The Great Health Care Debate of 2008 Is Finally Engaged

McCain's plan is Bush-lite. It takes away tax incentives for companies to offer insurance to employees.
This would be great for the health of the companies, for the employees not so much.
For a guy who has been on government health care for decades his scorn for universal health is laughable.

"Now you have a real battle," says Robert Blendon, professor of health policy and management at the Harvard School of Public Health. "It is one of the biggest philosophical debates we've had in a long time."

Interesting. I noticed Jay Carney yesterday (on that crappy new MSNBC election show) telling Rachel Maddow that it's still important to talk about Reverend Wright, rather than about side-issues like health care, the war, the financial crisis, etc.

(And Ms. Tumulty, you might want to slide your chair over to Carney and tell him to watch his body language whenever he's on a panel with liberal women like Maddow and Katrina van den Heuvel. His contempt and reflexive dismissiveness is palpable.)

KT: McCain's approach is smiliar to the one Bush put forth correct?

KT here--

Gy and P-NNTO: Some of the concepts are the same as Bush proposed a year or so ago (and that didn't go anywhere), but it is far more extensive.

Josh Marshall says it's identical to the Bush plan. KT, an interesting story for Time would be how many fo McCain's proposals are either extentions of Bush policies or attempts to implement policies that over 8 years, Bush hasn't been able to get through.

McCain's health plan and McCain's social security plans are both examples of McCain thinking, with Democrats in charge of the house and senate, that he'd be able to do in one term what Bush couldn't do in two.

McCain's plan for Iraq is merely an extension of Bush policies.

You know there's a story there.

Thanks KT. I'll say its extensive. It extensively leaves a lot of people without good health insurance. It also seems to me make it seem like healthy people are our problem. Now you may be excited about this hands off type of approach, but what I see is health care lobby smiling with glee at the prospect of earning more money.

KT:
[Under McCain's plan] individuals would ... presumably get[] a better deal thanks to vastly more competition in the marketplace.

Baloney. I appreciate you're not a health care / economics wonk. And on the front page of the dead tree NYT this morning Michael Cooper and Kevin Sack made much the same claim in the second paragraph. But it's baloney. I'm sure Justin Fox can set you straight.

The short version of why it's baloney:

1. Individuals have less bargaining power and sophistication than employers.
2. Negative selection.
3. Greater frictional costs from advertising to individuals, etc.

McCain's living in a dream world. He has no idea how much health insurance costs because he's never had to pay for it. His is a darwinian solution in which the people most in need of insurance will find themselves paying the most for it.

Hillary speaks as if her plan will of course become a reality if she's elected. Would that it were that simple- so she's also living in a dream world.

For many years Vermont has approached the problem by seeing that every child is covered, with a program called Dr.Dynasaur for children not otherwise covered by health insurance. There are also programs in place, starting with Healthy Babies, to see that every pregnant woman has access to health care and home visits if wanted, and to help insure that developing children get the best care and nutrition possible early in life. The goal (besides having healthy children!)is to reduce health costs down the road. Health care costs in this small state are staggering, but we are still finding ways to care for those in need. We generally rank as third healthiest state.

http://www.dcf.state.vt.us/cdd/programs/prevention/hbkf/index.html

A question, and then some comments. The question is tax treatment. I didn't follow the WWII link because I know that story. Is McCain saying a company may not deduct health benefits as a oost of doing business, like wages, or that an individual receiving a health care benefit must treat that as taxable income? Or both?

two comments.

First, this shows why Clinton and Obama have made a profound mistake by not just going for single payer, universal health care for all Americans. That's really easy to explain--Medicare for everyone--and makes a very clear distinction between the two ideas. It's easy to show it's better--Medicare is very popular, VA is doing really well, and the stats from the EU make a compelling case.

By continuing to insist on keeping value-subtracting, cost-increasing middlemen they have worse policy that is harder to explain and differentiate.

Second, McCain's plan can't work. The current system has demonstrably failed to lower costs through competition. Employers generally provide a set of alternative coverages. that competition hasn't lowered costs.

It also doesn't address the perverse incentives that lead insurers to not just cherry pick,but to deny coverage. Market systems to provide a service can't work if the service provider loses money as he provides more service. A car dealer makes more money when he sells more cars, while an insurer loses money when he processes more claims. And without intrusive regulation, it is impossible for a consumer to assess whether the insurer is likely process claims liberally or not. And all the while there is market pressure to reject claims. A system (from any of the three) that doesn't recognize this problem is just shifting the chairs on the deck of the Titanic.

Third, is another question, I think. The simple solution to McCain's risk pooling problem, and a way to trump Obama and Clinton is to call for universal catastrophic coverage. Once you hit some medical bill ceiling, like $50,000, it's on the government. Why doesn't anybody propose that? The thing everyone fears most of all is predicament of the couple in Sicko, who had to sell their house and move in with their children in order to pay their medical bills. The only sensible way to deal with that is to make the pool for catastropic illness the entire country.

KT here--

Okay, guys, you are really cranky today. I'm trying to lay out the argument of THIS election here, and help shed some light on the choice that people are going to make in November. Yes, McCain's has some of the basic features of a Bush plan that never went anywhere. But since Bush won't be on the ballot, I think it's far more important to tell people about the two visions of the future they are looking at, rather than engaging in "Bush-Lite" kind of labeling--especially on a policy that, unlike Iraq, DIDN'T GO ANYWHERE. McCain's plan, as best I can tell, also has many features that weren't in the Bush plan. I don't recall, and can't find on the White House website, any mention of the high-risk pools, and McCain's refundable tax credit is different from a Bush's tax deduction.

