Barack Obama's Healthcare plan

Senator Obama's long-anticipated healthcare plan has finally been released.

It's been receiving mixed reviews from people like Ezra Klein.

The two biggest complaints seem to be:

  1. It's not universal health care
  2. It doesn't do enough about private insurance companies.

Below I explain why these two concerns do not hold up after reading the plan, as well as a detailed look at the rest of the plan.

Cross-Posted from Daily Kos

These two complaints stem from the fact that Obama's plan doesn't contain as much (for lack of a better word) authoritarian mandates.

By authoritarian mandates, I mean mandates by decree. There are also mandates by circumstance. Let me explain the difference in the context of our energy problem and our desire to limit carbon emissions.

1. A law prohibiting the mining/drilling/burning of fossil fuels would be a mandate by decree.
2. If either
a) all fossil fuels have been used up
or [more likely]
b) a cheaper clean method of energy production has been devised
there would be a mandate by circumstance to limit mining/drilling/burning of fossil fuels

It's true that other than children (5), Obama's plan doesn't require people to be covered. However, it does provide people an affordable way to get health insurance.

Here's how it works:

Obama will make available a new national health plan which will give individuals the choice to buy affordable health coverage that is similar to the plan available to federal employees. The new public plan will be open to individuals without access to group coverage through their workplace or current public programs. It will also be available to people who are self-employed and small businesses that want to offer insurance to their employees. (3)

And here are the specifics (3-4) (although he of course doesn't have specific numbers regarding costs yet, those will come [note that Edwards plan doesn't have specific cost numbers yet either, just in case someone was planning to bash for that]

  • Guaranteed Eligibility-(obvious for a public plan, but still important)
  • Comprehenseive Benefits-similar to those in federal plan enjoyed by members of Congress; full coverage of preventive, maternal and mental health care, as well as " disease management programs, self management training and care coordination for appropriate individuals. "
  • Simplified Paperwork (emphasis on electronics to keep costs down)
  • Easy enrollment
  • Affordable premiums, co-pays and deductibles-"Participants will be charged fair premiums and minimal co-pays for deductibles for preventive services."
  • Portability-same insurance from job to job (also obvious and important, especially so these days)
  • Quality and Efficiency-Hospitals and providers participating will have to collect and report data to ensure that they meet standards for quality, administration and information technology
  • Subsidies-Of course important, because until people start getting fair wages, even non-profit health insurance will be too expensive for those on the lower end, but too affluent to qualify for Medicaid or SCHIP" These people "will receive income-related federal subsidies to keep health insurance premiums affordable.  They can use the subsidy to buy into the new public plan or purchase a private health care plan."

After reading this last line, you're probably crying "Corporate welfare! Corporate welfare!"

Well, not exactly. Of course, the subsidies for those who choose the public plan won't be corporate welfare.

But even for those who choose the private plan, it's not strict corporate welfare either. Yes, insurance corporations can get the money, but they have to meet an awful lot of standards to do it.

This is where Obama's regulatory commission, the "National Health Insurance Exchange" comes into play.

To provide Americans with additional options, the Obama plan will make available a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan.  The Exchange will act as a watchdog and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.  Through the Exchange, any American will have the
opportunity to enroll in the new public plan or purchase an approved private plan, and income-based sliding scale subsidies will be provided for people and families who need
it. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status.

 The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency.  Insurers would be required to justify an above-average premium increase to the Exchange.

In order to be eligible to accept clients receiving subsidies, an insurance company will have to meet these standards.

In fact, although it's not mandated by decree, in order to get clients who are eligible to receive these subsidies, an insurance company will pretty much have to meet these standards.

This is because almost everybody eligible for the subsidies will want to get those subsidies. If insurance companies refuse to step up and meet these standards, then that's fine. We'll just be that much closer to a single-payer system, as the tens of millions of uncovered Americans eligible for subsidies go with the new public plan.

Of course, even if they want to meet those standards, it's not going to be easy. They have to offer at least as much coverage as the public plan and meet the same quality and efficiency standards. In order to get access to those clients (or anyone else choosing to use the National Health Insurance Exchange), they'll have to give the same benefits in a more efficient/cheap manner than the federal government. Otherwise, they'll either have no profit margin or they'll be charging too much to compete with the public plan.

The Exchange would evaluate plans and make the
differences among the plans, including cost of services, transparent.

The federal government already does this sort of thing to a limited extent for some other industries (safety for auto industry, Energy Star for most appliances, etc.)

In recent years, the car insurance industry itself has sort of done something like this (or at least it seems that way based on the commercials; I don't drive so I don't know just how dishonest those compare-services are)

Of course, the health insurance industry hasn't, so the government needs to step in to allow people to make informed choices.

