Swampland, TIME

January 22, 2007 2:33

Hillary Care, Bush Care, Wyden Care

Posted by Joe Klein | Comments (479) | Permalink | Trackbacks (0) | Email This

I'm going to have a lot more to say in a few weeks about the importance of proposing a universal health insurance plan if you're running for President. But if you are going to make a health care proposal, certain minimal parameters seem obvious, especially The Two Mandatorys:
--an individual mandate, which requires everyone to buy into the system, even those young people who can afford health insurance and choose not to buy any because they think they're going to live forever and never have a motorcycle accident that requires emergency room care (which the rest of us pay for). Obviously, such a system would also have to provide refundable tax credits--that is, money--to the working poor, so they can afford to buy in, too (sort of like the earned income tax credit).
--an insurance company mandate, which requires insurers to cover everyone who applies at the same rate, regardless of pre-existing conditions (this is called "community rating" in the trade).

Several readers have commented that Hillary Clinton is just getting started on health care, and shouldn't be judged only on today's universal coverage for children proposal, mentioned two posts below. I suspect they're right, but we'll see..
George Bush's State of the Union health care "plan" apparently includes neither of the two mandatorys, but it does include a significant step forward--trumpet clarion here--higher taxes for those who receive more than $15,000 per family (and $7500 per individual) in health benefits per year from their employers. I am tempted to write GEORGE BUSH SUPPORTS HIGHER TAXES 500 times and add nyah, nyah, nyah, but hey, I'm a serious policy pundit so let me pose the following conflicting points:
--his plan probably won't raise taxes on very many people, since $15,000 per year is in the upper range of health expenditures.
--his plan opens the door for a real negotiation on changing the current tax code in a more progressive way, which is to say: all benefits received from employers should be included in salary totals.

To my mind, the best health care proposal out there is Senator Ron Wyden's plan, which would scrap the current employer-based system and create a universal tax credit (refundable to the working poor). Wyden's plan abides by The Two Mandatorys and has a lot of other thoughtful features. I'll have more to say about it anon.
UPDATE: Ezra Klein, no relation, who follows health care policy carefully, has this to say about Bush's proposal.

| Sphere Related Blogs & Articles |

Reader Comments (479)

Chief Angry Cloud:

I suspect that Joe has never actually purchased health insurance privately. Depending on exactly where you live, you can get near that "upper range" rather quickly, especially without community rating.

Anyway, we have double-digit inflation in the cost of health care premiums. Unless there is some sort of annual adjustment in the rate, this is a trap, just like our old friend the AMT.

Posted by Chief Angry Cloud | January 22, 2007 3:46 PM

konopelli:

Joke Lein is an idiot...and a dishonest, corrupt, venal one at that...

Any proposal that retains the necessity of private insurance companies as the reservoirs of universal health care is fated to fail...fail, at least to provide universal, equitable and comprehensive coverage to insureds...

There will inevitably be all the kinds of abuses which have attended all other private health insurance scams and schemes...see, e.g., hmos...

the corpoRats can't make money doing universal health care fairly, equitably or honestly.

so there'll be exceptions and exemptions, and additions and subtractions, and pre-existing conditionalities, and dna tests, and cherry-picking, and all the issues that have been so intrusively and expensively (to the insureds) imposed on users...

nice work, joke...corpoRat dickhead...

Posted by konopelli | January 22, 2007 4:17 PM

Terrapin:

Joe - The above commentors are asking a couple of reasonable questions:

Do you have any stats to show that $15,000 per year is in the upper range of health expenditures? If I were not covered I would be very close to that number and anyone else could easily top that with a single trip to the emergency room.

What are your thoughts on trusting private insurance companies to administer these plans? I understand that as a 'centrist' you hold the marketplace in high regard but the market functions best when it is able to extract the highest profit for a good or service. What would be their motive in a government-mandated, community-rated system like these?

I realize that this was just a heads-up post and that you will explain more later. I hope you can shed a little light on this.

Posted by Terrapin | January 22, 2007 4:48 PM

johng:

"hey, I'm a serious policy pundit"

Translation: I'm one of those Bush-loving chickhawk douchebags who thought invading Iraq would be tremendous fun.

Posted by johng | January 22, 2007 5:12 PM

DJ FunkyGrrL:

I'm surprised Bush hasn't asked Ann Coulter or Rush Limbaugh to design a tax proposal ;8)

Posted by DJ FunkyGrrL | January 22, 2007 5:18 PM

dave:

Why should we have to "buy into" the system? Do we buy into the education system? Do we buy into defense?