Maybe I should just post something else on Reverend Wright. I hear he was at the National Press Club this week...

Even though I (and Joe Klein) would take exception to your characterization of the Obama/Edwards(-Clinton) plans, this is an excellent piece, Karen.

I'm truly appreciative.

Who is being cranky?
People are rightly pointing out that it is very similar to a plan that went no where.
Also Crust pointed out specific problems with McCain's proposal.
That were McCain elected he would face a Congress more Democratic than the current one also dims whatever small prospects this plan has.

Gy

The idea, of course, is to make health care more expensive for people so they'll use less. A plan that costs the same amount as the tax credit would have to be significantly worse than the plans people have now, because, as the article points out, the total is less than half the current average cost. It'll be brutal on a large family.

Back when I had employees, I was paying Oxford 850 dollars a month for a single person, in high cost NY. 2500 dollars of credit is not gonna help those people much--and they may often end up forgoing insurance entirely because of cash flow. A payroll deduction is one thing. Having to wait to get back an annual credit is another. And it junks up the tax form some more. But McCain has already advocated making you do your taxes three times instead of twice.

This is a non-starter. His only chance is to convince people that there aren't any real differences, except that you make your own choice and you aren't penalized if your employer doesn't provide coverage.

So, McCain's plan is to uninsure the sick and the elderly? While I'm sure that is doable, are we all OK with that?

I'm not mad, KT... just think a story about McCain as a follower of Bush is relevant here. While you're right that Bush isn't on the ballot he's pretty much the least popular sitting president ever. If McCain is adopting the guy's ideas, shouldn't the voters know about it? And doesn't proposing things are identical to what the sitting president has been trying to get implemented mean that he's not the maverick he claims he is?

Good post, thank you!

I still have doubts that any candidate would be able to implement their healthcare plans, but it's important to see who the plans would benefit in the end.

McCain's plan looks like it will be a very, very hard sell for anyone giving this issue consideration come the GE.

Tell me where I am wrong here:

Conservatives say poor people pay no taxes. The centerpiece of McCain's plan is to offer a $5000 tax credit. Since poor people don't pay taxes, there is no tax for the credit to offset. Unless it is a refundable credit, like EIC. Is it a refundable credit? Doubtful. That would allow poor people to have more of a "negative" income tax. Can the credit be counted against the FICA tax? No. So, so far, McCain has offered nothing for the poor, who are the most likely to be without health insurance. So, he offers an undefined "GAP" for the poor. But don't ask him for any details. He doesn't know. Why do I get the feeling that this so-called "GAP" is a last-minute addition to the plan that has been tagged-on just to show McCain really and truly cares about poor people?

I actually like his plan. I think that if you look at other insurance types like auto insurance and you look at the states where most people buy and keep active car insurance the premiums are much lower then in states such as Louisiana where the majority of people don't have car insurance. (I lived there for 18 years. The police actually have insurance stops like DUI stops) I paid about 300 a month in car insurance when I was 16. When I was 18 I moved to Overland Park KS (my current residence) and my payment is $80/month. The reason is people buy it. I think that health insurance should run that way and we should get a break on our taxes for it. Because of every being mandated to have it like you are in college, the rates would go down and the insurance companies would actually have to make plans that work for people. Demand would, well, demand it.

I realize we cross posted KT. But the tax treatment really isn't clear. Do you happen to know?

the "pre-medicare" elderly, I mean. Of course, I don't rule out a McCain run at Medicare, given the opportunity.

KT here--

Smedley: I believe the tax credit is refundable, which means you get it whether you pay taxes or not. the real problem is, it doesn't buy you much insurance.

KT here--

Okay, I cried uncle on the Bush thing. I should have included it in the first place. Please see asterisk in the post.

yes smedley it is a refundable credit.

Another david--he can't touch medicare or the VA
This will be a disaster for medicaid recipients and for CHIPS kids.

One more thought before I get yelled at. I'm not supporting McCain. I just think the IDEA is a good one. The kinks of course need to be worked out. Also, Good post KT. This is what I wanted to talk about.

@Isumarkb - What happens with a pre-existing condition? (or one the company can claim later was pre-exisiting and deny benefits). A credit won't do you much good if no one will sell you a policy.

KT-

Good point, and I think some people here are very appreciative that you brought up this topic (with an expert's opinion!), because we are discussing the different proposals at this moment. Thanks, KT.

I'm glad you noted--correctly--that McCain's plan would cause people who have preexisting conditions to be denied their insurance or to get a crappy insurance policy. With his plan, the sick will end up paying more than the healthy, which defeats the ORIGINAL purpose of ANY social insurance, which is to pool risks and have everyone subsidize each other.

The US is the only developed country without universal insurance, and there's a good reason for it. If McCain wins in November, it would bring America even further away from reducing cost by expanding the current risk pool. I'm pretty sure eventually America will have universal health insurance -- it's just a matter of learning the lesson the hard way by a Republican president screwing up or have it shoved to you by a Democrat.

KT here--

I've added the fact that it is refundable, plus a link to the plan itself. Also, Tenderfoot, the high-risk pool is supposed to take care of the pre-existing condition problem--though Blendon notes it has been tried and doesn't work well.

Now I'm going to lunch. Will check back in when I get back.

By the way, McCain's "plan" stikes me as the stupidest, most irresponsible, reckless and counterproductive suggestion imaginable.
Regardless of the alignment of this detail or that with Bush's proposals, it is EXACTLY Bush in its triumph of ideology over responsibility.

