already ceded that negotiating chip to the health insurance industry. Just my thought.

The candidates want companies to insure pre-existing conditions, and I don't understand how this would ever work. What's the incentive to set up a great facility for the treatment of, say, breast cancer, if every breast cancer patient in town would then switch to your plan?

I also don't understand how Edwards would subsidize up to $100,000 income. That's like 95% of the country, isn't it? It sounds really unrealistic to me.

There's a NY Times article today bolstering the Obama side of the mandate arguement at
http://www.nytimes.com/2007/12/05/us/politics/05truth.html
and a Krugman blog entry disagreeing with the article at
http://krugman.blogs.nytimes.com/2007/12/05/nonpartisan-aei/

Posted by Rachel | December 5, 2007 7:46 PM

Go watch "Sicko" again, everyone. The Big Three candidates are acting like the problem will be solved if we get everyone a private health insurance policy. But health insurance companies do their best to deny care to their customers, or the employees of their customers, because they are in business for profit. As a result, an increasing number of doctors are refusing to accept patients from the more aggressive insurance companies. My family has lost two primary-care physicians that way, because doctors are fed up with being screwed.

Mandates can help with the "death spiral", in which only sick people try to buy health insurance because it's so expensive, which makes it even more expensive. But we need to transition away from private health insurance companies altogether.

Posted by Joe Buck | December 5, 2007 8:20 PM

The #1 cause of injury, disability, and DEATH in America is, Health Care. More people die now from contact with the American Medical Health Care system than from any other cause of death. More than from Cancer, Heart disease, or Stroke. More than any other country in the world. Many times more than any other people in the world. This fact is a catastrophic indictment of the entire US Health Care System.

Driven by greed. And a rush to profit. Thousands of Americans are killed, and injured daily in America. By compromised health care. Cutting corners. Over, and under treatments. And poisonings with all manor of toxic, poisonous pharmaceuticals. Especially the children. America only makes up 2-4% of the world population. But Americans buy, and consume 50% of all pharmaceuticals world wide.

But the tide has turned. I can see it. Hear it. And feel it. The message is getting out. And taking hold about the fact that we have a very serious, and major health care crisis going on in America. Hurting everyone. Especially our precious little children. Rich, and poor alike. And most all Americans seem to understand now that "HR 676 Not For Profit Single Payer Universal National Health Care For All (Medicare For All)" is the way to go. Like all the other developed countries have done. I have seen numbers as high as 90% of Americans want government managed health care Now. Medicare for all. Like other developed countries have. And like older Americans have now.

BRAVO!!! America. YOU GET IT! YOU REALLY GET IT! See sickocure.org.

It's NOW TIME to bring out the BIG GUNS!! The BIG GUNS!! are you. The American people. And anyone else that wants to help. From now until HR 676 is passed into law. I want every person to reach out and touch their fellow Americans every day if you can. I want you to take a phone book. And call at least one of your fellow Americans every day. And ask them to pickup the sword of HR 676 Single Payer Not For Profit Universal Health Care For All (Medicare For All).

Call more than one each day if you can. And ask them to do the same as you are doing if they can. And also to put maximum pressure on their politicians to get HR 676 done. And to make sure their politicians support HR 676. Accept no substitute. HR 676 is a no-brainer. It's the best way to go on health care. It's the only moral, and ethical way to go. That is why every other developed country has done it. Most did it years ago.

I know that many of you have been doing a fabulous job of spreading the word by talking it up with family, friends, and co-workers. And putting pressure on the politicians to get HR 676 done ASAP. The phone calls to your fellow Americans will increase the pressure. And grow the movement at an astonishing, and exponential rate. And I know many of you have been wanting to do something more to help. The phone calls to your fellow Americans is something you can do every day to help.

Trust me. It will be something to see. But you have to keep the focus, and pressure on getting HR 676 passed pronto. They will try to distract you. With all manor of other crises, and catastrophes. And other plans. Don't be distracted. HR 676 Single Payer Not For Profit Universal Health Care is the #1 concern of the American people. Thousands of Americans are dieing daily now. And you or your loved ones could be next.

There is no good reason HR 676 cannot be passed into law well before the coming elections. Do not tolerate delays. If it is not passed before the coming elections. All America will know which politicians are on the side of the American people. And which are not when they vote. Well before the elections.

