Thanks to a very high Google ranking this has been the most popular ever post on THCB. And it's an excellent analysis by Robert Laszewski. who writes The Health Policy and Marketplace Blog. However, it was written during the Democratic primaries in 2008 and is of course out of date. THCB suggests that you checkout a few other intriguing posts too.
For more recent posts on health care reform, try a smattering of these:
- Health Reform and Obama's Leadership by Rahul Parikh
- The Affordability Model by Robert Laszewski
- No Country for Old Men by Jeff Goldsmith
- Two Rules by Which to Judge a Health Reform Bill by Matthew Holt
- Ditching the Public Option by Robert Laszewski
- No Alternative: An Analysis of the GOP Plan by Harris Meyer
and of course enjoy Bob's analysis too!:
Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.
The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.
By contrast, the McCain Republican strategy for health care reform would first emphasize market reforms aimed at making the system affordable so more Americans can be part of the system and he claims that there would be no additional upfront cost.
Obama breaks his health care reform plan down into three parts saying that it builds “upon the strengths of the U.S. health care system.”
The three parts are:
1. Quality, Affordable & Portable Health Coverage For All
2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
3. Promoting Prevention & Strengthening Public Health
Obama claims that his health care reform plan will save the typical family up to $2,500 every year through:
* Health information technology investment aimed at reducing unnecessary spending that results from preventable errors and inefficient paper billing systems.
* Improving prevention and management of chronic conditions.
* Increasing insurance industry competition and reducing underwriting costs and profits in order to reduce insurance overhead.
* Providing reinsurance for catastrophic coverage, which will reduce insurance premiums.
* Making health insurance universal which will reduce spending on uncompensated care.
Will Obama be able to cut the typical family’s health care costs by $2,500 a year?
Well, yes and no.
All of the candidates, Republican and Democratic, are calling for most of what is on the Obama cost containment list; expanding health information technology, improving prevention and better management of chronic conditions, and a more vibrant health insurance market.
Obama is unique in calling for catastrophic reinsurance coverage in order to reduce the cost of family health insurance. Really, this is not a cost reduction but a cost shift. This idea, first proposed by Senator Kerry in his failed bid for the presidency, would have the federal government absorb a large portion of the highest cost claims thereby taking these costs out of the price of health insurance. That would reduce the price of family health insurance but would also increase federal spending by the same amount. It would also water down the incentive for insurers and employers to manage these claims since most of these costs would be transferred to the government.
Obama’s assertion that covering more people would reduce the overall cost of insurance is likely correct because it would mean less uncompensated care that would have to be shifted onto the rest of the system. Hillary Clinton would cover at least as many people as he would so there is no advantage for Obama here. Since the McCain health plan emphasizes making the insurance system affordable before ensuring widespread coverage as the first priority, one could argue that both Obama and Clinton would make gains toward near universal care well before McCain.
In the end, Obama’s claim that he would save families $2,500 every year are based upon a number of initiatives that the other candidates also argue that they will undertake. More, these ideas, such as health IT and prevention, are under way in the market anyway.
The only real difference between Obama and Mrs. Clinton over cost containment is his catastrophic reinsurance idea that isn’t so much a cost saver as a cost shifter.
Obama’s claim that he would save $2,500 per family beyond a simple cost shift to the federal government of large claims is unsubstantiated.
When compared to Hillary Clinton, the biggest difference is that Obama does not mandate that all adults have health insurance and Clinton does. In my mind, there is actually little or no difference between the two candidates on this point because the real issue in getting everyone covered is to make health insurance affordable—not whether it is required or not. I did a full post on this topic that you can access here.
Let’s take a look at the three main parts of the Obama health plan:
1. “Quality, Affordable & Portable Health Coverage For All”
Obama follows the Democratic health care template by building on existing private and public programs such as employer health insurance, private individual health insurance, Medicare, and Medicaid. This is unlike the Republican approach that would refashion the private market by providing incentives to encourage a reinvigorated individual health insurance platform focused on personal choice and responsibility (see McCain post).
Obama’s key components here include:
* Establishing a new public program that would look a lot like Medicare for those under age-65 that would be available to those who do not have access to an employer plan or qualify for existing government programs like Medicaid or SCHIP. This would also be open to small employers who do not offer a private plan.
* Creating a “National Health Insurance Exchange.” This would be a government-run marketing organization that would sell insurance plans directly to those who did not have an employer plan or public coverage.
* An employer “pay or play” provision that would require an employer to either provide health insurance or contribute toward the cost of a public plan.
* Mandating that families cover all children through either a private or public health insurance plan.
* Expanding eligibility for government programs, like Medicaid and SCHIP.
* Allow flexibility in embracing state health reform initiatives.
Obama would also mandate guaranteed insurability, a generous minimum comprehensive benefits package such as that required for federal workers, the ability to take their policy from one job to another (portability) when it is purchased through the new Medicare-like public plan or the "National Health Insurance Exchange," and he would require providers to participate in a new plan to collect and report data about standards of care, the use of health information technology, and administration.
How would Senator Obama do on improving coverage for all?
This is the section that separates him most from Senator McCain—while being very similar to Senator Clinton’s health care plan.
In Europe they have a way of explaining the general philosophy toward universal health care for all. You often here the term, “solidarity.” The concept implies that everyone is in it together—all are covered in the same pool and share the burden equally.
Democrats, like Obama and Clinton, tend to make an Americanized attempt at health care solidarity by crafting a structure that ensures everyone will be covered, not by a single government-run plan but by guaranteeing access to a mix of government and private plans. Clinton and Obama both understand that the vast majority of Americans are not ready to give up their private health insurance plans and that creates a political imperative to continue making private health insurance a part of any “unique American solution.”
