Marie Cocco and Paul Krugman have columns out today panning and praising, respectively, John Edwards’s national health care proposal. As much as I respect Professor Krugman, at first glance I have to side with Cocco on this one. The Edwards plan is a lot better than what we’ve got now, but I don’t think it’s where we want to go.
As explained on Edwards’s campaign web site, the proposal would achieve universal coverage by:
Requiring businesses and other employers to either cover their employees or help finance their health insurance. Making insurance affordable by creating new tax credits, expanding Medicaid and SCHIP, reforming insurance laws, and taking innovative steps to contain health care costs. Creating regional “Health Markets” to let every American share the bargaining power to purchase an affordable, high-quality health plan, increase choices among insurance plans, and cut costs for businesses offering insurance. Once these steps have been taken, requiring all American residents to get insurance.
You can read a PDF document explaining the plan in more detail here.
This sounds a whole lot like a plan being floated by Arnold Schwarzenegger in California, as Krugman acknowledges. I wrote about the California plan here, and quoted Krugman about why the Schwarzenegger plan was bad. So why is the Edwards plan good? Krugman explains,
People who don’t get insurance from their employers wouldn’t have to deal individually with insurance companies: they’d purchase insurance through “Health Marketsâ€: government-run bodies negotiating with insurance companies on the public’s behalf. People would, in effect, be buying insurance from the government, with only the business of paying medical bills — not the function of granting insurance in the first place — outsourced to private insurers.
Why is this such a good idea? As the Edwards press release points out, marketing and underwriting — the process of screening out high-risk clients — are responsible for two-thirds of insurance companies’ overhead. With insurers selling to government-run Health Markets, not directly to individuals, most of these expenses should go away, making insurance considerably cheaper.
Better still, “Health Markets,†the press release says, “will offer a choice between private insurers and a public insurance plan modeled after Medicare.†This would offer a crucial degree of competition. The public insurance plan would almost certainly be cheaper than anything the private sector offers right now — after all, Medicare has very low overhead. Private insurers would either have to match the public plan’s low premiums, or lose the competition.
Again, this is way better than what we’ve got now. But Marie Cocco says,
John Edwards is trying to get ahead of the political curve, but he would send us back to the future. To 1993, to be exact.
Edwards would repeat the mistake that was at the heart of Hillary Rodham Clinton’s misadventure in trying to fix a health insurance system that was then, and is now, so out of whack that it manages to cover fewer and fewer Americans at higher and higher cost.
Like Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business.
He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.
The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.
So Edwards wants them to be able to buy a new public insurance plan that would be like Medicare, but not exactly. And he wants affluent people to pay more taxes to support coverage of the less fortunate, but not directly.
I think that we need to get private insurers out of the picture except, maybe, for people who want to purchase supplemental policies like many folks on Medicare do. In practice, pure single-payer systems don’t seem to deliver as well as a system that covers everyone publicly but permits private insurance and providers to stay in business also.
Since Edwards’s big draw is that he’s strong on domestic policy, to be a candidate I would support he’s going to have to be amazing on domestic policy. I think the health care proposal falls short of amazing.
I do not think it is fair to require employers to offer health insurance for their employees nor do I want the government to require that everyone have medical insurance. I also do not want the health care of people under the control of insurance companies. They have way too much power even influencing the diagnoses which stay with people their entire lifetime.
My parents did not have health insurance and I raised my kids without health insurance. It can be done. Yes, I know, I am old and those were the “good old days” and life is different now. But that’s my view and I’m sticking to it.
I don’t know how to feel about health insurance being “required” which implies, oddly, that the reason poor Americans don’t buy insurance coverage is that they don’t want to, which is obviously not the case at all. And given how expensive the Massachusetts plan is turning out to be, that seems like a bad model anyway.
I like the “Health Markets” idea in theory but it’s like putting a band-aid on a broken arm.
grannyeagle, you are extremely lucky. Not all of us are. I had to have major surgery when I was 21 and we had to pay for it ourselves. It was very hard to do since we weren’t making very much money.
My daughter broke her elbow when she was 9 years old – and she had to have surgery. When my son was 16, he had to have emergency plastic surgery to reconstruct his face. When he was 17 he broke his arm. Fortunately, we had employer paid insurance that covered almost all of it. I don’t know how anyone would pay for anything themselves now. Also, back then, the hospital was willing to work with you and accepted time payments. Now, they just turn you over to a collection agency that doesn’t give a damn about you.