@Tenderfoot - I'm not sure. I wonder if the stipulation is that its a mandated law. Which would require the insurance companies to cover you. I think that there is more unhealthy people with pre-existing conditions then there are not now and days. It might actually make people not smoke or tax them heavily on it. (Yes I know its your right to smoke but not your right to kill me while doing it)

Because the insurance industry is involved in all proposals, the real losers in whatever plan gets adopted are the American people. As long as insurance companies are involved, people will be excluded and prices will continue to climb.

The only real way to have universal cost effective coverage is via Single Payer. But it's not "politically viable" (Translated: Insurance Companies, The AMA and Big Pharmaceutical companies have effectively bought off our government.

Meanwhile most of the civilized world enjoys universal coverage, which is better and much more cost effective than our for profit system.

Karen - whoa. are we being any crankier than usual? I thought we were starting out an interesting discussion. There are obvious flaws with all of these proposals, so you knew we would point that out.

I'd just as soon scrap all three plans and go with Jayack's. I've always thought I might be willing to gamble on paying a few thousand for medication and doctors' visits, if I knew operations, hospital stays, and catastrophic illness would be paid for.

McCain, especially, seems oblivious to the enormous loss of productivity and the ill health that results from the anxiety the average family has about these issues.

lsu-

The auto insurance thing is a false analogy. It's real insurance, protection against infrequently occurring bad events. What we have is pre-paid group practice with drug coverage with centralized administration run by companies that call themselves something else. Calling this stuff health "insurance" creates an immediately misleading narrative frame. It WAS insurance when it was "major medical" and covered just in-patient procedures, while out patient doctor visits were out of pocket, as were drugs. And were tax-deductible.

This is not insurance.

KT-

You wrote that the $5000 would be a refundable credit. I really doubt that. Please double-check that. It is more likely a non-refundable credit, which can only be used to offset tax.

it's in the article smedley

Those tax credits would be refundable, meaning that low-income people who do not pay income taxes would still be eligible to receive it.

Bottom of the first page in the NYT.

Why in heavens name is Michael Cooper doing this analysis? DOn't they have someone on the health insurance beat?

...the real problem is, it doesn't buy you much insurance

Yes, especially if you're not in a pool of HR negotiated policies.

Didn't we go through this sort of thing when the Republican congress enacted a Medicare Part D that specifically forbade Medicare from negotiating prices for prescription drugs en masse (for its pool) of prescription drug benefit recipients?

OK, so if it is refundable, it will have Republican opposition in Congress. It will go nowhere.

Wait a minute! Is this a discussion of... policy issues? During campaign season?

In this post, I don't see one mention of anyone's pastor, barber, or next door neighbor.

This does not compute! Paradigm exploding... Respect for journalists growing (very very very slowly)... Brain shutting down...

I linked to the WAPO article. It wasn't in that one.

For a party that bows down to the power of the market place it's odd that they don't understand how purchasing works.
The bigger you are the better price you get. Breaking everyone into individual "buyers" gives the insurance companies all the leverage.

None of these plans are getting through Congress as formulated smedley. And I still say the determinant of the future of the health care in America is how many Dem freshmen get elected.

Insurance Companies, The AMA and Big Pharmaceutical companies

If the doctors I know are any indication, the AMA is out of the conspiracy. Doctors hate the system. It's expensive and aggravating to deal with claim denials and slow paying insurance companies.

"This is a non-starter. His only chance is to convince people that there aren't any real differences, except that you make your own choice and you aren't penalized if your employer doesn't provide coverage."

The only choice I see people are going to be making under McCain plan is what kind of care are they not going to get because they can't afford it. The insurer is still going to be the one to decide what's covered, how much and if you are costly drop you.

Yet again, now that the damage is done and the MSM has pie on their faces, they want to pretend to be high-minded rather than correct the record.

I can't express how disgusted I am with the political discourse right now. This election will not be decided by the issues of the day, by whether or not our journalists can function on some minimal level to stop from getting bamboozled by the Swiftboat, Willie Horton BS. If you guys spent half the effort letting the public know what McCain really believes as you do forwarding rightwing malarky, McCain would be behind 20 points.

You can't keep brushing this off. Eventually this has to stop. I mean, all this time spent perhaps irrevocably making Obama and Rev. Wright synonomous, when the real question all along is why Wright has such a vendetta against him? What did Obama do to tick this guy off?

Is the media going to do anything about the fact that they've falsely painted Obama this way? Are you going to be any smarter next time around?

Healthcare is impossible so long as you are powerless to resist this idiocy.

Posted by jayackroyd | April 30, 2008 12:13 PM:

...this shows why Clinton and Obama have made a profound mistake by not just going for single payer, universal health care for all Americans.

Is there any possibility that single-payer is simply not affordable based on current revenues, and assuming that we continue to borrow at the same volume in order to finance a nine billion dollar a month occupation (that neither candidate will end conclusively before 2010 or 2011)?

KT: But since Bush won't be on the ballot...

Disagree. Bush will be on the ballot in the same way Jeremiah Wright will be, if not even more so.

lsumarkb: I think that if you look at other insurance types like auto insurance..

Excepting that health insurance is not the same as auto insurance, if for no other reason than you can't stop driving your body and get a new one if you get into an accident or it breaks down...or have time to get estimates on what will give you the best value for your money while you're in the middle of a heart attack.

Because of every[one] being mandated to have it like you are in college...