Republicans, like McCain, on the other hand, build their health reform plans on the classic American foundation of “rugged individualism” promoting choice and personal responsibility.
Therefore, the Obama and Clinton plans put as their first priority getting everyone in the system by spending lots of money up front to ensure that everyone can afford a benefit rich traditional private plan—or have access to a public plan. Clinton admits her plan would cost at least $100 billion a year while Obama claims his plan will cost half to two-thirds of that.
Since there is little policy difference between the Clinton and Obama plan there cannot be much cost difference either.
McCain argues that we already spend too much on health care and says his plan will not cost more than that since he will rearrange existing tax benefits to provide the incentives and support necessary for a more efficient system. It is hard to see how McCain can rearrange the existing employer tax benefits those who are insured now get, reapply them on an individual basis to those same people and also have enough money to provide assistance for the millions of uninsured who get no such tax benefits today.
Obama sets as his goal quality, affordable, and portable coverage for all.
Let’s take them one at a time:
* Quality- Obama’s quality initiatives look a lot like Clinton and McCain’s as well as those things that are going on in the market anyway. All good points—but no advantage here or expectation there will be quick savings.
* Affordability – Like Clinton, affordability is more about shifting the cost of insurance to the government then it is making a more efficient U.S. health care system. Health insurance is more affordable for people because he spends many billions of dollars subsidizing access for everyone.
* Portable Health Coverage For All: While Obama does not have an individual mandate to purchase health insurance; it is likely that he would cover as many people as would Clinton because he argues he makes coverage affordable for about as many as Clinton claims to. Compared to McCain, he puts far more emphasis on getting people covered upfront.
Obama would be successful in getting most of the uninsured covered and securing coverage for those that now have it. But when it comes to crafting a system that will not continue to outstrip the rest of the economy in what it costs, I see no evidence that he has tackled the drivers in health care costs—in fact he has likely poured some highly inflationary “gas on the fire” by adding tens of billions more to the system with no effective cost containment features to offset the new inflationary pressures.
2. Modernizing The U.S. Health Care System To Lower Costs and Improve Quality
Obama would argue that I am wrong about the notion that he has no effective cost containment ideas. In this section of his plan he argues he will contain, if not reduce costs, with a long list of proposals.
He would reinsure employer plans for a portion of their catastrophic costs. This would reduce employer costs but it would do so by simply shifting them onto the government. He runs the risk of shifting these costs away from a market that now has incentives to manage them to a big government program that likely will not have the same incentives to confront and manage them. I don’t see this as cost saving as much as just cost shifting.
Obama goes on to outline a long list of quality initiatives that include disease management programs, coordinated care, transparency about cost and quality of care, improved patient safety, aligning incentives for excellence, comparative effectiveness reviews, and reducing disparities in health care treatments for the same illness.
McCain and Clinton have virtually the same list—all good ideas and all things the market has been tackling for years with only incremental success. The notion that Obama will suddenly make any or all of these more successful than others have with all the billions spent on such programs in recent years constitutes a leap of faith. Why will Obama be any more successful in this area than any other candidate or than those who have been tackling these things for years—no new ideas here and no cost containment “silver bullet?”
Obama would also reform the medical malpractice system by strengthening “antitrust laws to prevent insurers from overcharging physicians for malpractice insurance.” Clearly a malpractice reform strategy supported by the trial bar! He also makes a vague pledge to “promote new models for addressing physician errors that improve patient safety.”
Obama makes investments in health information technology an important part of his cost containment strategy. This is something every other candidate supports and is generally regarded at the heart of what’s needed to improve both cost and quality. And it is something the market has been spending billions at for many years and has shown only slow but steady progress on.
Obama would make the insurance markets more competitive and efficient by creating the “National Health Insurance Exchange” to promote more efficient competition and he would set a minimum health cost ratio for insurers—not defined in detail. Reducing insurance company overhead is important but constitutes only a small percentage of costs and those overhead costs have been increasing at the rate of general inflation while health care costs have been increasing by two to four times the basic inflation rate in recent years. The biggest cost containment challenge is in the fundamental cost of health care itself.
He would legalize drug reimportation. However, the amount of drugs imported from Canada, for example, has fallen by half in recent years, as this once popular scheme hasn’t produced the savings to even maintain itself at past levels. Somewhat surprisingly, even Republican McCain favors drug reimportation.
He would emphasize the use of generics by making it harder for drug companies to payoff generic makers to stay out of their markets—a good idea that also has bipartisan support.
He proposes lifting the ban on Medicare being able to negotiate drug prices—including those for the senior Part D program. However, recent Democratic proposals to do so do not allow Medicare to take a drug off the Medicare formulary when the manufacturer is not willing to reduce its prices. If Medicare doesn’t have the power to walk away from a drug maker, its power to negotiate is a hollow one. Obama does not tell us if he would give Medicare the leverage it would need to get real results.
When the day is done, Obama gives us a list of generally good cost containment ideas that are more often than not in both Senator Clinton and Senator McCain’s health proposals and have been part of a market struggling to being costs under control—nothing really new and nothing that promises to get better results than each of these cost containment ideas are going to be able to get us anyway.
What would it take to really contain costs?
McCain would say a more robust market and more reliance on personal responsibility and consumer choice to make the market work better.
Obama, like Clinton and McCain, came up with the same generally good list of things that are underway in the market anyway with only a limited success to point to so far.
To really get at costs you have to gore some very powerful political oxen among all of the key stakeholders.
McCain won’t do it because he simply doesn’t believe that a direct assault on the market players is the right thing to do—put market incentives in place and it will encourage and reward efficient behavior.
Obama and Clinton won’t do it, not because they don’t like government intervention, but because they don’t want to offend key stakeholders who could derail any meaningful health care reform effort.