The final question: how is he paying for this? Several ways:

1. repeal of the Bush tax cuts on the wealthy

  1. Tax on employers not providing health insurance (4-5)
  2. Many, many cost-reducing provisions.

* Pushing for care management programs to eliminate duplicity in care for chronic illness-" More than half of Americans with serious chronic conditions have 3 or more different
physicians, leading to duplicate testing, conflicting treatment advice and prescription drugs that are contraindicated. " (7)

  • Disease Management Programs-75% of health care dollars are spent on those with chronic conditions; increasing use of these programs will improve quality and lower costs (7)
  • Pay for quality of care rather than just for quantity (7)
  • Institute for research on comparative effectiveness-This institute will guide research and reviews of the comparative effectiveness of different treatments and drugs (especially important for drugs; for one health problem, I was put on as many as 8 different drug regimens before one of them worked) (8)
  • Malpractice reform-Obama goes the progressive root on dealing with the rising costs of malpractice insurance (most Democrats don't seem to want to touch it, perhaps because the current system works well not only for insurance companies but for their top campaign donors as well). Obama's plan is to strengthen anti-trust laws to prevent insurance companies from overcharging doctors, and he'll also be promoting new models to address physician errors to make patients safer, strengthen doctor-patient relationships, and thus avoid the need for so many malpractice suits. Good for patients and doctors; awful for insurance companies, and slightly bad for trial lawyers (depending on how much error goes down) (8)
  • Take action against monopolies-"Barack Obama will prevent companies from abusing their monopoly power through unjustified price increases.  In markets where the insurance business is not competitive, his plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration."
  • Drug Reimportation-Obama's Secretary of HHS, will certify that safe drugs are safe and thus allow reimportation assuming the bill pending before Congress passes and nothing better happens in the meantime.
  • Generics-Obama will ensure market power doesn't keep generics out of the market
  • Allow negotiation with pharmaceutical companies for Medicare prescription drug plan
  • Cracking down on waste and abuse in the private plan alternative to Medicare
  • A strong emphasis on cost-saving prevention (after all, "an ounce of prevention is worth a pound of cure," that still holds true 250 years after Franklin said it).

Tags: 2008, Barack Obama, Election (all tags)

Comments

66 Comments

Great review.

Please rec all Obama supporters and non supporters as well.

I read it over at Daily Kos and was impress with your thorough analysis.

by lovingj 2007-05-30 04:12PM | login to reply | | 0 recs
This part is incorrect

He doesn't want to "repeal of the Bush tax cuts on the wealthy."

He wants to let them expire. A big difference, not least because they don't expire till 2010.

Edwards wants to repeal them.

by david mizner 2007-05-30 07:21PM | login to reply | | 0 recs
Re: This part is incorrect

Well, it depends on when the plans are promised to go in effect, and how they plan to pay for them as they go. Such finer details I haven't seen in any of the plans from the front three (except that Edwards said they aim to achieve universal coverage by 2012). Please illuminate if you know better, with links, quotes and such.

by nuevoliberal 2007-05-30 10:09PM | login to reply | | 0 recs
Re: This part is incorrect

Since we could not even begin to start repealing tax cuts before 2009 there is little actual difference between Edards and Obama on taxes.

Why fight a battle that you are going to win anyway by default?

by sam i am 2007-05-31 12:11AM | login to reply | | 0 recs
Re: This part is incorrect

Of course, the Edwards plan calls for rolling back the Bush tax cuts on incomes over $200K, and Obama for allowing tax cuts to expire on incomes over $250K.

Bear in mind, under a marginal tax system, that means that the revenue from the higher rate is collected on people with incomes between $200K and $250K, and for everyone with incomes above $250K, that collects an additional:
* rate_increase x $50,000

Of course, Obama's plan is able to cut its revenue requirements substantially, compared to Edwards plan ... down to $50m to $65m (I presume externally costed, I presume in 2007 dollars), as opposed to the external costing of Edwards plan $90m to $120m in 2007 dollars.

Some of the ways they do that are by leaving, they estimate, 15m uncovered (according to what Obama staff has told Jonathon Cohn at TNR) and by putting the "pay" side of the employer pay and by increasing the premium payments by individuals by having the "play" side go into the public plan, rather than into supplementing the individual premiums in the Health Market, as in Edwards plan.

by brucemcf 2007-05-31 06:49AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

Thanks for that run-down.  It'll be interesting to see the economic ramifications of having a public run health care system compete to improve private health insurance.    

by jeremiahthemessiah 2007-05-30 04:19PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

It's not a public run health care system though is it?