Everyone can do this. Most of you are well informed about HR 676. This truly is one of those no-brainers. Be considerate of your fellow Americans when you call. But be comfortable about calling. These are your fellow Americans. Some will be receptive. And some will not be. Some maybe rude, and mean. Just thank them, and move on to the next. Most will be with you. And if you get a call from one of your fellow Americans about HR 676. Let them know you are already on board. And thank them for calling. Build them up. And keep them strong. They are fighting for all of us.

I will try to make a second post with just a few of the reasons everyone with 2 working brain cells agrees HR 676 is the best way to go. But you can also look them up for your-self. And read some of the positive informed post on many of the message boards too.

Lastly, I am sick and tired of hearing how the candidates, and politicians health care plans are going to protect, and preserve the private for profit health insurance companies that have been killing, and ripping off the American people. And now the politicians want to mandate (require) that every American has to support the private for profit insurance company's that have been killing, and ripping you off. Or you will be fined, and PENALIZED. Thats right. PENALIZED. Ridiculous! The politicians really think you are all detached idiots. CASH COWS! To lead to the slaughter. Don't put up with that.

So get on it America. Get those phones going. Chat it up! Save some lives. You want all of America talking about HR 676 becoming law, Now! Before more die needlessly. Make it happen. And to my fellow cyber warriors. You have been doing great! I see it! Keep it up. 1 of 2 post...

Below are a few reasons why "HR 676 Single Payer Not For Profit Universal Health Care For All (Medicare For All) is a no-brainer. And some reasons why private for profit health insurance is a stupid idea, and injuring, and killing you and your loved ones.

Medicare cost 2-3% to administer. Private insurance cost 30% to administer.

Under HR 676 everyone would be covered from birth to death. No co-pays. No-deductible. No out of pocket cost. Plus Dental. And Vision. For less cost than we pay now under private health insurance.

With private insurance. You have 47 million Americans with no insurance.

And 89 million Americans that had no insurance part of the time from 2006-2007.

And over a 100 million that are under insured.

18-30 thousand Americans that die each year from lack of health care.

Health Care bills as the #1 cause of personal bankruptcy. And loss of homes.

Under HR 676 health care is moral, and ethical.

Private for profit insurance is immoral. And unethical.

Profit is the primary motive of the private insurance companies.

They make profit by charging needy, vulnerable, sick Americans as much as they can charge them.

Then they make more profit by denying them care when they most need it. And are most vulnerable and unable to fight back. When they are sick. Or trying to recover from major illness.

Yep! I know you are getting angry. I'm sorry. But I have to continue.

Under HR 676: we will save 300 billion dollars in administrative cost each year.

With private insurance: we spent more per capita on health care than any other country in the world. Over twice as much as most other developed country's. Yet we have 47 million with no health care.

We rank at the bottom in quality of health care #37.

Americans have a shorter life expectancy than people from all other developed countries. We rank # 42 in life expectancy. Down from #1.

For the first time in American history. The life expectancy of American children is less than that of their parents. American children are dieing at a record rate. And are in terrible health generally.

People from other country's enjoy a much higher level of general health than the best privately insured Americans.

Americans are also shrinking. We used to be the tallest people in the world. Now we are down to # 10.

People from other country's never have to worry about going bankrupt, or loosing their homes over medical bills if they get sick.

Maybe you should go take a break for a while before I go on. I know this must be upsetting. But this is just a small part of the sad truth about private health insurance that HR 676 can fix.

Under HR 676: Health care will be based on need. Not on profit. And high standards, and quality will be enforced, and patients protected by the Government through a dedicated civil service. With the power, and resources to rain in abuses of patient care. Like they do with Medicare now.

With private insurance: Medical care is base on ability to pay. And profit. Tens of thousands of patient are killed, and millions are injure, crippled, and mutilated each year under private for profit health care, and insurance.

By insurance companies denying needed care to increase their profits.

By hospitals cutting corners. And using the cheapest least experienced personnel, equipment, and standards they can get away with.

By doctors that over treat, and under treat. Who injure, mutilate, and kill patients with unnecessary test, procedures, surgery, and invasive diagnostic test for profit. Who poison, kill, and injure millions of Americans with all manor of unnecessary pharmaceuticals for profit. Men, Women, Children, and babies.