The Democrats learned a very powerful lesson in 1994 when many of the special interests all united in opposition to the Clinton Health Plan.
Capping or even reducing costs means you have to cap or reduce costs. There are no magic bullets that reduce payments without doctors, hospitals, insurers, and lawyers getting less than they would have gotten. All of the health IT, prevention, wellness, and the like will not reduce costs by any big amount at least in the short term.
McCain avoids the notion that aggressive cost containment is important because he just doesn’t believe in it—a vibrant market will do the job.
Obama and Clinton avoid the notion that their cost containment list will be inadequate because it is politically expedient to do so—they aren’t going to risk their health care reform proposals by taking on the big stakeholders head-on.
I have been convinced for some time that we will actually do health care reform in two parts—access first and cost containment second.
These Democratic proposals are about access—getting just about everyone covered. Getting everyone into this unsustainable system will then make things even more unsustainable creating an imperative for a second wave of real cost containment when the feel good list of cost containment proposals now in their plans falls short. My sense is that most Democratic health policy experts already know this but see no other political alternative.
3. Promoting Prevention & Strengthening Public Health
At the core of this Obama health care proposal is the notion that, “Each must do their part…to create the conditions and opportunities that allow and encourage Americans to adopt healthy lifestyles.”
Obama lists employer wellness programs, attacking childhood obesity in the schools, expanding the number of primary care providers, and disease prevention programs as part of his effort.
Again, his emphasis on healthier lifestyles is embraced by all of the other candidates and doesn’t give him an advantage.
Perhaps the most important thing a new president can do in this regard is to use the “bully pulpit” to place far more emphasis on just how unhealthy Americans are becoming. We can pass all of the health care reform proposals we like and spend the many more in billions of dollars each year but that will do little as we watch our youngest generation on its way to becoming the first in American history to be less healthy than the prior generation.
Will the Obama health reform plan work?
The Obama health reform plan would get almost everyone covered. In spite of Senator Clinton’s claims, I don’t see her plan covering more people.
The Obama and Clinton plans are nearly identical in that they focus on access by making it possible for everyone to have coverage in an existing private or public plan and by making a Medicare-like program also available for those who don’t have private coverage. Both would spend about the same to accomplish near-universal coverage—at least $100 billion a year.
Neither plan really is a universal health care plan. A universal plan, like those in Europe and Canada, start out by including everyone in a plan they are automatically enrolled in and that is paid for by various mandatory taxes. While people in these truly universal systems can sometimes opt out for a private plan, as in Britain, they are in one on day one.
Clinton and Obama build on the American tradition of people having to buy their coverage. Both claim to make it affordable to buy—but the consumer must make the purchase. Clinton mandates it and Obama makes that an option for adults. In the end what matters is not the mandate but whether coverage is in fact affordable to everyone.
McCain takes a completely different view continuing to build on options and choices and relying upon the market to do the work in creating an affordable system.
Would the Obama/Clinton health care system work?
It would clearly get almost everyone covered sooner rather than later.
The real question is how would it be sustained. Are their cost containment strategies going to support a system that is affordable in the long run?
No.
The Obama/Clinton cost containment proposals are only incremental cost containment proposals that are layered over $100 billion of upfront spending to cover tens of millions of more people—far too little cost containment for the new massive injection of money, almost overnight, into the health care system.
Both Clinton and Obama offer us a long list of good cost containment ideas—most of which they share with McCain. Most have been underway in the market for many years with limited success. Undoubtedly, a government infusion of resources or requirements aimed at a more efficient system would have a positive impact but it is hard to see how they would be enough fundamentally alter things and bring the system under real control.
More likely, a $100 billion infusion of new health care spending by an Obama or Clinton plan would actually increase the rate of health care inflation and ultimately create an imperative for more draconian government intervention in the health care markets both Obama and Clinton would preserve.
Cost containment is the big missing link here.
The big question John McCain has to answer is how will his health care program cover everyone—particularly the older and sicker—and how will he be able to provide enough assistance to those who are now uninsured by simply redistributing the tax breaks now only enjoyed by those currently covered?
The big question for Obama and Clinton is not in getting almost everyone covered—their plans spend enough money up front to likely do that—the question for them is how will they create an affordable health care system with only incremental cost containment ideas?
Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.
Robert –
Thanks you for an excellent, realistic discussion of
the health care plans.
I am so very tired of hearing people suggest that with national health reform and universeal coverage, we will suddenly save money.
The truth is that will be covering more people–people who not getting healthcare today. As you point out, there will be some savings insofar as people will get timely care–rather than getting care only after they have become very sick.
But we’ll see that savings way down the road. In the first year or two, we are going to be providing treatment for people who haven’t been seeing a doctor. There will be a lot of “catching-up” to do. That will be expensive.
Secondly, many of the reforms that have begun (in terms of beginning to use IT, more emphasis on preventive care and chronic care management) have just begun, and
the payback won’t come for a long time. Upfront, the costs of health care IT is as we all know very, very high. Again, in the early years, this will be an expense, not a savings.
And in order to really emphasize preventive care and
chronic diseaese managment, we need primary care docs, family docs and pediatricians to provide the services.
Meanwhile, as we speak, the number of primary care and family docs in this country is shrinking.
Recently, I attended a heatlhcare dinner where primary care physicians were just shaking their heads at the way policy-makers talk about providing a “medical home” for everyone.
“Who exactly do they think is going to staff the medical home?” asked one primary care doc who is about to retire. “It
will take years to train new family docs to replenish the system–even if we raise their pay or forgive their medical loans in order to attract doctors inot primary care.”
Nurse practiioners can do some of the work of providing a medical home. But they need to team up with a doctor.