If it's similar to the federal plan, then you're still choosing a list of private plans right?
Also only certain people are eligible for the public plan.

by adamterando 2007-05-30 06:44PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

That's right ... none of the plans rely primarily on government delivered health care ... not Obama's, not Edwards, not the Medicare for All advocated by Kucinich. They all are providing coverage to allow access to health care.

The open questions are whether the coverage provided is adequate to actually provide for universal health care.

by brucemcf 2007-05-31 06:51AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

Much quieter over here...

I think the mandate question is going to be interesting.  It's such an obvious low-hanging fruit (you could easily add a caveat that all the plans have to be in place and working, as Edwards does) that I imagine Obama left it out intentionally.

I really like two elements:  the national Health element, rather than states (I don't trust MS) and the catastrophic coverage by the government (which will really help lower premiums in private plans).

Hey, actual policy discussion!

by rashomon 2007-05-30 04:34PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

I think it would be interesting to go over some of the key differences between the Edwards and Obama health care plan.  

Now, if I am wrong about something, please correct me.  I am going with from what I have read, but I haven't gone extensively into this.  

--Edwards' health care is a requirement, whereas Obama's health care is a choice.  

--Edwards' health care plan creates regional public systems, whereas Obama's has one big public system.  

--Obama's plan goes after malpractice reform, Edwards' plan doesn't.  

--Obama's plan creates a "National Health Insurance Exchange" as a watchdog to private companies... Didn't see anything like this for Edwards.  (Again, correct me if I'm wrong).

--Obama's plan gives estimates, whereas Edwards plan doesn't give numbers.    

Those were the big differences I noticed, assuming what I have read is correct.  Comments?  Corrections?  Additions to the list?  

by jeremiahthemessiah 2007-05-30 04:55PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

Edwards' health care is a requirement, whereas Obama's health care is a choice

That's what I like the most.

by obamaedwards2008 2007-05-30 05:10PM | login to reply | | 0 recs
You'll get an argument...

and a fair one, IMHO, that a true "universal" plan MUST mandate coverage for everyone.  My belief is that Obama wants to set up the system and fill in the gaps as needed, whereas Edwards is calling for an explicit (only partially funded) mandate in his plan.

by rashomon 2007-05-30 05:12PM | login to reply | | 0 recs
Re: You'll get an argument...

Edwards has said that he would fund his plan by raising taxes:

"Yes, we'll have to raise taxes. The only way you can pay for a health care plan that costs anywhere from $90 [billion] to $120 billion is there has to be a revenue source," the former North Carolina senator said....

Edwards said he would free up money for health care coverage by abolishing President Bush's tax cuts for people who make more than $200,000 a year and by having the government collect more back taxes. On war in Iraq, Edwards sought to differentiate himself from another leading candidate, Senator Hillary Rodham Clinton of New York.

Note this was released in February.  He's the only candidate willing to talk about tax increases, and I don't mean repealing the Bush tax cuts.  There's this aversion to raising taxes, but in this case raising txes will put money into the pockets of working Americans.  Because high healthcare premiums from private insurance plans are every bit as much a drain on people's wallets as taxes.  And if people have to pay $200 more in taxes a year, but pay $2,000 less for health insurance, that puts $1,800 back into that families budget.  It saves them money in the end.

by manfrommiddletown 2007-05-30 05:51PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

Obama's plan has a catastrophic coverage component by the government...similar to what Kerry proposed in 2004.   I didn't see that in Edwards' plan.

by rashomon 2007-05-30 05:10PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

That has never really hit me.  I've heard it a couple of times, but I think the wording almost forces me to day-dream about something catastrophic or... Who knows.  Could you ellaborate just a tad on what the point of catastrophic coverage is and what it does?  

by jeremiahthemessiah 2007-05-30 05:14PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

It is designed to take claims for mega expensive procedures like cancer treatments, open heart surgery, premature babies, major car accidents ala Jon Corzine, etc out of the private system and have them insured by the federal government.  It basically makes the fed govt a reinsurer for these claims.  Since 30% of the people spend 70+% of health care dollars, this theoretically should bring down insurance premiums significantly.  

by john mills 2007-05-31 04:09PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

having worked in a healthcare dealing with products that treated a chronic health condition, that this purposely funnels liability for catastrophic coverage onto government books seems like an incentive for them to dump the most sick onto government books.