Health insurance coverage for college students is mandatory? College must have changed a lot since my time going to one...

...the rates would go down and the insurance companies would actually have to make plans that work for people.

Ideally the rates would go down due to the expanded risk pool and insurance orgs would make plans that cover everyone, or at least there would be some regulatory mandate that everyone gets covered. Unfortunately, I can't rely on for-profits to act in their customer's best interests - and I have ample justification for that opinion, Robert Sullivan - and McCain's plan actually weakens government mandates that try to ensure coverage for everyone:

Steve Bernard was talking about treatments for his 9-year-old son, Jake, who was born with a cleft lip and palate. Jake has already undergone numerous surgeries with more to come. Bernard described his battle to get insurance coverage for speech therapy. “Every time they say, `No, speech therapy isn’t covered,’ and we say, `yes it is covered.’ As a matter of fact in the state of Florida there are specific statutes that were created by other parents of kids with clefts that will protect those kids.”

He ended his comments with a plea to McCain, whose adopted daughter, Bridget, also had a cleft palate: “If there’s ever going to be somebody in leadership position who is going to know it, it’s going to be you, and we’re hoping you understand that,” Bernard said.

Left unsaid was that McCain’s health plan is designed to weaken state regulations like the one in Florida that, like 14 other states, mandates that insurance companies cover treatment for cleft palates. McCain says that mandates like this one drive up the cost of insurance, and he would allow people to buy coverage across state lines. Many experts predict that under this system, insurance companies would simply gravitate to the states with the fewest rules.

Asked about the contradiction between the family on the stage and the McCain policy, McCain senior policy adviser Douglas Holtz-Eakin said that the marketplace will fill the void. If there is a demand for this kind of coverage, he said, some insurance company will offer it. “There are boutique products in every other market,” he said.

Apologies for the long excerpt.

(h/t once again to Kevin Drum)

KT:
Okay, guys, you are really cranky today...

Not sure if I'm one of the guys in question, but my complaint is definitely not that you posted on this important topic rather than putting up the hundredth post on Wright or whatever.

My point is that you're making a false claim (admittedly caveated with "presumably") -- swallowed whole and unfiltered from the McCain camp -- that this plan is going to get us better value for our dollar in buying health care.

Really, it's hard to overstate their level of sheer bogosity on economic matters. Examples are endless. Perhaps the worst is McCain's repeated claims that tax cuts increase revenue (not promotes growth, but actually increases revenue) a claim that as Justin Fox has rightly observed no "serious economist" believes.

Is there any possibility that single-payer is simply not affordable based on current revenues, and assuming that we continue to borrow at the same volume in order to finance a nine billion dollar a month occupation (that neither candidate will end conclusively before 2010 or 2011)?

Single payer is cheaper. Sure, there's more government expenditure, but it is more than offset by the increase in takehome pay and profits.

There's not question about this. The EU provides better health care at half the price of the US. Without any of the sickening worry that goes on here, nor the discouragement of entrepreneurship.

And if they had gone for it

Thanks for this post, KT.

McCain has a general theme of introducing the free market into new areas - education and healthcare, for instance - and I think it's madness. I don't see why you can assume that free market capitalism is some sort of panacea that will solve all the world's woes?

As for health insurance, I've read arguments that it simply cannot function like a regular market would. The people that need it the most are the ones who will cost insurers the most (and are less likely to be able to pay for it), so the insurers court the ones who need it the least.

Also, and I'm stealing this from Kim Stanley Robinson's Mars books, why should good health be for sale?

theyu'd be makiung these good, powerful clear arguments to people who are unhappy with and worried about their health care.

"Asked about the contradiction between the family on the stage and the McCain policy, McCain senior policy adviser Douglas Holtz-Eakin said that the marketplace will fill the void."

Does that type of non-answer still work? No matter the economic question "the marketplace will fill the void" is the answer.

And then Ezra Klein takes the ball into the end zone:

..aside from his awful internment in a Vietnamese prison camp, it is hard to find a day in McCain's life when he was not sheltered by the government-run health care he now claims to loathe. Born the son of a Navy admiral, he was cared for by Navy physicians during his childhood. After graduating from high school, he enrolled in the U.S. Military Academy, and the military's care continued until he retired from the service in 1981. In 1982, he won a seat in Congress, ushering him into the Federal Employee Health Benefits Program, and in 2001, he qualified for Medicare. When he says, "we have the highest quality of health care in the world in America," he is speaking as a man who has enjoyed a lifetime of government-run care.

But now John McCain is seeking the presidency as a Republican, and a healthy distaste for government-run health care is de rigeur. "I am convinced," said John McCain at Miami Children's Hospital, "that the wrong way to go is to turn over your lives to the government and hope it will all be fine. It won't." Spoken like a 71-year-old whose government health coverage has kept him healthy enough to run for the presidency.

Of course "the marketplace" does work in the healthcare industry for some

"(Bill McGuire) will be allowed to keep stock options valued at more than $800 million. That’s on top of about $530 million in compensation he pocketed while running UnitedHealth from 1991 to 2006."

http://tinyurl.com/5nnyj9

Posted by Paul-no not that one | April 30, 2008 1:18 PM

Of course "the marketplace" does work in the healthcare industry for some

"(Bill McGuire) will be allowed to keep stock options valued at more than $800 million. That’s on top of about $530 million in compensation he pocketed while running UnitedHealth from 1991 to 2006."

http://tinyurl.com/5nnyj9

Brilliant, brilliant post.