Maybe we could import more primary care docs from developing countires but a) those countires desperately need their doctors and b)many American (particularly older Americans) are not comfortable with a doctor if English is not his native language.
As you point out, the only way to really save money is to do some very unpopular things: standing up to lobbyists, and standing up to an American public that doesn’t want to hera the word “No.”
For example, you write: [Ob]ama proposes lifting the ban on Medicare being able to negotiate drug prices—including those for the senior Part D program. However, recent Democratic proposals to do so do not allow Medicare to take a drug off the Medicare formulary when the manufacturer is not willing to reduce its prices. If Medicare doesn’t have the power to walk away from a drug maker, its power to negotiate is a hollow one. Obama does not tell us if he would give Medicare the leverage it would need to get real results.”
You are aboslutely right. Medicare has to be able to refuse to cover drugs, devcies, tests and surgical procedures that are overpriced (and no better than the less expensive older drugs devices, tests and procedures availabe) and Medicare has to begin refusing to cover treatments and tests that are ineffective.
We don’t even have to worry about “cost-effectiveness” at this point (how many additional months of life do you get for how much money?) There is so much low-hanging fruit in our system– stuff that simply isn’t effective–at all..
I was at a world health care conference in Berlin last week where I mentioned how we continue to do PSA tests for early-stage prostate cancer, even though we know that there is absolutely no evidence that these tests save lives–or even lenghten lives by a single day. The
British women sitting next to me–from BMJ– shook her head: “We’ve known that for years. We don’t cover them.”
On my right, a doctor from Sweden expressed complete surprise: “Really– you still do them?!)
Of course people in this country are completely unaware of the medical evidence that people in other countries talk about. We are so insulated–so xenophobic–if the idea wasn’t made in America, it is of
no interest.
This was the biggest health care conference in Europe–and I didn’t meet a single other American attending the confernece. The people who attended were not just from Europe, but from Israel, Taiwan, etc–all very interested in what people in other countries are doing.
The consensus, btw, was that Sweden has the most efficient, highest quality system. As one brilliant speaker from the London School of Economics noted: “You can’t help but admire what the Scandanavians do. The same holds true for education.”
There was only one American speaker at the conference–Uwe Reinhardt–who told me afterward, that he very much doubts that the U.S. will ever have a health care system that provides high quality care for everyone. Instead, he said, we’ll have a tiered system.” And at the botoom tier, we’ll have poor care for the poor and probably for the middle class as well.
(By middle class I mean the second and third rungs on a five rung income ladder. Though if health care inflation continues at the presesnt rate, ultimately those on the second rung from the top will also find themselves getting second-rate care.)
In his speech, Reinhardt had compared European countires to China, saying that because so many European countires are mainly middle class, they can provide a single high quality system for everyone, but in China, there are about 4 classes of people–the new multimillionaires, the urban middle class, migrant workers, and deperately poor peasants, who each need a different health care system. When I asked him whether the U.S. was more like
Europe or China, he didn’t hesitate: “China.”
I aksed whether, with healthcare reform, the U.S. couldn’t build a public sector health care system more like Germany’s–a system that is so good that half of Germany’s most affluent citizens chooose it over more expensive private care.
He said “Never.”
I asked why.
He said “no social solidarity.”
I’m now writing a two part post on obstacles to health care reform in the U.S. The first, which I’ll probably put up today on http://www.healthbeatblog.org will
focus on the lobbyists. The second post will focus on the second big obstacle: the American public.
When anyone tries to suggest that the U.S. might look to Europe for ideas about healthcare reform, inevitably, someone says “You can’t do that. Americans are different.”
Ultimatley, my question is this: Is America really so “different” from European countries that we can’t provide high quality, sustainable, affordable health care for everyone?
If the answer is “yes” then “different” means “so much more corrupt” (the power of the lobbyists’ in Congress) “so much more immature” (the American public’s unwillingness to accept “no” and to realize that more care is not beter care) and “so much more selfish” (the lack of social solidarity.)
I’m not yet willing to accept that we are that “different.” But even Don Berwick says, “We need a mroe mature public.” And he didn’t mean older.
It does continue to astonish me how unwilling are politicians (and those who draw up their talking points) to acknowledge the massive gorilla in the corner–the unsustainable demand for increasing services. But of course that would mean saying no to people’s demands. We could save so much just by refusing coverage for things that, by broad consensus, simply don’t work. Demand for these things would vanish if they weren’t covered.
I keep raising the question and never seem to get an answer, so I’ll throw it out there again: When Obama says we need to spend $65 billion in new money to get everyone covered, and Hillary says we need $100 billion, and (formerly) Edwards said we needed $120 billion, were they offsetting the new spending with the savings that would come from (presumably) ending the Medicare and Medicaid Disproportionate Share Hospital program? This is the program by which Medicaid reimburses hospitals (mostly urban safety net and rural community) who see a disproportionate number of indigent patients who get uncompensated care. If everybody’s covered, there would be no uncompensated care, and therefore no need for DSH payments. The program could end.
According to HHS, in FY 2008, the federal government will spend $17.8 billion on DSH payments. See here:
http://www.hhs.gov/asl/testify/2007/10/t20071101f.html
I have not been able to find an accounting of the state contribution to DSH spending, but I have to assume it’s a near equal amount. So we’re looking at an instantaneous $30 billion in savings, just from going universal.
If Obama and Clinton have already calculated this into their plans, then we are looking at good numbers from them, but if they haven’t, their plans could wind up being cheaper than they are already saying.
Nice to meet you. I claim to be kadu.
I serve as a reference very interestingly.
I am fortunate when I link.
Whether DSH spending is $17 billion or $30 billion, you need to keep in mind that, on average, health care spending is increasingly by over $120 billion a year (6% a year inflation on $2.2 trillion.) So that $30 billions (or $17 billion) in savings would be wiped out by just a few months of inflation–even if we didn’t cover any of the uninsured.