Americans makeup 2-4 % of the world population. But Americans buy, and consume 50% of all pharmaceuticals world wide. This is a monstrous evil. And immorality.

And lastly, by politicians that take blood money from all these despicable groups and turn blind eye's to this slaughter of the American people. And the slaughter of their own loved ones. And them-self.

Well I could go on. And on. But I think this is enough to get you started making your daily phone calls to your fellow Americans to support HR 676. And to help them understand how important it is that each of them join the fight. And bring the MAXIMUM pressure to bear on all individuals, parties, and especially your politicians, and Representatives. To get HR 676 passed into law immediately.

This is an emergency. America is in a crisis. More Americans have died from this health care crisis than have died in all the wars in US history. Do your best. Millions of Americans lives are counting on each of you. Including your own life. Remember, you are Americans. You know how to fight for your country when you have too. The whole world is in your blood. I'm with you.

All the best... 2 of 2

Posted by jacksmith | December 6, 2007 1:12 AM

Jasper,

Mixner: I deem it unlikely that a credible, major party candidate for national office would just make up numbers without resorting to the opinions of experts.

I'm not terribly interested in what you think is unlikely. You claimed Edwards' numbers are based on "sound methodology." Show me your evidence for that.

But tell you what, since you made the original claim that Edwards has "no idea how much revenue such a policy would produce," why don't you produce a link to back that up?

I don't have to produce anything to justify my skepticism of Edwards' numbers. You need to produce evidence that his numbers are plausible, rather than just estimates or guesses that are unlikely to be even close to the true costs of his plan.

Posted by Mixner | December 6, 2007 2:53 AM

Why is it that universal coverage in the "medicare for all/single payer/French" model would be so unpalatable to the 85% of Americans who have insurace because they're afraid of losing what they currently have? After all, while some such systems -- like Canada's -- actually prohibit purchases of private insurance, they needn't do so. In fact, the more people continue to use private insurance, the better, since they'll place fewer financial demands on the public system, while still paying taxes. Of course, it is to be expected that more and more people will drop out of their private plans as time goes on, as they realize that they're basically wasting their money, but as more and more people start relying on the public system, wouldn't political support for it grow along with the costs?

In short, if 85% of people like their insurance, and want to keep it, they can do so, and the universal health coverage will, in practice, only be paying the actual medical bills of 15% of people, so the costs of the tax-funded system, while applying to everyone, including the 85% who already have insurance, would be comparatively small. If people stop buying private insurance, then the tax costs born by the whole population would grow as the public system funded more and more medical care, but support would also grow in proportion to the population relying on the public funding system.

In short, what do currently-insured people have to worry about?

Posted by Julian Elson | December 6, 2007 6:34 AM

Great comment, Julian Elson.

Posted by Jennifer | December 6, 2007 8:39 AM

Julian Elson,

Why is it that universal coverage in the "medicare for all/single payer/French" model would be so unpalatable to the 85% of Americans who have insurace because they're afraid of losing what they currently have?

Because under such a system they may lose coverage or have to pay more for the same coverage.

In short, if 85% of people like their insurance, and want to keep it, they can do so,

Not under a "medicare for all/single payer/French model" they can't. That's one reason why none of the leading Democrats has proposed such a model.

and the universal health coverage will, in practice, only be paying the actual medical bills of 15% of people, so the costs of the tax-funded system, while applying to everyone, including the 85% who already have insurance, would be comparatively small.

So they'd be paying more for the same thing. They'd be paying whatever their current insurance costs them, plus whatever taxes are needed to provide health care for the 15% who are uninsured. Sorry, no thanks.

Posted by Mixner | December 6, 2007 12:01 PM

"I also don't understand how Edwards would subsidize up to $100,000 income. That's like 95% of the country, isn't it? It sounds really unrealistic to me."

By spending $120 billion per year on the subsidies. He gets the money by repealing Bush's tax cuts for those making over $200k per year.

The numbers work out. They are real numbers.

Also, the subsidies are on a sliding scale up to $100,000 per year. In other words, if you make $25,000 per year, the subsidies will make your healthcare free, but if you make $70,000 per year, while the subsidies will make your healthcare cheaper, it won't be free.

Posted by Petey | December 6, 2007 7:07 PM