I have a disabled granddaughter who was born with a major birth defect. My daughter ended up $70,000 in debt with a $10 an hour job. She was forced to go bankrupt. Luckily for her, she went bankrupt before Congress passed those changes recently. Now, she wouldn’t be able to. My daughter works in the service industry and is up to $14 an hour + benefits and she thanks her lucky stars every day now that her employer provides health benefits.
You should have to ‘walk a mile in someone else’s shoes’ before making comments such as you have.
Your excerpt of Marie Cocco’s ideas was not very persuasive. Maybe that’s her fault, maybe yours.
I like and trust Paul Krugman on so many of his previous positions that I’m going to believe him on this.
I am already so sick of the 2008 Presidential campaig, I am going to leave the country. There should be a law that forbids any declaring and running for President before 6 months before the election. If you campaign before the 6-month period, you can’t run.
marijam–Did not mean to insult anyone. It does seem your family has had extremely bad luck. And I did not say people shouldn’t have health insurance. I said I do not like the government requiring people to have insurance and I do not like the government making employers provide health insurance for their employees. And I do not like insurance companies making decisions concerning health issues that only the doctors should be making. I have worked as a RN and I have seen the abuses. I have also dealt with insurance companies as an acupuncturist so I am aware of how much control they have. And it’s all about money. I do not need to walk in someone’s shoes to know the suffering. I see it every day.
Obama did a health care plan here in Illinois that covers anyone under 18. We had a repug state house then. But, at least the kids are covered. I think that it is great because it shows he has actually done this kind of thing before.
I’m with Cocco. the private ins based system with public gap covering we have now is just too FUBAR to patch up. Time to make a new quilt.
Getting real reform will be difficult in the best of circumstances. It’s vital that any proposal be both easy to explain (sell) to the public and resistant to right-wing lies and distortions. In other words, it should be simple — just the oppposite of Rube Goldberg monstrosities like HillaryCare (and EdwardsCare) that try to cater to private/employer-based insurance plans. Start with the concept that what people need is Health Care, not Health Insurance.
Some incrementalists want to just cover kids, thinking it would be an easy sell. But how well do kids do when their parents get sick and can’t work (or die)? And frankly, who needs good health care more — a youngster, or someone in their forties or fifties? Besides, it’s been over a half-century since Truman proposed national health care. People have been born, grown old and died waiting for incrementalism to work.
While I’m at it, why is it that so-called progressives are so eager to slap on another payroll tax? You need new funding? There’s an ocean of money sloshing around in financial markets. How about a small-percentage tax on speculative transactions and offshore conversions/transfers of wealth?
Oh, and one more thing. If you really want to control costs and provide good access to care, most hospitals and clinics need to be government run or at least returned to non-profit status. The ones, that is, that haven’t already been destroyed or closed by monster corps like HCA.
I am with you, grannyeagle. I have long wondered just how I would react if the guvment told me I had to pay into a big profit-making business in which I would be forced to succumb to the monopoly which alleopathic medicine has on the health [unhealth] field. Geez, that would be, for me, as though guvment forced me to join the Republican party.
I am not trying to make a blanket anti-medicine statement. I am trying to say that the present system is much too narrowly twisted conceptually and much too subject to big-bizness profit-making decisions. There is something to be said for taking responsibility for one’s own well-being rather than putting oneself into the health-care meat-grinder that costs big bucks and locks a person into theories which stop at ‘conventional’ and is the ultimate institutionalization of the ‘doctor daddy knows best’ lockdown on one’s freedoms.
Anyway, I have long thought that I might be really out in left field in not wanting health insurance for motivational reasons. I figure if I put out hard-earned money month after month, I better get something back for that money…..in the health field, that means I need to get ill or injured. Don’t want that kind of subconscious motivation thing going on inside me, nor do I want to slip away from the heightened alertness I have developed about my well-being that comes from ‘it’s up to me’.