Also, my guess is that, even with universal coverage, hospitals located in indigent areas will need higher payments because taking care of poor people who haven’t seen a doctor for a long time will be very time-consuming–and expensive.
In addition, it’s not clear to me what happens with Medicaid under Obama’s plan (or Clinton’s).
Matthew- do you know??
Is Medicaid folded into national health insurance? If so, payments to doctors and hospitals would be much higher than they are now. (Right now, health care providers are paid significantly less to provide a serivce to a Medicaid patient than they are paid to provide the same service to a Medicare patient, or someone under private insurance.
This is because when the Medicare/Medicaid legislation was passed in the mid 1960s, Southern Congressmen refused to vote for it if doctors and hosptials were going to be paid the same amount to care for poor (read “black”) patients as they
were paid to care for Medicare (mainly white patients because black people died so much earlier–and still do.)
The Southern Congressmen did not want white doctors and white hosptials caring for black patients–a two tier fee system would ensure a segregated health care system.\
To this day, Medicaid pays so much less that many doctors will not take Medicaid patients (who are often black or Latino.)
If health care reform is going to be equitable–and provoide equal access– Medicaid should be folded into the national plan, and docotors should be paid the same amount for taking care of those poor patients.
That will be a major additional expense that will more than equal the DSH payemnts.
Yes, it is certainly true that the health care consumer needs to change their attitudes re medical services, but this is an excuse not an explanation. It allows the responsible parties for change to avoid making the tough decisions on the road to reform. I think the first steps to reform belong to the Congress (forget about help from the current occupant of the White House). Therein lies the problem; lobbyists for the status quo won’t give up without a fierce fight. The US spends more for their health care than other nations and some special interests like it that way. I beleive this is where the battlefront starts. I believe it will take a groundswell of support at the grassroots level where the citizen demands change; Congress won’t do it on their own.
Bob— does your quote here”The big question John McCain has to answer is how will his health care program cover everyone—particularly the older and sicker—and how will he be able to provide enough assistance to those who are now uninsured by simply redistributing the tax breaks now only enjoyed by those currently covered?”
mean the same thing as your quote with Bloomberg today in reference to McCain’s suggestion of drug reimportation and flat payments to doctors for diagnoses, in addition to the tax breaks he offers?
article here:
(http://www.bloomberg.com/apps/news?pid=20601087&sid=aeIPTBzZJZVg&refer=home)
just asking for a clarification…
Here is one of McCain’s latest HC policy points that Bob didn’t cover:
“Jesus is My Health Insurance”
http://store.theonion.com/jesus-is-my-health-insurance-p-122.html
An emphasis on natural health care solutions would be very clinically effective and much cheaper than drugs and surgery. I’d like ot see a legislator actually go there. It’s not a risky idea culturally except the pharma lobby would flip.
Help me with the numbers. Who would vote for Obama because of his health plan?
I don’t think those with generous company plans will. Will those with company plans under cost/benefit attack vote for him? I guess the uninsured might, but $2500 in savings is not going to attract many and according to Eric Novak their numbers are less than a 100 people at any one time anyway. What about those on Medicaid? They’re already covered and they know their coverage won’t get any better, and they don’t vote anyway. Will the underinsured? If any of those can remove their rose colored glasses they may I guess, but I doubt the plan would improve their situation anyway. What about those in Medicare? I don’t think so as they will be looking for the slightest hint of a tax increase to fund this and vote against Obama because of healthcare along with all those who are not in a position of needing coverage or care. And lastly what about those who have been screwed by the health insurance industry. Well the plan won’t give those people an option to bolt to a government plan. So tell me who in any meaningful numbers is going to vote because of this healthcare plan?
P.S. I wonder if any of those just fired Wall Street brokers/employees (who want the government out of their lives until they need a financial bailing out) and must now possibly buy their own insurance will vote for this plan?
There is NO way that any kind of government run health care system is going to work without serious regulation and reforms to costs in this country.
If people think they are getting a free ride by voting in the fall for health insurance for all, they have another think coming. As it stands, Medicare is slowly going bankrupt with the ever increasing costs, and in fact, many large companies are scaling back long term medical benefits for their employees.
Let’s put it this way…have you ever seen the government run ANYTHING beter than the private sector could?
“have you ever seen the government run ANYTHING beter than the private sector could?”
Wall Street bailouts for one.
["have you ever seen the government run ANYTHING beter than the private sector could?"
Wall Street bailouts for one.]
Lol. True. But there is the other side of the coin as well- had the Feds not worked aggressively to bail out financial companies with the mortgage loan issue, we would have seen a substantial loss of market value and putting the economy into a serious tailspin and jeopardizing the world economy, not to mention the retirement funds of tens of millions Americans.
Well Thomas, at least that’s the line from the Fed and the administration in DC. Don’t forget this is an election year so printing money is the easiest way to buy votes. I for one did not have any risk in the market and conducted my personal and business loans with responsibility. Unlike the market cowboys who created trash (even fraudulent) paper and re-sold it over and over to leave the next chump with the risk. Bottom line is an unregulated corporate America is dangerous.
“There is NO way that any kind of government run health care system is going to work without serious regulation and reforms to costs in this country.”
You’re exactly right. That’s why single-pay works and why any other plan without those controls will not. I wonder if this administration will bail out those crushed by health costs – which (unlike Wall Street) people have little control over.
[You're exactly right. That's why single-pay works and why any other plan without those controls will not. I wonder if this administration will bail out those crushed by health costs - which (unlike Wall Street) people have little control over. ]
I have never been a big fan of government regulation. I cheered the day they deregulated the airline industry. But unfortunately, SOME regulation is necessary in an industry that everyone NEEDS (unlike flights which everyone WANTS). That’s why utility companies, for example, are regulated.