More seriously, I think that with the chronic conditions like diabetes there's also a possibility that insurance companies will not cover the cost of testing supplies, but will continue to offer coverage.  Which means that you create a situation in which a person is ineligible for the government plan because they have coverage that doesn't cover testing supplies through their employer.  So because they are unable to pay for testing supplies, they'll end up using the emergency room to receive treatment at tremendous economic  and human cost rather than being able to use self testing to prevent hypoglyemic incidents (which are terrifying particularly for kids.)

by manfrommiddletown 2007-05-31 02:54AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

This scenario doesn't make sense on a host of levels.  

For one thing, Obama establishes the federal employees plan as the base plan for all private insurance and as a former federal employee I can tell you this is a comprehensive benefit package that covers diabetic testing supplies as well as the medication to treat it.

Also, if, as under your scenario, a private plan cannot put someone with diabetes into the catastrophic pool, it doesn't make sense to deny coverage of testing supplies which are relatively inexpensive and have these people in emergency rooms which are very expensive.  Even if they could put them in the pools, there is usually a minimum coverage which has to be met by the private insurer.  For example, in most reinsurance cases, which is what this would be, the fed govt covers everything over say $25K so the cost of running up the ER claims up to this amount would far outstrip the cost of the diabetes testing supplies.  

Also, diabetes can be controlled with good disease management that emphasizes proper medication/testing, diet, and exercise.  One of my pet peeves with our current health system is that it sucks at treating chronic conditions like diabetes, asthma, hypertension, etc.  This really isn't that hard, improves the lives people living with the diseases and saves a ton of money.

by john mills 2007-05-31 04:29PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

I've seen private insurance in action working on the floor in a call center dealingwith diabetics, they aren't going to committ to covering diabetic testing supplies, and the plans that do will undoubtedly cost more.  Likely placing them out of reach of many lower income worker.

Access alone isn't enough. Price matters.  If workers face a premium that's a quarter of their income, they aren't going to get health insurance.  Reinsurance seems like a great idea, but I'd say that the pooled insurance plans that home insurance companies face in Florida give us a good idea of how this will work in action.  Which is to say that premiums will be high, and companies will avoid paying bills do like the plague.

by manfrommiddletown 2007-06-01 03:19AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

A couple of thoughts - I am not sure the reinsurance idea will work either.  It should in theory but I am skeptical it will in practice.  

I also work in health care and many insurance policies cover diabetic testing supplies and Obama's plan of using the fed plan as a base would guarantee coverage of them.  Virtually every state has an appeals process for denied benefits (some are better than others) and if people are actually being denied this coverage, they should file an appeal.  The process in most states requires a letter along with denial documentation to the Department of Insurance or regulating body.  

by john mills 2007-06-01 06:25AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

"Virtually every state has an appeals process for denied benefits (some are better than others) and if people are actually being denied this coverage, they should file an appeal."

And how many working people living on the edge of poverty have the time/will/or knowhow to go through this process?

by adamterando 2007-06-01 06:33AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

The point is that there are recourses if people are not being provided with access to their health coverage.  No system is perfect and while there are major issues with private insurance even Medicare denies claims wrongly at times which is why it also has an appeals process for people to contest those decisions.  Do you think the only Medicare beneficiaries who contest decisions are wealthy?

There are ways to make people more aware of their rights such as notifications to all beneficiaries and allowing advocacy groups to have stations in social service offices, hospitals, medical clinics, etc.  Just because you are poor or not knowledgeable does not mean you have to be denied access to your rights.

by john mills 2007-06-01 07:41AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

Have you ever read Kafka?

I think he made a far description of the way that an impersonal bureaucracy like modern (for-profit, no one ever talks about how the insurance industry was until very recently not for profit) insurance works.

It's all good and well to say that people can appeal to the Department of Insurance, but for those who need it most this makes no difference.  

Many chronic diseases (in particular diabetes) are endemic in low income and minority populations where lack of access to affordable food that isn't loaded with sugar and simple carbohydrates has created an epidemic.

I'll give Obama this, this national health insurance exchange idea might make insurance more transparent, but if you have to sort through 7,000 plans it makes no difference.  I think that we have to transition to a single-payer government run plan that expands off Medicare in the long term.  

But in the short term I think that we should reduce the burden on consumers by forcing the standardization of insurance plans into a set of 4-5 plans that offer the exact same coverage.  So that way the consumer only has to choose between 4-5 plans instead of 7,000.

The mess that is the Medicare prescripton drug benefit should serve as a cautionary tale of the dangers of allowing insurance companies to write thousands of different plans.

Back to the idea of strandardization, I'd say put it on a grading scale.  Medicare or equivalent is an A-plan, and so on down to junk D and F plans that cover virtually nothing.  It's intuitive.  No one wants to buy grade D eggs at the grocery store, I think that will work for insurance also.

by manfrommiddletown 2007-06-01 07:46AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

"But in the short term I think that we should reduce the burden on consumers by forcing the standardization of insurance plans into a set of 4-5 plans that offer the exact same coverage.  So that way the consumer only has to choose between 4-5 plans instead of 7,000."