OT, I’m off into the great 9 degree [-5 wind chill] weather to help park cars [downtown Springfield, IL] for the Obama event this am. On Thursday evening, at a grass-roots sign-making party, egad, there were media folks there from three different European countries as well as our media. Last night, I helped as the media folks came for their press badges and credentials…..there seemed to be hundreds of press folks, queued up for a couple of hours to check in, and not just the big guys, but lots and lots from smaller outfits. Just seeing all the ones from other countries and the small newspapers and tv stations, I have to say…..I think Obama is not just a media creation, but has something that causes all these heads to come up.
A Mandatory Insurance law like Schwarzenegger is proposing and Mass. has is a sham, and Edwards’ plan isn’t much better. They all preserve the overlapping bureaucracies of private insurers, and that’s just too expensive and inefficient.
Funny how virtually every other industrialized country knows how to provide health insurance for all its citizens but us. Maybe we’re not the great, good country we like to think we are.
granny eagle, why do you say “I do not like the government making employers provide health insurance for their employees.” ? What is your take on an alternative? Do you want us all to just give up and die? I agree in that I don’t want to provide such a give-away to the insurance industry by the taxpayers. However, what will happen to us if the government doesn’t offer health insurance or make employers offer health insurance and employers drop insuring everybody? Besides, did the government ever make employers offer health insurance? Wasn’t it a win-win thing before globalization and greed took over? I agree with you if you are looking at this from the point of view of say, giving over social security retirement taxes to Wall Street. Since you call yourself “grannyeagle”, are you on medicaid or medicare? Will you ever be? Health care shouldn’t be dependent upon how much money you have or don’t have.
grannyeagle, one other thing. I think you are referring to HMOs when you say that you don’t want insurance companies making decisions doctors should be making. I certainly agree with you there. What I would like to see is Congress re-regulate the entire insurance industry which is totally out of control. It’s criminal what is happening to homeowners in Hurricane Katrina ravaged areas and it’s criminal to deny someone health benefits they’ve paid the monthly payments on for decades.
Listening to Americans discussing health care is like listening to Martians speaking English. I understand the words but the concepts seem to come from another planet. I am stunned that any wealthy, first-world country is unable to accept and implement the concept of basic, universal health care.
Bush has proposed a 700 billion dollar defense budget for 2007. I suspect that a measly 300 billion could be trimmed out of all that excess spent on weapons systems that are going nowhere, and be applied to making health care a bit more affordable for all Americans. After all, it’s our money and it goes back into the economy..it’s a matter of allocation for a greater benefit for all.
I like Edwards.. he seems like a decent guy, but I recently read an article about his impressive digs.. He’s got a 21,000 square foot crib sitting on 82 acres of prime land.. It kinda left me feeling a bit alienated, wondering if we could relate when it comes to understanding the burdens of the common man. I guess it’s just my own inadequacies coming up to buffet me.
marijam–If an employer wants to offer health care benefits, that’s fine with me. However, when they do this, they decrease the amount they pay the employee. I personally have had health benefits with an employer simply because it was there and affordable. However, I hardly ever took advantage of it because I enjoy excellent health. Yes, now I am retired as a RN and do have Medicare, part A. That is the hospital part. I have never used it. I did not choose part B because that is doctor’s visits and outpatient stuff. I choose to take responsibility for my health and if I need to go see a doctor, I will pay out of my pocket. I am not rich. I realize everyone’s experience is different but I am not so pessimistic that I think everyone will die if the government stays out of the health care business. I would be for some kind of extension of the Medicare plan for all people not just the elderly but only on a volunteer basis. Lord knows we are wasting enough money in Iraq to pay for something like that. I would rather see my taxes go for something that is more beneficial than a war. As I said, working within the system, I saw the abuses from all sides, doctors, patients and the insurance companies. It’s not a system I care for. As for insurance companies making decisions, it’s not just the HMOs. It’s Medicare and the big companies too. As a matter of fact, the insurance companies patterned their policies after Medicare. The insurance companies have it all planned out and they’re very smart. They have all kinds of tricks to deny benefits and I have seen doctors choose a diagnosis on the basis of what the insurance will cover. Another player is the drug companies. They tell us drugs are expensive because of all the money they have to spend on research. However, a lot of research is done at universities which are subsidized by the government. Also, more money is spent on perks (lunches, dinners, vacations, pens, notepads & numerous other small items) than on research. I have a drawerful of pens that have drug names on them. Don’t take my word for it, check it out. If you go to a doctor, just about all they have to offer you is drugs. There are at least 100,000 deaths/yr. from properly prescribed drugs. I have seen older people taking as many as 20 different kinds. That is not quality of life in my opinion. As for the government requiring people to have health insurance, I think that puts an unfair burden on people who are self-employed or do not get insurance through their employer. I agree with you that good health care should not depend on how much money one has and I do know we can’t go back to the old system.