It’s not the insurance companies that are getting rich that’s for sure. Most health insurance carriers are B rated at best and are often gobbled up at some point by another carrier as their costs soon outpace their underwriting ability. Hospitals are going broke daily. So where’s all the money going? Pharmaceutical companies for one, and medical supply companies for another. They don’t seem to come up with medications that ‘cure’ anyone any more, just medications we all seem to need to take – aka ‘maintenence’ drugs- which are highly profitable. These companies have unlimited financial resources to change legislation and manipulate markets.
If I was looking to change the health care system to make it more affordable, that’s where I’d start. I’d also look at the medical billing system and tort reform for second. There’s an entire cottage industry of medical billing practicioners. Anytime you have to go to special schools just to learn how to pay a bill, something is definately wrong.
Expensive premiums are not the problem, they are the symptom to much deeper issues.
I think you misunderstand the purpose of creating a national insurance market. It’s not about marketing costs. Each state now sets standards for what insurance plans are “required” to cover. What is covered is highly political. It varies widely by state. More requirements mean more cost for insurers. By letting shoppers shop across state lines, they have access to a greater variety of plans and put pressure on states to remove their regulatory burdens. Insurance can start at $5,000 in N.J. but start at only $1000 in Pennsylvania. It is important that states retain the right of regulation so that an even bigger and more politicized federal government doesn’t acquire that power and responsibility.
“Insurance can start at $5,000 in N.J. but start at only $1000 in Pennsylvania.”
AG, I’m interested in your explanation of this. Claims/Risk history, plan benefits, greater competition in each state? Are you saying the same insurance company charges those different rates in both states or different insurance companies charge those different rates?
Hey Peter,
Every state has different “mandates,” which are the diseases or conditions that insurance has to cover if the insurance companies want to sell insurance in that state. This is influenced by the disease lobbies in each state. For example, Maryland has the greatest number of mandates, and I think Idaho has the fewest. If you have to cover more things, you’re going to have to price your insurance higher. Of course, this is only one of the factors that affects insurance costs, but it’s a big one.
Pretentious, you would want to play disease Russian Roulette on choosing covered and not covered plans? How is this going to solve healthcare costs? “I’ll take the $10 a month plan please that only covers pancreatic cancer. It sure is nice to be covered.”
Yeah, I would, but I’m more educated than your average consumer on this stuff. I’d like to choose a plan that doesn’t cover obstetric care since I’m not going to have any kids (and would hugely bring down the cost of insurance for a woman my age), but I live in Maryland and don’t have that choice. So in effect, I’m subsidizing other women my age to have babies. But I figure those babies will be paying into Medicare around the time I’ll be taking advantage of it, so it’s an investment for me.
Pretentious, you just discovered the concept of shared community. We don’t have kids but support public education. The universal single-pay heathtcare system is also shared community, but not without responsibility.
[AG, I'm interested in your explanation of this. Claims/Risk history, plan benefits, greater competition in each state? Are you saying the same insurance company charges those different rates in both states or different insurance companies charge those different rates?]
Different states have different rates for the exact same policy from the same company commonly. The most typical reason is claims history, although other factors, what doctors charge, and how they treat patients (ie test and surgery rates) all will affect premium prices from state to state.
Another poster said [So in effect, I'm subsidizing other women my age to have babies. But I figure those babies will be paying into Medicare around the time I'll be taking advantage of it, so it's an investment for me]
If BO or HC has their way, get used to paying higher rates on your health insurance- substantially higher ones. You’ll be subsidizing everything from Bob Smith’s smoking habit to Jane Doe’s DUI’s and alcoholism. since insurance will have mandatory coverage requirements and insurance companies will be forced to insure everyone, that will be the end result.
No thanks.
If the National Healthcare includes all aliens in the United States plus any future aliens, will National Healthcare work. Presently many of the aliens are on our Medicare and Medicaid programs, this is a major financial drain on the Medicare and Medicaid programs.
(If the National Healthcare includes all aliens in the United States plus any future aliens, will National Healthcare work. Presently many of the aliens are on our Medicare and Medicaid programs, this is a major financial drain on the Medicare and Medicaid programs)
How is paying their health insurance bills through taxing me any different than paying their bills through Medicare taxes?
Just coming from a different fund is all. And since it would be legal, more than likely it would be used more often.
No thanks.
I think the dems, especially Sen Clinton, need to realize that the system is already designed for a small percentage of uninsured patients the problems arising are do to out of control costs. I like Sen Obama’s emphasis on technology in general, I believe the other candidates are lacking in promoting tech. This will be especially important in the health care space which has been EXCEPTIONALLY slow at adopting technology.
http://Savvydoc.wordpress.com
What do all of you think about the recent report by Public Citizen that claims that global tade agreements will pre-empt many of the cost containment methods that the candidates are pitching. In other words, they would subject the US to huge financial penalties in WTO and NAFTA tribunals for restricting free trade.
http://www.citizen.org/hot_issues/issue.cfm?ID=1846
“Although they have nothing to do with trade, key health care cost containment proposals on the creation of health insurance risk pooling mechanisms, reduction of pharmaceutical prices and electronic medical record-keeping, a proposal to expand coverage by requiring large employers to provide health insurance and a proposal to establish tax credits for small employers as an incentive to provide health insurance fall within WTO jurisdiction. ”
The full report is at:
http://www.citizen.org/documents/PresidentialWTOreport.pdf
A health coverage program which is extended to all the citizens of a governmental region along with the permanent residents, universal health care program vary…….to read more of this review kindly visit http://www.janetmhenderson.com.Thanks for such great reviews with such realistic discussions.