The 'free-market' has allowed a handful of individuals to siphon off billions of dollars at the expense of individuals in great need of one of life's most basic requirements. But to attempt to correct this aberration of the market - or to even discuss it as a problem - is quickly labelled 'class warfare' and shunned from public debate.

Terra, Thom Hartman fleshes out this topic in a very smart way if you have access to his Air America (I think) radio show.

jayackroyd:

Single payer is cheaper. Sure, there's more government expenditure, but it is more than offset by the increase in takehome pay and profits.

Sure, it's cheaper by far to operate than the aggregate of insurance industry firms, and cheaper by far for the vast majority of people in this country.

But it's not "cheaper" for the Federal Government, since it had not taken on those expenditures previously. As an economist, is it your opinion that the initial "startup" costs (beyond what normal tax-payers would contribute to an ongoing program) for such an endeavor simply beyond the scope of budgetary constraints, given that the candidates plan to continue a $100 billion occupation for at least the next two years?

The downfall that I did think about while reading this is that if we allow the government to control health care, what is left for them to control? We are handing it over to the inefficiencies we face today in our government are we not?

Because of every[one] being mandated to have it like you are in college...

Health insurance coverage for college students is mandatory? College must have changed a lot since my time going to one...

Yes if you attend a college or university you are required to have health insurance.

Dangit... I have been writing in HTML too long to close my tags after every paragraph.

Because of every[one] being mandated to have it like you are in college...

Health insurance coverage for college students is mandatory? College must have changed a lot since my time going to one...

Yes if you attend a college or university you are required to have health insurance.

I have been writing in HTML too long to close my tags after every paragraph.

The lack of an HTML editor in these textareas is irritating as hell, isn't it?

@SZ- A little...

I just finished reading up on Single-payer because I hadn't heard of it before. (Sorry new to this whole political world but trying to learn) I think its sounds fantastic. My only worry is that the care we provide would go down because the money motivation won't be there. It would even the playing field as far as hospitals and doctors right? So would that field be even at a high standard or a low one?

KT here--

I might just take issue with the suggestion of some commenters that McCain is unique in introducing a free-market philosophy to this debate. Both Obama and Clinton claim--correctly, I think--that theirs are also free-market approaches, building on and strengthening the private marketplace. The Democrats each would bring additional competition to the system. Neither is really a "big government" solution, at least in terms of direct government involvement. (And both only open the door slightly to the true big-government solution, single payer.)

The real difference, as I read it, is the one spelled out by Blendon. McCain thinks everyone should be out on the market as individuals. Obama and Clinton think purchasers' clout in the market will be much greater if they are banded together with other purchasers.

lsumarkb: Yes if you attend a college or university you are required to have health insurance.

I guess it depends on where you go.

The "philosophical" debate IS this:

Do decent people have to keep involuntarily paying the bills, and more, for the druggies, drunks, over-eaters, medical misfits, hypochondriacs, and basic slackers infecting the democrat party?

In other words, why do my kids have to pay for your fat lazy ass, or that of your life partner?

I'm not talking about breast cancer cases and infant AIDS.

I'm talking about the dolts in Detroit and Cali that can't keep their meth head communicable pants suits on any longer than the Time it takes Say Joe Klein to yell JIHAD whenever a member of the U.S. Army shows up for actual peacemaking duty.

What IS is.

"Obama and Clinton think purchasers' clout in the market will be much greater if they are banded together with other purchasers"

Wal-Mart "thinks" that too.
There may be legit arguements against Clinton and Obama's plans but is purchasing power disputed?

KT: I'm not sure what your own assessment of John McCain's plan is because you seem to want to focus on the fact is has a lot of moving parts without stating if those parts move together very well.

I don't think you have to be an expert to observe that there are some serious problems with McCain's approach, no matter how extensive it is. If he wins this with what he has put forth so far this country is going to be in a world of hurt. There are also some additonal tax issues beyond the refundable credit that aren't address.

KT: McCain thinks everyone should be out on the market as individuals. Obama and Clinton think purchasers' clout in the market will be much greater if they are banded together with other purchasers.

This is a hugh difference. Individuals will get run over and pounded into the ground on the market by themselves. The only ones who will make out with McCain's approach is the private health insurers.

The argument for following a path like Clinton's or Obama's or, moreso, like John Edwards is that it provides a way to ease the transition to a single payer plan, by offering a government alternative.

There's plenty of money for a transition into Medicare eligibility for everyone. Restore the Bush tax cuts, tax capital gains as normal income, lift the FICA cap and cut defense procurments. And, if you need to, raise the Medicare payroll tax.

This won't hurt anybody in the middle class except for the last one. And they would see their contribution for their health care go away.

It's only expensive if you care what happens to the insurance companies.

It appears you are correct grape_crush. I just know at the two colleges I attended you had to have some form of HI. I just assumed that was a general policy for all universities. I guess I just made an a$$ out of u and me eh? It seems Michigan cya'ed in a different way.

QH: Please come up new material.

My only worry is that the care we provide would go down because the money motivation won't be there.

You can't get much worse than the US. Doctors would prefer a system where they spend more time doctoring and less time and money on claims administration.

See Sicko. It's really very good, except for the stupid trip to Cuba.

lsumarkb:

I just finished reading up on Single-payer because I hadn't heard of it before.

Frontline and T.R. Reid did a pretty good piece on recently called "Sick Around the World" which examined other countries' delivery of universal health care. It's worth watching, if for no other reason than Reid's almost constant look of slightly shocked bemusement.

KT: I might just take issue with the suggestion of some commenters that McCain is unique in introducing a free-market philosophy to this debate.

