Hillary’s Pivot Left on Healthcare

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Is Hillary Clinton really moving to the left on healthcare, as the NY Times and many others have asserted, pushed by continued pressure from Bernie Sanders to endorse the public option? It is a strange claim. First of all, her campaign’s explicit support of the Public Option goes back to at least February, when her site was updated with language backing it, and which seems essentially identical to the language the campaign uses today.  She hasn’t moved left in the last three months due to the lingering strength of the Sanders campaign.
Has she changed at all from previous years? There isn’t any indication of that, either. If anything, her plans today are scaled back from her 2008 presidential campaign, in which the public option, based on Medicare, figured prominently.
Her support of the public option in 2016 is cautious, burned by past failures and acutely conscious of the need for a sympathetic Congress to pass meaningful legislation. She does not say today that she would seek new legislation to enable a public option, leaving it implicit that with a Democratic congress she would test the waters and jump if the opportunity arises. Instead, what she does promise is that she will “work with interested governors, using current flexibility under the Affordable Care Act, to empower states to establish a public option choice.” In other words, leave it up to the states to decide under existing law. So a state like Vermont would be likely to adopt it, but a state like Alabama wouldn’t. In other words, the states that would benefit most would be least likely to take advantage of the opportunity, if history is any guide.
This does not sound like a move to the left under pressure, but an acknowledgement of desires long present. This is a more subdued, perhaps wiser, expression of the ideal of universal coverage within the the constraints of political reality, and Bernie has little or nothing to do with it.



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10 replies »

  1. Bobby:
    Apologies! I’m new to THCB and, add to that, those I crossed paths with were the Northern Callifornia State of Jefferson folks and they threw “free market” around with impressive intensity…

  2. It was snark, Keith. There’s no such thing as a “free market.” Only an endless onslaught of No True Scotsman moving-target fallacy definitions of “free market.” “Private Market” is not an automatic synonym phrase equating to “Free Market.”

  3. Is not ColoradoCare, which Colorado is going to vote on in November, the experiment your looking for?

  4. “Free market” as a fix for our healthcare woes?

    Theoretically, it is difficult not to wholeheartedly agree with this because inherent in it is a mechanism that contains cost. Love that. But as a fix in 2016 the idea has all the umph of a Ludditian grand plan for reform.

    As some model for primary care? The idea has some merit. But, in the context of an ATV roll-over accident where you can’t take your eyes off just how dented the head is except to look at the mid-shaft femur fracture where the splintered ends point >90 degrees out beyond the confines of that human’s body, and the heart beats on, and where help is but a 1000 mile helicopter ride away to a level one trauma unit hospital facility in the big city? And where a life-long care facility will be the best case scenario outcome? “Free market” is no answer. Noncontributory.

    Of all the “free market” proponents I have ever crossed paths with they are either loving their Medicare, loving their government subsidized healthcare and health insurance plans, or are tragically underinsured through their church or via private insurance. Or, in the case of one who made his millions in pharmaceuticals, very happy to be not so concerned with the problem of fixing healthcare at all.

    Revisiting the free market idea when we enter some post apocalypic recovery phase? Good idea. Between here and there? Put that idea on the shelf.

  5. There is good logical in this piece, but:

    Remarkable it is how, in 2016, the issue of single payer continues to be couched in left versus right terms. At best that perspective is anachronisitic, but even in its heyday it lacked validity as it was nothing more than a component of a PR campaign more than a half century ago.

    Between the Whitaker-Baxter campaign of 1948 and now, count the number of times the left and the right turned 180s on the issue of healthcare.

    Also, one of the more cogent arguments for single payer financing of health care is advanced in a documentary film called “Fix It, Health Care at the Tipping Point.” This film was produced by a conservative businessman from Pennsylvania.

    When left and right agree there is no left and right.

  6. “Free Market.” Problem solved. Everyone just move along, nothing more to see here.

  7. The rub for a public option is the premium and how to finance it when Medicare is already financially precarious. Liberals say a public option, which presumably would pay providers at Medicare rates, plus the fact that it’s administrative costs are low and it doesn’t have to make a profit suggests it should be able to sell health insurance policies at lower cost than private insurers can.

    However, what happens if the public option is subject to significant adverse selection which is highly likely? Average costs per person could easily turn out to be far higher than liberals contemplate. If the premium paid by the individual insured person or family is capped at 8.5% or 9.5% of modified adjusted gross income with no income ceiling, that means the cost of subsidies will also be higher than expected.

    In the end, what we would likely wind up with is a national high risk pool at enormous cost and taxes will need to be raised to pay for it or else we will have even higher deficits and faster growing federal debt with our kids and grandkids getting stuck with the bill. Is that really what we want? Be careful what you wish for.

  8. For months during the Democratic presidential nominating contest, Hillary Clinton has resisted calls from Senator Bernie Sanders to back a single-payer health system, arguing that the fight for government-run health care was a wrenching legislative battle that had already been lost.

    But as she tries to clinch the nomination, Mrs. Clinton is moving to the left on health care and this week took a significant step in her opponent’s direction, suggesting she would like to give people the option to buy into Medicare. but that’s all to it. Its all for winning the campaign.

  9. There’s potential for confusion here. Hillary’s purported “shift to the left” widely reported in the news this week centers on her comments at a campaign even in Virginia about allowing people over age 50 or 55 and up to buy into Medicare. Hillary has toyed with this idea before, as have many Democrats (including her husband) over the past 20 years.
    The words “public option” in recent years refer more often to a government sponsored health plan being offered in the insurance exchanges, to compete with commercial plans. That was bitterly fought over in the run-up to passage of the ACA and was ultimately dropped by the Obama Administration — in part because of opposition from the insurance industry.
    It’s an idea/concept that’s unlikely to revived anytime soon, especially in Republicans retain control of the House and/or Senate.
    The Medicare buy-in, in my view, is absolutely something that should be on the table in coming years, though it ,too, would be a heavy political lift.
    It has technical challenges, as The New York Times story noted this week. But it also has many merits, not the least of which is that it could free up the exchanges to focus on covering younger uninsured people and thus remove pressure on insurers to raise premiums. Premium increases–which might be steep again this year– have been occurring in part because the population signing up for coverage in the exchanges has been trending older and sicker (and thus more expensive) than anticipated.
    It also has the advantage of offering an additional insurance option for people in late middle age, and pre-Medicare, who find themselves out of work or self-employed and facing very high premiums (3X more than younger folks in the exchanges…so $500 or more a month and up). I know quite a few such people and they count the days until the turn 65.
    I would say the buy-in would be more palatable politically if restricted initially to age 60 and over.

  10. I wish we could try a public option at a state or county level first and not the full Monte. Think of the number of stakeholders that will be put out of work! Think of an agency controlling 17-19% of the GDP. You cannot really want this. Read about the TSI and Midway Airport today. Healthcare dilemmas are going on all over the world. No one has magic answers. We may have to live with, and accept, a mess for awhile. If we became a single payer ‘Sweden’ with their management, drug, labor and professional costs, it is one thing, but if we still had our own input factor costs, we would be putting 60% GDP into this sector with a full public option plan. Besides, our actual medical chores are being done OK here( I think.) It is all the other non-medical energy that we are pouring into healthcare that is such a disaster. This comes from the infinite line of folks trying to help us [read: make a buck too]