This makes a lot of sense.  I have no problem with a single payer system - in fact it makes the most sense. However, I have worked on healthcare/health policy for 15 years and the chances of it happening are slim due to political will/new winners and losers issues.  In fact, all the candidates are proposing modified versions of the Health Alliances from the Clinton plan of 1993-94.  It's not perfect but it is a huge improvement over the current system.

by john mills 2007-06-01 07:54AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

The Clinton's were never able to create a political coallition that united large trade unions and large manufacturers like GM.  I tihnk that Edwards plan can.

Already, there's talk that Cerebrus is making an offer to the UAW for workers employed at Chrysler to tranfer healthcare costs to the union in exchange for the company creating a funded VEBA.  The Steelworkers just made a similiar deal with Goodyear.

So I think that Edward's plan anticipates that in the next few years, you could use his open enrollment Medicare based plan to transition union workers to public healthcare.  This takes a group that traditionally has seen universal healthcare as a possiblity to get screwed (union workers took lower wages in exchange for health care, if you unload their healthcare off onto a system that they have to pay into, you're stealing from them) to something that the union is going to decide for them.

I have a strong feeling that Bonior was involved in this.

by manfrommiddletown 2007-06-01 08:09AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

Hopefully you are right.  THe piece people miss is there are a tens of millions of jobs in health care from hospitals to doctors offices to device manufacturers to pharmaceutical companies, etc.  Any changes create new winners and losers in this industry.  All you have to do is look at the beating Eliot Spitzer took when he tried to move state health money around to expand health insurance for children in NY to see how hard this is politically.  People ignore this part pretty regularly when taking about universal coverage and it is a mistake.  

by john mills 2007-06-01 10:10AM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

The estimated cost of Obama's plan, according to each campaign, is 50-65 billion (Obama's) compared to 90-120 billion for Edwards. That's an enormous difference; Edwards is planning on spending almost twice as much as Obama. That's partly because Edwards's plan covers everyone, and party because Edwards is being more honest about the cost.

by david mizner 2007-05-30 06:09PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

I messed up the wording. Obama says his plan will cost 50 to 60 billion and Edwards says his plan will cost 90-120 billion.

by david mizner 2007-05-30 06:13PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

Obama does not have one big public system. It maintains the private patchwork of insurance plans and then works to fill in the gaps. Edwards will also keep the private insurance companies, but they will have to compete with the one big public system that is like medicare plus.

In addition the regional health markets act as a gateway that insurance companies must compete in order to participate. Thus, in order to provide coverage to people, they will have to be able to compete with the government plan and so in effect, individuals will have as much market power as the largest corporations in this country.

by adamterando 2007-05-30 07:23PM | login to reply | | 0 recs
This is a good review

but I think that Obama's plan has serious flaws.

Now to be honest, no candidate is offering a plan for an immediate transition to a single payer plan.

And internationally, singler payer government insurance is the conservative position.  Ezra Klein did a series he called Health of Nations in 2005 comparing the healthcare systems in Canada, the UK, Germany, France, and Japan.  Japan is a special case, but for most industrialized nations healthcare falls into one of two categories.

1.  National Health Insurance-France, Germany, Canada.  There's a public healthcare plan that gives everyone medical care.  It's common for employers to offer supplemental insurance as a benefit.  The hospitals and clinics are privately owned.

2. National Health Service- Britain and Spain fall into this category.  In this system the government actually owns the hospitals and clinics employinh doctors directly.  There is a small private sector that works on self pay or supplemental insurance.   This is socialized medicine.  Having been to the emergeny room while in Spain (I passed out because I was dehydrated.) I have to say that the care was excellent.  The hospital was sparse but functional, no fancy decorating, just cinder block walls.  I had blood work, xrays, and three stitches.  €120, or about $160 at current exchange rates.  And this was the total cost without insurance coverage.

Coming back to Obama's plan I have two major criticisms: Public vs. Private plans, and entitlements vs. means tested programs.

On the first, Obama's plan envisions far less of a role for a public run plan than Edward's plan.  Edward's plan calls for a publically run plan to compete against private insurers.  Seeing as Medicare's overhead is a third that of private plans it's not hard to see this as leading to most people being on a public plan in the long term.  But, it allows for private negotiation that allows workers who receive healthcare benefits as a the result of a contract (instead of receiving equivalent wages) to transition to the new public paln as contracts come up.  And as a result exchange insurance benefits for higher wages.  This matters a great deal for unionized workers. Obama's plan does have a public component, but when he says that all Americans will be able to buy the same healthcare plan as Congress, he's not clear whether this plan will be publicly or privately run.  The latter would appear to be the case. Nor does Obama say at what cost individuals will be able to buy into the plan.  Remember Medicare's overhead is a third that of private insurance.