Not really. More like McCain is pushing for a more extreme application of free market principles to health care.

The real difference, as I read it..

Yeah, that's pretty much it; Ownership Society, as in, "you're on your own".

Both Obama and Clinton claim--correctly, I think--that theirs are also free-market approaches, building on and strengthening the private marketplace

Yes, and this is my point on differentiation from McCain. They're both following the DLC-branded "I am so providing a market solution." in order to keep from being called socialists. This is a mistake in the current climate, imo. I think it's going to make people think it doesn't make any difference-two incomprehensible plans from the two candidates.

Still wondering about that tax treatment, KT. Will employers report health care benefits as income to the employee? Or will it be a non-deductible cost of doing businss?

lsumarkb: I guess I just made an a$$ out of u and me eh?

Oh gawd, no. You're mostly right, and I learned something new today. Hooray for me.

It seems Michigan cya'ed in a different way.

Only one example; there appears to be hundreds of higher ed institutions that mandate insurance coverage.

Isumarkb: The real free market philosophy McCain is pushing is this hands off approach that will leave it to states to obsorb the costs when these health companies screw people over.

KT:
McCain thinks everyone should be out on the market as individuals. Obama and Clinton think purchasers' clout in the market will be much greater if they are banded together with other purchasers.

That's accurate. Remind again how you get from there to presuming that under McCain's plan individuals would get a better deal? (I gave my thoughts on why they would not above.)

@Gy- I have definitely learned that much today. I wish other people had a forum like this because listening to McCain's speech yesterday, it sounded like a good plan. I fear it will also sound very good to a lot of people. I mean I still like the idea of it...I just understand that the dynamics of it won't work.

The sick notion that we have to soon pay for EVERYONE to abuse the health care business (yes, it is a business -- even you Medicaid and Disability insurance ripoff types know that) not now abusing the health care business makes me and every other over-paying, under welfared American want to THROW UP.

Obama (Rev Wrong bless him) has a fair idea: Cover kids 100% until age 12, and everyone else is on their own.

The reckless rendering of heroic medical practices to 90 year olds may sound humane, but it is KILLING our ability to develop and introduce faster, effective treatments that actually matter to the nation's prosperity and not just the wonder drugger reps during dinner hour.

BTW, KT: If you media mavens really want to restrict speech not the DNC, howbeit you start with the pharmacy company ads that come packed into the Evening National News every night?

[On the plus side, having followed the CBS chimerical directives over the last 6 months, my penis IS now 3 feet longer.]

Sweet Viagra Be Praised.

Moral: There IS plenty of blame to go around, but not that much cash.

Somebody has to take one for the All Slacker, All The Time team, but it won't be my kids.

Sorry guys, I keep missing posts.

@Jack - I will have to see Sicko. From my experience though (and yes its a lofty one, I am lucky enough to have had insurance through my parents and at UPS while in college), certain hospitals are better then others and depending on your insurance or status in life you get better doctors because of this. Its not right and I don't necessarily agree with it but I also am hoping that the level of care won't go down. I realize it will be more even but that doesn't discount the fact that the care will go down even for the fortunate few.

@Grape_crush - I will take a look at the special when I get home. I think this health care issue is the biggest issue along with our education in this country.

we have to soon pay for EVERYONE to abuse the health care business

As usual, QH has it exactly BACKWARDS. Which is cool. He's like Bizarro Pundit... whatever he believes, it's the opposite proposition that makes sense.

America spends more on health care than the rest of the industrialized world precisely because "everyone... is on their own." Preventive care costs less than catastrophic illness... but that's only interesting if you view this as a public policy issue and not another partisan brickbat to wield against "domestic enemies."

Of course, QH is convinced that he will never get an illness that his insurer declines coverage for. Maybe that's Nature's way of getting blind partisan loyalty out of the gene pool, though...

"...certain hospitals are better then others and depending on your insurance or status in life you get better doctors because of this..."

One of my best friends, one of the most highly decorated Vietnam combat vets (he did 6 -- six -- tours between divorces) was killed by a nurse in Jackson, Mississippi, that stupidly gave him too much blood thinner during an unrelated surgery. He was feeling fine after the procedure, eating ice cream -- and was dead 2 days later, bleeding to death internally unbeknownst to anyone (until the autopsy). He was not yet 70 years old. He earned his Purple Hearts on the battlefield, not on XBox. He was a volunteer for AIDS victims (shocking to liberals, for a Republican), as part of his retirement work. He was one of those people that most members of the Howard Dean household couldn't possibly imagine, someone that defined no stereotypes of the loon left, apologized for nothing, defended the classless and the purely unlucky -- and was killed by an American with a priority unionized lunch break in a major medical center.

Along with excessive controls on basic drugs (non-reimporting, non-use of pharmacists ala the UK), stupid marketing, moronic liability insurance costs fisted upon everyone by the trial lawyers (my friend's family did not sue the inept nurse, being Republicans), inability to track defective doctors and medical staff, screwed up health privacy claims (AIDS patients and STD passers), and lousy DC math skills, this "issue" may as well be wrapped in swaddling clothes, for the maturity of the "national debate" that's "just beginning".

We've already promised more than we can give to the AARP mobsters -- and that's lacking basic cost and universal quality controls, of any kind.

Before we start deciding who gets what, we need to determine who DOES what -- and hold them accountable for not only their actions, but their costs, in a non-court environment.

If we leave this simply for the trial lawyers to feed, we'll get nothing (just as most of the smoker suit states did).