Why shouldn't it be a basic right?

Why keep the insurance companies?

The federal government spends enough on healthcare right now to finance a universal coverage health care plan comparable to other industrialized nations. No need to raise taxes. We could do it now.

Posted by dave | January 22, 2007 5:38 PM

Jeff:

Hey - konopelli and johng ... I don't like Joe Klein in the least either, but us liberals have been complaining a lot about needing a BETTER press corps. Swampland has the potential to be a useful tool for providing some real-time feedback to these Time columnists. IF Klein et al continue to post and perhaps even read the comments. But if it's just name calling, then that helps nobody. Go vent somewhere else please.

Posted by Jeff | January 22, 2007 5:43 PM

Joke Line:

Who's yer daddy?

I'm yer daddy!

Posted by Joke Line | January 22, 2007 5:45 PM

dukej:

As a self-employed 'entrepreneur', I buy a very basic, high-deductible insurance for my family of three: cost is close to $10k (and rising. fast.). $15k+ plans are readily available. (The insurer might actually have to pay something out at that rate.)

Making my premiums deductible would be a big help, actually.

Single-payer, or Medicare for All, or even universal mandate w/community rating would be a big improvement.

Posted by dukej | January 22, 2007 5:47 PM

Joke Line:

Jeff has the right idea.

Time Warner will save us!

Bwahahahaha! Jeff, you crack me up!

It's fish wrap with gloss, dude.

Posted by Joke Line | January 22, 2007 5:48 PM

Swift Loris:

I'm self-employed. If I weren't going Medicare next month, I would be paying $13,000+ per year, as a *single individual*, for PPO *group* health insurance through my professional association. Some of my colleagues in the association have chosen somewhat less expensive HMO plans, but few of them pay $7,500 or less a year.

Posted by Swift Loris | January 22, 2007 6:02 PM

Rt Hon McAdder KBE Esq:

Klein misses the point. Insurance companies need to be abolished. But his salary depends on missing that point. Universal healthcare proposals will not work unless this happens. Those rich enough to have private care will be able to have private healthcare even if this happens.

Posted by Rt Hon McAdder KBE Esq | January 22, 2007 6:57 PM

jjcomet:

$15,000 is a paltry sum for anyone who has a condition that requires hospitalization - you can ring up that kind of tab in a day or two without breaking a sweat. Anyone who thinks such a sum is "in the upper range of health expenditures" clearly has little or no real knowledge about this issue.

Posted by jjcomet | January 22, 2007 7:00 PM

Morris Sheppard:

It seems that pols - and some "pundits" -will do any sort of contortion, twist any fact, perform any feat of confusing, illogical and downright silly thinking all in order to somehow keep insurance companies in the business of basic health care.

It is plain that the paperwork, the inefficiencies, the confusion, the unfairness, the denial of coverage and a lot of the cost is the result of private insurers and their quest for profits. All these plans of mandatory "buy-ins," tax credits, insurer mandates are just so much crap. And cumbersome as they are they won't work well, either.

What is clearly needed is a simple, universal system of basic health care. It will save lives and money. If private inurers want to compete with that (as they do with medicare) let them, but don't make them the basis for health care provision. If some want more coverage, or fancier coverage, or private rooms, let them buy that, too, or get insured for it. But get private insurance out of the basic health care delivery system. Anything else is bound to fail.

Posted by Morris Sheppard | January 22, 2007 7:28 PM

Thers:

The link for Ezra Klein goes to his whole blog, not the post Klein has in mind, which is at:

http://ezraklein.typepad.com/blog/2007/01/bushs_health_pl.html

Gotta use the permalinks, Joe.

Posted by Thers | January 22, 2007 7:30 PM

Joe:

hahaha! He called himself a "serious policy pundit"! hahaha!

That's good stuff, Joke Line.

Posted by Joe | January 22, 2007 9:44 PM

Steve D.:

So let me see if I have this right. I'm an employer and depending on single versus family coverage, each pays $4K to $12K per year, which both parties get to write off on our taxes already.

If I didn't provide coverage, most employees couldn't write off if they didn't itemize or couldn't write off the whole amount.

BUT, given this, as an employer, why wouldn't I just drop everybody and say "you're on your own?"