The second criticism that I would make follows on this.  Under Edwards plan, entrance into the publicly run plan would be an entitlement.  It's like Social Security, everyone is allowed to take part, there are no income restrictions. Under Edwards plan you have a right to public healthcare coverage regardless of how much money you make.  In contrast, Obama's plan calls for means testing to opt in to the public plan, so that the healthcare is not a right, it's something you receive assistance with only if you're under the income guidelines.  History teaches that universal entitlements like Social Security are much more politically durable than means tested programs like Welfare.  

And entitlement program like Edwards envisions is unlikely to be killed by subesequent Republican administration's.  Obama's means tested plan is highly likely to be cancelled by a GOP admnistration.

Obama has emphasized market solutions here, rather than social solutions.  This is a turn away from one of the key planks of the Democratic party platform since 1948.

by manfrommiddletown 2007-05-30 05:19PM | login to reply | | 0 recs
Re: This is a good review

On a third reading, it looks like on page 3 he says that the public plan won't be means tested, but will not be open to individuals who have coverage through their workplace.  

I forsee this to be a huge problem, because it can lock out individuals from effective coverage, because their employer offers access to a junk insurance plan.  This is really common anymore, particularly with temporary workers.  Much of the time, these junk insurance plans don't cover for chronic healthcare costs like diabetes testing.

So in this case, you could have a company offer junk coverage to employees who would be eligible if it were strictly means tested.

So say you have a single mother with $1200 gross income, and the junk insurance plan offered through her employer is $300/month for her and her 3 children.  Obviously, that's not going to be an option for most, but they're also going to be locked out of the public plan.  This does nothing to insure workers trapped in precisely this position.  It's actually places an incentive for the mother to quit her job, and live on welfare if she's got a kids with Type I diabetes or another chronic illness.

by manfrommiddletown 2007-05-30 05:42PM | login to reply | | 0 recs
Re: This is a good review

Do you enjoy responding to yourself?

by obamaedwards2008 2007-05-30 09:52PM | login to reply | | 0 recs
Re: This is a good review

I thought that I said something that may no be accurate, and wanted to offer a clarification.

Would you rather that I make no attempt to admit a possible error in what I said?

by manfrommiddletown 2007-05-31 02:42AM | login to reply | | 0 recs
Re: This is a good review

Maybe it is a good thing to have a market based solution.  We are not going back to FDR or 1948.  Keynes is dead.

Can a bonafide progressive direct a  market based solution for the public good?

I think so.

Remember this isn't your Bush medicare/prescription plan.

by aiko 2007-05-31 04:15AM | login to reply | | 0 recs
Re: This is a good review

We are not going back to FDR or 1948.  Keynes is dead.

We're not going back to the 1980-90s, either.  Reagan is dead.  It's time for something new.

by jallen 2007-05-31 04:19AM | login to reply | | 0 recs
Re: This is a good review

Oops, meant to include Reagan in the first sentence, say Friedman is dead.

by jallen 2007-05-31 04:19AM | login to reply | | 0 recs
Re: This is a good review

Fuck it.  I've had 6 hours of sleep in the last 70 hrs, I can't put together a coherent thought.

by jallen 2007-05-31 05:14AM | login to reply | | 0 recs
Re: This is a good review

The logic of the market destroys what's human, because it places profits before people.  Remember that in insurance, the market says that having a policy holder die before they collect benefits is a positive thing.

The market has to be subjugated to human needs, and that can only work it the people making the decisions are subject to democratic control.  The market is a clever way to evade democratic control and social obligation, and pretend there's something natural about it.

by manfrommiddletown 2007-05-31 04:29AM | login to reply | | 0 recs
Re: This is a good review

The market isn't going to magically go away. It is here to stay. We have to find ways to make it work for the public good--to embed a social conscience.

You may think that naive but I think pining for the past is a losers game.

by aiko 2007-05-31 08:08AM | login to reply | | 0 recs
Re: This is a good review

And the market isn't going to stop being embedded in a social context because neoliberal economists say so.

I don't think that what you're saying is naive, I think that it turns you into a collaborator with the system that kills 18,000 prematurely every year.  