Moderation, like attention, works.

lsu,

Under all these systems in Europe you can pay extra and get more stuff. In France most people do buy the equivalent of MediGap coverage.

Reimbursable expenses are also tied to efficacy.

Of course, what they consider essential is not what we consider essential. There was a recent NYTimes article about a woman working there who found the post-partum vaginal exercise therapist a surprise.

http://www.nytimes.com/2007/12/13/opinion/13druckerman.html

And Michael Moore found it surprising that you get a mother's helper once or twice a week (I don't remember the frequency) to come by and help with the baby, including doing laundry.

Having the government in control of the entire system greatly enhances its ability to implement public health measures, like reducing the number of smokers, diabetes maintenance etc. Since it is much cheaper to prevent lung cancer than it is to treat it, this is a major cost advantage. In your researches look up how the VA works.

This was supposed to be what PPGP did for Americans. The idea is that you would spend decades in the same practice, where there was an incentive to keep you out of the hospital by keeping you healthy. The HMO planners did not envision mammoth national organizations with thousands of physicians on their panels.

Wow, looks like somebody's meds kicked in...

Before we start deciding who gets what, we need to determine who DOES what -- and hold them accountable for not only their actions, but their costs, in a non-court environment.

You'll get no argument from me. What would your "non-court environment" look like? I'm presuming you're not calling for regulatory oversight... what mechanism do you suggest to ensure accountability?

"Having the government in control of the entire system greatly enhances its ability to implement public health measures, like reducing the number of smokers, diabetes maintenance etc."

Other than raising smoking taxes, what PROOF do you have that the government has controlled costs of ANYTHING?

Do you know how much the costs of basic commodities are jacked up, due to government intervention?

Good grape.

You'll get no argument from me. What would your "non-court environment" look like? I'm presuming you're not calling for regulatory oversight... what mechanism do you suggest to ensure accountability?

...

I'm open to suggestions, but it would have to render decisions quickly, cheaply, and broadly -- to protect both patients and decent practitioners.

Our goal should be excellence, not dumbing down the system to the point that it ends up killing more people but for the sake of employment and politic points.

I think their are valid ideas across the aisle, but we're now discussing starting points that are quite frankly non-starters that won't get close to getting through Congress.

The idea that we can make private medical practice and corporate pharmacy research illegal acts dooms the Democrat party solutions to the historical waste heap where they belong.

Um, the French spend half what the US does on health care, covers everybody and has much better mortality and morbidity statistics. The "private" US system is the most expensive, least comprehensive and least effective health care system in the OECD.

Clapping louder doesn't really bring Tinkerbell back to life, nor does doing so change any facts. The jury was arguably out on the US system in 1994. Development of minimally invasive procedures seems to have stemmed in part from the adoption of PPGP policies. Those outpatient procedures were cheaper and safer.

The jury is in now. The US system is a disaster. The universal care systems of Europe are cheaper and better. There's no doubt about this.

Our goal should be excellence, not dumbing down the system to the point that it ends up killing more people but for the sake of employment and politic points.

Again, I'm with you. The devil, as always, is in the details.

I'd like to see a solution that didn't involve either big government or big business controlling everything for their own benefit, but the likelihood of that IS about the same as a July snowball...

The idea that we can make private medical practice and corporate pharmacy research illegal acts dooms the Democrat party solutions to the historical waste heap where they belong.

[sigh]

Nobody suggests that.

No country does that.

Hey you all, you silent readers of Swampland out there---and there must be 1,000 readers out there for every regular commenter. Just take a look at our good friend QUESTION HILLARY's comment:

"Do decent people have to keep involuntarily paying the bills, and more, for the druggies, drunks, over-eaters, medical misfits, hypochondriacs, and basic slackers infecting the democrat party?"

There's your modern Republican for you, in a nutshell. Fundamentally ignorant about how a simple matter of policy actually works. Ungenerous. Un-Christian. Boneheaded, bitter (yes, bitter), and bigoted---and proud of it!

If you're comfortable with the sort of attitude QUESTION HILLARY displays here daily---if you agree with the sentiments s/he expresses---if you feel like QUESTION HILLARY speaks for you---then by all means vote McCain. Early and often!

@QH- Sometimes you have some good points and then you sandwich them with insults. I realize this is a blog and you are not actually talking to legislation but if you want someone or something to change, you have to change yourself first. Its just a suggestion but I don't think you need to tell me they belong in a waste heap.

From McFlipFlop's site:

"Families should be in charge of their health care dollars and have more control over care."

Typical codewords. This means simply increasing the size of the menu of selectable plans and/or options.

"An important part of his plan is to use competition to improve the quality of health insurance with greater variety to match people's needs, lower prices, and portability. Families should be able to purchase health insurance nationwide, across state lines."

I was right. I'm guessing that there is some goodies in here for insurance company mergers. More choices? Sh*t! They are confusing enough already. The "lower prices" are probably only going to come from selecting a less comprehensive health care plan. Lower prices through competition? Don't make me laff. Hasn't worked yet. Not even once. Same slop, same taste as what has been served by market-cures-all enthusiasts b4.

"John McCain Will Reform The Tax Code To Offer More Choices Beyond Employer-Based Health Insurance Coverage."

Look at the details on this one. The "tax break" is nice IF you can afford to spend that much on insurance. No help to those 47,000,000 who dont.

And, LOOK at this! Insurance companies will be hooked directly up to the money pipeline, with any unslurped slop left by those pigs to go not into your pocket, but into your MSA!