In fact the government health plan devised by Obama will run poorly if compared with private health programs.
I someone can help me understand the most important part of Obama’s healthcare plan I would appreciate it. He states:
“Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.”
This simply says that as a citizen with no insurance, I will have the option of “buying into” the FEHBP. But if I am not a federal employee, the monthly premiums would be huge (over $1000 a month for a family). If people cannot afford to purchase insurance now, how is the above going to help them? Are there more details to this that I don’t know about?
The Democrats want the system to crash and burn. They will do this by implementing Obama’s plan by injecting millions of uninsured people into the system with government money. The system will collapse mostly because it is going to cost way more than they think. That will pave the way for Universal, European style health care. The problem is there are not enough practitioners right now. It will only get worse. To be honest, it would be nice to do only 1 surgery a week instead of 10, even if the pay is a lot lower. Plus, I would be getting government benefits. The only people that will suffer with that is the general public. Wait times for procedures will be LONG due to lack of incentive for the practitoners.
I’m all for helping those in need, but I don’t understand why we would offer health insurance to capable adults who are unwilling to work. In my opinion, our shift toward universal health coverage should be offered to the working poor first, rather than trying to overburden the system by covering people who are capable, but unwilling to work. I think people would be more willing to take low wage positions if they were guaranteed access to affordable health care. This could also alleviate some of the burden placed on the wellfare system by people who can work, but choose not to. Wouldn’t this be a more realistic starting point rather than trying to cover everyone at once?
Any discussion of the McCain plan which overlooks that the money the employer pays now for health care WILL BE PASSED on to the employee as additional income when the employer stops subscribing to these one size fits all health care plans is not being very analytical.
If McCain stops giving an employer a tax break on insurance benefits, then any wise employer is going to appreciate the fact that all they do is re-direct this money to the employee, and dissolve that monster health care pain in the you know what. The employee now takes this money, which is taxed income, buys their own plan, including the sort of health care they need, and then gets a $2500 to $5000 tax credit to pay the taxes. Everyone who buys health care off the street knows that you can get personal plans now for less than an employee/employer pays for “group coverage”. The reason is that “group coverage” covers everything that could possibly happen to a person, including pregnancy insurance for MEN!
Yes, true enough, McCain’s plan doesn’t address the down and outs but one can see that his plan will reduce health care costs once these insurers begin competing for every policy they sell. And, this way, even if the federal goverment has to come up with some sort of Medi-caid for the down and outs, it will be cheaper than simply continuing to feed the monster that is health care in this country.
I’m sorry, I don’t see how McCain’s plan has no upfront costs. He says he will provide a $2,500 tax credit to every single American in order to purcase healthcare. That cost is well north of $100billion/year.
To deal with that cost, he could raise other taxes, or cut other programs, or increase the deficit. These are exactly the options open to Obama, and therefore the cost is directly comparable.
this health and care blog for Barack Obama is great.If i were grading this i would give it a 100,000
I agree with mm. I am all for helping the poor as well, but by just giving everyone coverage will not fix the system. You must give people a reason to want to work and better their lives. If you give someone something there entire lives, what incentive do they have to get out of their ruts? By over taxing the rich they will be less likely to give their money to charities that help the poor and disabled. These same rich people also provide jobs to get the poor working again! I agree that the Government needs to help those that are not insured, but the individuals in need have to show that they are willing to work for that coverage!! Everyone can get some type of job if they want to work, unless they have a mental illness or drug addiction.
This renewal my group Carefirst HMO OA went from $798 a month to a staggering $1,100.
I figured the cost would increase to $900, not over one thousand dollars.
A cost savings of $2,500 a year is paltry. A tax deduction of $5,000 for a family is worthless.
The offices of Carefirst are gorgeous. No wonder they need so much money. And I bet the salaries for the executives a very lucrative and posh.
This health care crisis has everything to do with greed by those at the top, not the selfishness or immaturity of most Americans.
American citizens want to be treated fairly. We believe in a sliding scale where every citizen contributes what they can.
We pay more to get less. When I hear stories from my parents generation (baby boomer) and the amount of days the were allowed to stay in the hospital after giving birth I am amazed. A friends mother stayed in the hospital longer because her Doctor wanted her to get a few extra days rest before going home. My Aunt stayed in the hospital 15 days after her c-section.
The following comments are in part taken from Dick Morris’s “Fleeced” which I was reluctant to read for various reasons (I’m a democrat here changing her position to independent) but very glad I did.
- the extended coverage to tens of millions of people will dramatically increase the demand for medical services.
- with immigrants allowed to work freely in US under Obama’s plan and free healthcare, there will be a rush to the US of immigrants
- doctors will be crammed to the gills with new arrivals (immigrants for free healthcare)
- the limits and cost controls Obama will impose on the medical community will probably limit the income of doctors
- those limits will also have fewer and fewer young people choose medicine as a career
- greater demand will create costs to go us dramatically
- The more immediate answer to the issue this all will create would be ‘rationing’
- Federal bureaucrats will have a veto on any medical procedure you want, even if you are prepared to pay for it yourself.
- Elderly would be subject to a new cost-benefit analysis. -it’s easiest to ration (turn away) the elderly first.
- WE HAVE NOW: 1/3 of those uninsured are already eligible for Medicaid but don’t sign up (usually until they are sick).
- ALSO NOW: we already have “State Children’s Health Insurance Program (SCHIP), healthcare to all children wihout insurance!
The information I listed, I failed to put down that this would be under Obama’s plan.
So it recently came to my attention that Obama commended Oregon for the decision to legalize physician assisted suicide.