The bottom line is health care is in a crisis. It has become a business and the patient suffers because of that. I do not have hopes that the government will be able to fix it.
Last year my wife was diagnosed with ovarian cancer. She will survive because we have good health care, and because it was discovered early. Let me bore you with details that are important; she had some mild pain and her cycle was irregular/stopped. Because we have insurance, she went to her OB; becusase we have insurance tests were run; there was a mass; becuse we have insurance she went to a cancer hospital in Tampa for the surgery. They determined it was malignant while she was on the table and removed, well, a lot of female plumbing. Tests on the tissue showed the cancer had NOT spread to the lymph system or to other organs.
If we did not have insurance, she.we might have delayed. Or waited on geting tests. We could not have afforded surgery; insurance I purchased AFTER diagnosis would NOT have covered a pre-exixting condition. Bottom line – she would have died and our 3 YO daughter would be without a mother.
I agree with ‘Canadian’ that we Americans have our heads up our rectum(s) on the subject of health care. This is a problem that has been addressed and SOLVED by a lot of countries we consider inferior. The most impartial barometer of health care I’ve found is the infant mortality rate by country. We are so far down that list it’s obscene. When someone proclaims we have the best medical system in the world, ask him why we are 42nd in infant mortality?
My point, and I apologize for taking the long way around, a universal health care system (not nescessarily insurance-based) needs to be studied. We have a damn good idea who’s doing a better job than the US and that’s where we need to go for ideas.
Swami,
That article was intended to make Edwards look elite; but, he did work hard for the money that bought that house. I don’t begrudge him getting his or his wife’s dream home after working long years to get it. Unlike Bush who has done nothing for every thing he has. I guess we can say that that article did its job if someone as discerning as you think less of Edwards now. It was like the hatchet job the right wing noise machine has been doing to Pelosi and her transportation.
Edwards undoubtedly means well, but it occurs to me that you’re correct in feeling leery about this plan, Maha.
Any plan that requires the private sector to keep insuring employees while the public sector steps in and takes up the slack is an invitation to tighten the financial noose around the privately insured. Push the less profitable and more risky persons into the public sector pool through various sleights of hand– making employees “independent contractors”, increasing deductibles to absurd numbers(I’ve seen individual policies with 7,500 and even 10,000/yr deductibles here in Texas, with 2 or even just1 paid doctor visit per annum, and even then they’ll only pay the first 45 or 50 bucks the doc charges, and the nice lady at the front desk wont let you see the doctor without agreeing to pay what the insurance company won’t, and similarly stingy stipulations on ER visits, etc.
You want everybody to have access to insurance for a hundred bucks a month or less? Easy, sign right here.., and by allowing the private insurers to cull the herd of the poor, the elderly and the sick, such tactics will inevitably make the cost of the public sector insured higher, reduce the capacity of the public sector to realize efficiencies by having a normal risk pool, and reduce political support for federal health care from the healthier and wealthier voters.
Or, how about we nationalize the major for-profit health companies like Choicepoint and HCA; allow investors to convert their equity stakes to less-lucrative but more-tax-favored federal healthcare bonds. The government could give the markets 12-18 months to make the conversion, then the gov’t would buy up holdouts for 1-2 cents on the dollar, based on a predetermined baseline price.
One of the problems that dems have traditionally had in selling single-payer healthcare has been their seeming indifference to the concerns of individual investors.
Bonnie… I don’t think less of Edwards, I always knew he had gobs of money, but a 21,000 square foot house seems a little excessive. I checked on the Square footage of the Biltmore estate and it came in at 175,000 sq ft., so by that standard, Edward’s house is a little bit more than a hogan. It’s all relative.
If the intention of the writer of that article was to separate Edwards from the common man they had some degree of success in causing me to pause and reflect upon our commonality of concern. I’ll get over it though..It’s just not easy when such an economic disparity is in place..makes you wonder if they can even begin to understand the burden that the financially challenged endure or whether their motivation to act for the less fortunate is sincere.
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