I know you're a student right now, believe you me, once you get out into the real world any illusion that you might have that the world actually works the way economist think it does will dissappear.

by manfrommiddletown 2007-05-31 08:14AM | login to reply | | 0 recs
Re: This is a good review

Maybe it is a good thing to have a fascist state. We are not going back to Jefferson or 1776. Rousseau is dead.

Maybe it is a good thing to have slavery. We are not going back to Lincoln or 1863. Frederick Douglass is dead.

by adamterando 2007-05-31 04:40AM | login to reply | | 0 recs
Re: This is a good review

In a perfect world, a single payer based system would be the most logical solution.  However, having worked in Congress on the Clinton health plan I know it is not going to happen due to the politics so a market based approach is fine by me.

I believe achieving universal coverage is more important than being wedded to single payer and I applaud Obama, Edwards, Massachusetts and everyone else who is attempting to move us in this direction.  It is a crime that we are the only first world nation that doesn't provide all its population with health care coverage.

by john mills 2007-05-31 04:47PM | login to reply | | 0 recs
Germany Does Not Have A Single Payer System

Germany has universal coverage but does not have a national health insurance plan like Canada and France.  It is a private based system.  See the first paragraph of the Germany section of Ezra Klein's article -

"The German system offers a possible model for those who want to retain the insurance industry but end its ability to profit by pricing out the sick and shifting financial risk onto individuals. The German system's insurers are 300 or so different "sickness funds" that act both as both payers and purchasers for their members' care. Originally, each fund covered only a particular region, profession, or company, but now each one has open enrollment. All, however, are heavily regulated, not for profit, and neither fully private nor publicly owned. The funds can't charge different prices based on age or health status, and they must continue covering members even when the members lose the job or status that got them into the fund in the first place. The equivalent would be if you could retain membership in your company's health-care plan after leaving the company."

by john mills 2007-05-31 04:41PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

Obama intentionally does everything intentionally.  Does that make sense?

by aiko 2007-05-30 05:19PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

He's baaaack... Welcome back ByronLuntz.

by vox populi 2007-05-30 07:17PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

No way is DL the same as BryonLutz of myDD. Are you trying to smear DL or do you have anything by way of substance?

by nuevoliberal 2007-05-30 09:09PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

It was BryonLuntz, I don't think it's a far cry to assume they are the same...

by vox populi 2007-05-30 09:30PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

I think it was BrionLutz.  It was definitely Lutz.

by jallen 2007-05-30 09:33PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

It was BrionLutz (as JA pointed out).

Now its time an apology to DL for attempted derision (and a rude welcome on top of that).

by nuevoliberal 2007-05-30 09:56PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

I didn't realize you were the certified polite police.  I'm glad you find it appropriate to tell me what to do.

by vox populi 2007-05-31 01:44AM | login to reply | | 0 recs
Its not universal

You can't apoligize that away.

Its simply not a universal plan and Barry can't hide that with a speech no matter how hard his handlers try to package it.

by dpandrews 2007-05-30 08:37PM | login to reply | | 0 recs
Re: Its not universal

It's better than Monica, no Paula, I mean Hitlery Clinton has.  We know she is the queen of Health Care.  She is so great Newt and the Republicans took over Congress on her hubby's watch and it took this long for the Dems to recover.

What really did happen to Vince Foster in that park?

by lorraine 2007-05-30 08:58PM | login to reply | | 0 recs
Re: Its not universal

Everyime you call him "Barry" I am going to troll rate you.

by korha 2007-05-31 08:28AM | login to reply | | 0 recs
Thats sad.

Really sad.  You are sad.

by dpandrews 2007-06-01 09:56AM | login to reply | | 0 recs
Excellent article on New Republic

about Obama's plan:

http://www.tnr.com/user/nregi.mhtml?i=w0 70528&s=cohn053107

it explains clearly why most progressive health care experts feel mandates are essential to achieve universal health care.

Overall its a positive thorough review that finds that its a rather tentative plan with gaps that apparently will be filled in later.

registration required for the full article - if you havent registered to do so.

by okamichan13 2007-05-30 10:35PM | login to reply | | 0 recs
on mandates:

"The best studies out there--by Urban Institute researchers, the RAND Corporation, and MIT economist Jonathan Gruber--suggest that, without a mandate, improving affordability will cover roughly one-third of the people who don't have coverage. Mandating that kids (but not adults) have coverage bumps that up to about a half. Obama's advisers think that, by really loading up on the subsidies--and making enrollment a lot easier by, for example, having an automatic enrollment with voluntary opt-out at your place of work--they can goose that up to two-thirds. But that's getting optimistic--and, even then, you still have around 15 million people who are uninsured.