It's like Wal-Mart encouraging people to go on Medicaid and food stamps. There's very little corporate responsibility these days, and we're already being pushed by rate increases to offer high deductibility plans and MSAs (more paperwork nightmare).

Why can't we have a simple solution? Why are we burying the American economy in more and more paperwork??

Posted by Steve D. | January 22, 2007 10:20 PM

trifecta:

Mr. Klein rights as if the HMO's have a God given right to extract $50 billion in profit each year. Probably more under this plan. Some people would be added into the system, increasing their profits. So this is a win win plan. Maybe we "only" get 30 million uninsured and the HMO's generate 60 billion in profit.


Or... we could go to a national plan, remove that 60 billion from the equation. Save a ton of money on overhead both in the redundant costs of all the workers at the HMO's in the paper pushing categories doing redundant work. We could eliminate the need for one or two staffers in each doctors office, with the expertise to code for each different HMO's billing scheme and get Universal Coverage for everybody with an outlay per year that is less that what Iraq costs.

That's not an option though. Gotta keep those corporate profits humming. Who gives a shit if some sick people fall through the cracks. They can put it on their visa cards.

And thanks to the bankruptcy "reform" they can keep paying for decades to come.

Posted by trifecta | January 22, 2007 10:30 PM

dave:

I'm going to have a lot more to say in a few weeks--

Dear God, NOOOOOOOOOOOOOOOOO!!!

Posted by dave | January 22, 2007 11:19 PM

porgy tirebiter:

Pundit Joe sez: "I'm going to have a lot more to say in a few weeks about the importance of proposing a universal health insurance plan if you're running for President."

Is that a threat?

Posted by porgy tirebiter | January 22, 2007 11:33 PM

freejack:

"I'm going to have a lot more to say in a few weeks about the importance of proposing a universal health insurance plan if you're running for President. But if you are going to make a health care proposal, certain minimal parameters seem obvious, especially The Two Mandatorys:
--an individual mandate, which requires everyone to buy into the system"

By definition, a 'universal' policy proposal of whatever description would necessitate that 'everyone' is concerned.

Someone wake up the Editor, he's drooling on that nice shirt he has on.

Posted by freejack | January 23, 2007 7:49 AM

Kari Chisholm:

Hey folks. If you're interested in more info about Ron Wyden's plan, head on over to Stand Tall For America.

[Right up front, some full disclosure: I'm working with Senator Wyden to develop that website. That said, I don't speak for the Senator. I speak only for myself. I'm a web developer, not a policy wonk, so any errors are my own.]

For those who want a single-payer system, consider this: There simply aren't the votes for it. After all, abolishing private health insurance would eliminate billions of dollars of market cap, which comes right out of pension funds, state investment funds, and more. It'll also put tens of thousands of people out of work.

Now, I'm for a single payer plan anyhow. But it's not going to happen.

Once you acknowledge that, the question becomes: Do we do nothing while we dream of single-payer? Or do we find a way forward?

Let's focus on outcomes. Ultimately, we need health care that's universal, portable, comprehensive, nondiscriminatory, and affordable. Senator Wyden's plan gets us there.

It fulfills President Truman's fifty-year-old promise to America, and it can actually pass.

Posted by Kari Chisholm | January 23, 2007 1:56 PM

Kari Chisholm:

p.s. Stand Tall for America is here -- http://www.standtallforamerica.com

Posted by Kari Chisholm | January 23, 2007 1:57 PM

freejack:

Kari Chisholm sez....

"Now, I'm for a single payer plan anyhow. But it's not going to happen.Once you acknowledge that, the question becomes.."

Well Heck, I'm kornvinced!

Posted by freejack | January 23, 2007 7:13 PM

dvl666:

Kari is Correct. In today's political climate one payer is DOA. When did it become a sellout to take 3/4 of a loaf?? When Social Security, Medicare etc. started they did not cover all working Americans...over time they were expanded to include more people. We have to start somewhere so that we stop the loss of good paying middle class jobs. Every American business that provides good health care is at an immediate disadvantage with it's competitors who do not and with all of our Industrialized World rivals.
The caps should be raisde top 20,000F, 10,000 S or higher. They must also be indexed to any rise in health care not just regular inflation. A plan that PO's the Right and Left is perhaps the best solution for a start. Unfortunately while most Americans are in the middle, the political class is mainly made up of ideologues(idiots pandering to their bases) who forgot how to COMPROMISE, when in fact the USA was formed by COMPROMISE.

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