Hillary Clinton did a live webcast on Tuesday night. Given what’s happening in less than 36 hours I was way too busy to watch it. But luckily for me and for you Amanda Goltz who works for a certain large hospital system in Boston was there to blog it for us. Thanks Amanda! And despite this being her first post Amanda seems to have got the cynical style we like at THCB down very quickly!

8:00 PM:  Right on time, Senator Clinton welcomes us to her webcast, where she will answer questions she has received in the past two days since she announced her plan. She tells me I can submit a question if I like, but somehow I don’t think she’ll be taking the on-the-fly submissions. 

8:12 PM:  Nothing that deviates from what she said when announcing the plan on Monday. She is going after private insurers and pharma, who may not be angels, but are not the only blot on an otherwise perfect healthcare system. She also just said something about putting doctors back in charge of your healthcare, which doesn’t even sound that good, when you think about it. I know she meant “as opposed to payers,” but I don’t want my doctor in charge of my healthcare. *I* want to be in charge of my healthcare. Especially since in the next answer she essentially announces that fat smokers will be required to take better care of themselves. It could be just a cliché or campaign saying, but it would have flown better if she had put the patient (or, “ordinary Americans like you and me”) in the middle of her new plan, not the doctor. 

8:16 PM:  Now she’s talking about the EMR’s magical ability to reduce waste and administrative costs. I wonder how an EMR is going to save $70B a year in administrative costs if no doctor uses it. The latest numbers show that only 25% of physicians in the US use an EMR, even with a number of robust solutions that have been on the market for more than a decade

8:18 PM:  She has gumption, though. She just said "I will inherit two wars: the war in Iraq and the war in Afghanistan." No "if I am elected," no "if I am in office," no "when I am in office."  Oh! And she just said "as soon as I am elected President." Evidently the primary process has already happened and we missed it and Hillary is the nominee. (By the way, she is talking exclusively about the war now.  Evidently, healthcare is so depressingly messed up it is easier to talk about the morass that is Iraq.)

8:22 PM:  Now she is talking about bolstering the VA, which is all very well and good, but it highlights the total disconnect you must sustain when proposing progressive healthcare policies.  You can’t EVER talk about anything that has a whiff of national, public, single-payor care; but you can and should talk all you want about providing exactly that model to specific (very large) populations, like the armed forces and veterans. The VA is huge now and is going to grow a lot in the coming years as the troops return from Iraq and Afghanistan with TBI, mental health issues, and a whole host of other stuff we’re going to need cutting-edge medicine to deal with.

8:25 PM:  She just said the forbidden "universal" word. She was talking about access to mammograms, which is pretty mom-and-apple-pie, but still. I wonder if she struggles not to fall into 1994 speech patterns of talking about healthcare, even though this plan is quite different. Maybe it’s enough that she is preserving the insurance model. I know this has been discussed here as a shortcoming  but it is so obviously a political accommodation I can’t find it in my heart to be surprised. She is making no change to health insurance as a concept, and it will still be administered privately.  She is essentially insuring the 47 million uninsured by pulling them onto the federal employees’ plans, with a range of products.  It’s more or less just a fix to the uninsured issue, so that’s why her use of “universal” struck me as unnecessary strapping on a big bulls-eye and asking someone to take a shot, especially when this isn’t really universal healthcare at all – you still have to buy it.

8:30 PM: She ends by saying "this is a uniquely American solution to the healthcare problem" (so I guess she is implying that this is not that commie pinko European Canadian healthcare.)  Topics she did not cover: improving quality and preventing medical errors; eliminating unwarranted variation in healthcare practice; bolstering Medicare in the face of the baby boomer retirement wave; price or quality transparency, pay for performance, what happens to Medicaid in her plan.