In other words, the "mop-up" job at the end would quite likely be more than a mop-up. It'd be a substantial task, maybe even a huge one. That's why most health care experts believe you can't get that close to universal coverage without some sort of a mandate."

by okamichan13 2007-05-30 10:42PM | login to reply | | 0 recs
Re: on mandates:

If mandates do not matter, why is coverage for children mandated?

In addition:

But some experts said the plan was short on specifics, particularly regarding the hoped-for savings and the costs of providing coverage to the estimated 45 million uninsured.

"The numbers don't seem to work very well," said health policy analyst John Sheils, senior vice president of the Lewin Group, a top healthcare consulting firm. "I think [the savings] are just dramatically overstated."

Consultants to Obama said in a memo released by the campaign that $200 billion or more in annual savings were possible through a combination of changes to increase efficiency, including converting to electronic medical records, better coordination of care for patients with chronic illnesses such as diabetes, and a dramatic reduction in duplicative tests and medical procedures of dubious benefit.

But Sheils said most major employers and government healthcare programs were already pursuing such reforms, and the jury was still out on how much money could be saved. Moreover, some of Obama's proposals would require doctors to change the way they treat certain medical conditions, a reeducation process that could take years.

"They don't explain how they are going to get at the inefficiency," Sheils said. "I don't see anything [in Obama's plan] that changes the fundamental incentives of the system."

http://www.latimes.com/news/politics/la- na-healthpol30may30,1,2889575.story?coll =la-headlines-politics&ctrack=2& cset=true

by citizen53 2007-05-30 11:30PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

I like what I'm seeing of Obama's plan so far. I agree that there should not be a mandate to cram everybody into government insurance. Anybody lacking insurance or unhappy with their private plan can get quality coverage this way, while people who like their current coverage can stick with it. Even those who choose not to join the public plan will benefit from the competition between the government and private sector, which should stabilize or even reduce private insurance premiums.

by officeoflife 2007-05-31 04:23PM | login to reply | | 0 recs
Nice wording

"mandate to cram everyone into government insurance"

thats an interesting take on things, do you work for an insurance company?

by okamichan13 2007-05-31 05:34PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan

"Anybody lacking insurance or unhappy with their private plan can get quality coverage this way,"

No, that is incorrect. If you are unhappy with your private plan (which most people would get through their employer), you are stuck with it. Only those that can't get coverage through work or are self-employed would be able to get access to the federal plan (which itself would be a set of choices of private plans I believe).

by adamterando 2007-05-31 05:52PM | login to reply | | 0 recs
Repost

Reposting what I had just posted in another diary, as it is relevant here as well:

I thought that Obama's concept of a national healthcare exchange, on top a national public health plan, was a very interesting one. It places a regulated market alongside the unregulated one and encourages a reform of the latter system. Kudos to the person/team/Obama that formulated and worked on the idea:


    (2) NATIONAL HEALTH INSURANCE EXCHANGE. To provide Americans with additional options, the Obama plan will make available a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.

   Through the Exchange, any American will have the opportunity to enroll in the new public plan or purchase an approved private plan, and income-based sliding scale subsidies will be provided for people and families who need it. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status.

   The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency. Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange would evaluate plans and make the differences among the plans, including cost of services, transparent.

A couple of suggestions for possible improvement that I have are these:

  1. allow companies also to purchase group coverage through at the exchange
  2. allow individuals to shift their 6% payroll deductions from their company plan to either the national plan or purchase something via the exchange.

I encourage everyone to download and read Obama's full plan from here, regardless of whether they plan to support Obama for 2008 or not.

ps: I also thought that Hillary's arrogant and patronizing response to Obama's plan was uncalled for, and unbecoming.

by nuevoliberal 2007-05-31 05:56PM | login to reply | | 0 recs
Re: Repost

How does this encourage reform of the unregulated market?

by adamterando 2007-05-31 06:29PM | login to reply | | 0 recs
Re: Repost

it can encourage competition under stricter terms. When there is market and money can be still made (perhaps by running a more efficient operation, which is good in its own right), there will be  insurers interested in joining the pool.

I am guessing that this would work like a commodity/stock exchange where the commodity is healthcare.

by nuevoliberal 2007-05-31 06:51PM | login to reply | | 0 recs
Re: Repost

Thanks.

by adamterando 2007-05-31 07:03PM | login to reply | | 0 recs
More than a few people.

This has so many holes.  Doesn't give Universal health care to all Americans.  Will not control the costs.  This will be a nightmare

by lindasfnm 2007-05-31 06:31PM | login to reply | | 0 recs
Re: Barack Obama's Healthcare plan
FlonaseacyclovirUltracetProzac
by pit 2007-06-01 01:58AM | login to reply | | 0 recs

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