WOW, I can hardly stand the corporate enthusiasm and corruptionability factorizations! Let me count the ways...

He goes into greater depth, but I just don't see how radical this is. Sounds like more "Market Voodoo Equity Solitions" to me...

"Um, the French spend half what the US does on health care, covers everybody and has much better mortality and morbidity statistics."

Um, they also have 12% unemployment, and watch their elders fry every August in the dead heat of summer while the kids go off to Spain to take in the bull fights.

Euthanasia Deluxe.

Next!

I will say this for the Lower Belgians: Their bidets are spotless.

Seems to me, QH, that the unemployment rate doesn't have a thing to do with health care costs.

BTW, what ARE you going to do about that rapidly falling life expenctancy? Is your Omnipotent Eye (the one watching Iran) able to see for miles and miles and miles...

Give me something other than some social Darwinist voodoo...

"The universal care systems of Europe are cheaper..."

Sorry, which abacus in Tax Amnesia Land IS you talking about?

Note: The Frogs and other boot people drink a lot more wine than we do, which may have more to do with their lifer heart health than their decisive dinner conversation about the evil Bush.

If we have to emulate anything Euro, let's start with sangria.

Ole!

jayackroyd, great analysis, although I don't think single-payer is politically feasible yet. Baby steps...

Also, Clinton's and Obama's plans are very different, especially in practical terms. As jayackroyd has pointed out, single-payer is a much more economically feasible system, and Clinton's plan goes as far away from single-payer as is possible while still being workable. Obama's plan is theoretically not that different, but in practice it won't be affordable because it doesn't sufficiently utilize economies of scale. And since it wouldn't be affordable it would probably never be passed, and even if it did it would be very ineffective and could end up causing a backlash against the left (which would be completely unfair, but it's not like that's never happened before).

So yes, if in some alternate universe Obama's plan were politically and economically feasible, it wouldn't be that different from Clinton's. But in this universe there is a big difference between the two plans.

And thanks KT for writing a policy post.

I guess the meds are short-acting.

You said give me an example. I gave you the relevant on topic example. You change the subject.

And I got bad news for you. Quality of life is better in France than it is here. They're healthier, they live longer, they eat better, they have more leisure time and they're happier.

Unemployment in France is something like 7%, FWIW. And they still pay less per head than we do on health care.

They live longer than we do, too. QH.

Now me, I wonder just how many of these nuggets you will remember in your old age...

Perhaps maybe you aren't planning on making it to old age, but instead, will go the way of your mental comrade Timothy McVeigh?

If so, maybe Al Queda can offer you pointers...

Question Hillary was never good at facts. He makes up his own.

How is McCain's plan "radical"? Not seeing it. Mostly reworked codespeak for market solutions that haven't worked, and likely never will work.

The reason why France pays less for better health care is the same reason why big corporations can provide goods at lower prices. It's amazing how so many right-wingers just don't get the concept of economies of scale when it's applied to health care...

KT:
"I might just take issue with the suggestion of some commenters that McCain is unique in introducing a free-market philosophy to this debate."

Fair enough. I was just trying to point out that there seems to be a pattern to McCain's policies - taking a bad situation, and then adding more free market to it.

It seems unimaginative to say the least, and judging from the other comments here (from people who obviously know a lot more about our health care system than I do) there's a good chance that his approach will be downright harmful.

Wow. For a brief moment there our very own conservative ideologue, QH, was interacting with us on a mature level! No bizarre rhyming or gratuitous, alliterative insults. Huh.

Anyways, I am not sure if this was posted before but I recommend everybody go watch this:

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

It is viewable online and is free. It provides a very interesting look at several different models of healthcare delivery.

I am especially interested in QH's opinion - as long as it is not in rhyming verse.

"...the unemployment rate doesn't have a thing to do with health care costs..."

Not an economics major, eh?

Some basic math, then:

1. Employer's taxes and overhead go up, by guvment mandate.

2. Employer cans 3 socialists, to make up for the higher costs.

3. Socialists take to streets, burn someone not Allah in effigy, and blame America.

4. NATO screams for help, they can't handle their own back yard, demands USA come to rescue.

5. USA comes to rescue, NATO stands down, USA gets to handle it all themselves all over again.

6. Euros vacation in Florida on cheap dollar, and buy your old house for 50 cent on the pretty greenback.

7. Red China opens up this week's 3 new coal powered electric plants. Al Gore blames Alabama hair curlers.

8. India opens their first Interstate highway, from Bangalore to Bollywood. First Responders everywhere cheer the coming unionization.

9. Bill Clinton does another intern. First Responders everywhere cheer the coming unionization.

10. See CANADA (and take a number).

"Perhaps maybe you aren't planning on making it to old age, but instead, will go the way of your mental comrade Timothy McVeigh?"

REVEREND WRONG HAS LEFT THE FOYER.

Shouldn't you be at the NAMBLA Meet Up or something else expensive?

The Folly of McCain-Care

Ahem. His windows of lucidity are always small.

KT:

I also don't agree that McCain ISN'T trying to push more free-market voodoo. It is clear from his website that he is.

The tax proposal is the only thing "radical" that I see in that it definately ISN'T free market stuff. Instead, it's a desguised handout to corporations similar in concept to donating money to a worthwhile cause in someone else's name. Of course, that "worthwhile cause" is the insurance companies.

Virtually NONE of his solutions are unique, havn't been tried, or benefit the 47,000,000 who don't have health insurance now.

Paul Daniel Ash:

I don't think he has more than one window of lucidity