He said and I quote, “I am in favor of palliative medicine in circumstances where someone is terminally ill. … I’m mindful of the legitimate interests of states to prevent a slide from palliative treatments into euthanasia. On the other hand, I think that the people of Oregon did a service for the country in recognizing that as the population gets older we’ve got to think about issues of end-of-life care. …” The link is http://www.mailtribune.com/apps/pbcs.dll/articleAID=/20080323/NEWS/803230336&emailAFriend=1
After reading these words, I found myself concerned with the future of our country. So in this interview he wasn’t asked about the elderly but included it anyway. What caused him to say that? History shows that men who said one thing, but intended something else have taken over the minds and lives of innocent people. Is this a plan towards a more efficient healthcare plan? Is there a chance that maybe all the things that are questionable about him are warnings? Is anyone else paying attention to these things?
Some of us have had a national health care plan for many years. In fact many have threatened to vote for a strike when thier goverment funded jobs have tried to pass on the health care cost to them . I have heard comments from people on strike, “its not about the money, its about the changes in thier benifits from thier health care plan”. If you work for the school system, do road work or have a construction job working on any goverment funded projects ,or are a Politicion you problably aready are enjoying the national health care plan. Also if are very clever at hiding all your money from the goverment you also can qualify to get free or very cheap health care. As someone who has just been laid off, Iv`e been offered to continue the same coverage with my now former employer for 1036.00 amonth (12,432.00 a year).I chose to go to a major medical plan on my own for 640.00 amonth. Those of us that dont think thiers a problem with the cost of health care are probably in th group of people aready enjoying the benefits of the rest of the publics money. I say rich or poor or in between every one should have the same benefits from our taxes. (why does it cost $10,000 to have a baby ? Why does it cost $10,000 for an overnight stay in a emergency room ? Why does a 15 minute surgerys cost $10,000 ? ).
Here is a quote by the author of the Declaration of Independence which should settle once and for all whether healthcare is a right or responsibility.
“Liberty is to the collective body, what health is to every individual body. Without health no pleasure can be tasted by man; without liberty, no happiness can be enjoyed by society”.
Jeffrey Kreisberg, Ph.D.
i have a brother who will be out of high school soon and he’s not going to college. does obama’s healthcare plan cover my brother? who will pay for it if he cant?
I’m not sure I have time to read this entire entry – but I”m interested in the breakdown of both candidate’s plans. This blog does a great job of doing just that: http://www.therelevantelephant.com/blog/entry/the_audacity_of_negative_campaign_ads_health_care
I DONT HAVE TIME TO READ ALL THIS AND I WONT PRETEND I UNDERSTAND IT ALL, BUT THE BOTTOM LINE IS, IS OBAMA FOR SOCIALIZED HEALTH CARE LIKE CANADA HAS? OR IS HIS PLAN A LITTLE OF BOTH?
Obama plan will make me pay taxes on my corp available insurance premium to help for for someone elses. Many of whom to lazy to work and want everythign free. That is crap. Also gaurantee coverage will cause costs to go way up. And remember when politician estimates costs, Double it and you will be closer to the real cost. No matter how you slice it it’s socialism and the last capitalist will be hung using the rope he made(To quote Karl Marx)Goodbye America as out founding Fathers made it.
I own a small business, employ 35 people full time, have always offered health care, and currently pay for most of a single coverage, and about 60% of family coverage. If Obama’s plan is implemented I will drop my plan and let the taxpayer cover this ever rising burden. It’s just that simple, if you want more of something subsidize it. If you wnat more people on the government dependancy, make it possible. See Hawaii for reference.
One thing I don’t think has ben addressed under either plan—-Income Tax Schedule B. How do both plans deal with itemized medical costs? I would see this deduction going away under Obama’s administration (“Fairness”), and significantly under McCain (“Income Adjustment”). Under McCain, most might lose this dedution as they are “given” the money to “buy” their insurance. Thus, those of us who itemize would pay more in the end with a smaller refund, or end up paying more taxes.
this sucks balls
I am only thirteen years old and i have alot to say about everything and alot to say about this whole campaign i think sum of u just cant app that we are fixing to have a wonderful president who is fixing to make life alot better for alot of us people who care about of life’s and taxes even though i dont pay taxes my parents do and me nor my family is rich but we have money and im sure that it’s like that for sum of u and alot of people in this world sum of u complain about obama and say he is not going to be this or not going to this but let me tell yall grown people something i dont see u up there tryning to do none of that i like him already and he is not even president yet I know im using some slang in here but that really doesn’t give whoever reads this the right to call me some ghetto black girl beacasue i am black and proud to be and i love white people i love martin luther king so i have no reason to hate white’s i think u know where im going wiht this so i dont have to say much more but back to the sistuation i like that he is running and trynnig to be president and i hope he make it and i know he has some haters but im sure he is not worried becuase those are his motavators you will always need haters in you life or shall i not call them that i should say people who are confused about who they are and who they wanna be like OBAMA now back to what i said earlier i am only thirteen at forest heights middle school in the eight grade i really dont know much about the whole thing except that people or some are running to be presidents for very good reaasons and i have benn watching some of the campaigns on tv and i enjoy them very mcuh now im just a child expressing my feelings as an very angry child that is tired of all the anamosity in the world and the hateful people and seeing my parents brake their neck for me and my life and seeing our people in and out of jail kids dropping out of school thats not good at all and i’m hopin OBAMA can see this and tell that i am a concerned child ready for war to end and him to take over to stop high taxes and early deaths now i got to this whole thing and writing this because i am asigned a project to do on someone running and ofcours i chose OBAMA for many good reasong and im doing good on this project but i need help so for u adults how feel how i do please feel free to help me and comment back and tell me how feel as an adult thanks for your time and GO OBAMA!
IT’S TIME FOR A CHANGE AND THAT’S WHY OBAMA IS HERE!