17 September 2007

HillaryCare, part deux

Long-awaited, here it is.

I should say in advance that I'm not too interested in the details of the various health care reform plans that the candidates put out. If Hillary (or Barack or Edwards) gets elected, their plan still has to get through the meat grinder of Congress, and will come out looking rather different, presuming anything at all comes out the other side, which is hardly a certainty.

But the health wonk in me just can't resist the urge to peruse the details, which I will justify as perhaps giving some insight into the values and priorities of the candidates. The details are sketchy as yet, but FWIW:

The Good

  • Continues the system of commercial insurance carriers competing for subscribers (and providers)
  • Opens the Federal Employee Health Benefit Plan to individuals
  • Establishes a "ground floor" for benefits (i.e. FEHBP)
  • Requires plans to be community rated (i.e. no "pre-existing condition" exclusion)
  • Personal responsibility: individuals are required to purchase insurance
  • Tax credits for low-income working families to purchase insurance
  • Tax credits for small employers to offer insurance
  • Inter-state standardization of insurance regulations
  • Appears to be universal
The Bad (or unanswered questions)
  • How will the mandate be implemented (and enforced)?
  • Is it really universal?
  • What incentive/requirement is there for employers to continue to purchase insurance for employees?
  • Does not eliminate Medicaid; universality seems to be based on a patchwork of programs
  • Phantom cost-savings ("Over half the savings come from the public savings generated from Hillary Clinton's broader agenda to modernize the heath systems and reduce wasteful health spending" Huh?)
Overall it looks good; certainly as good as Obama's or Edward's plans. (And not too different from them, except in the details.) I'm not bothered by the lack of a real cost-control mechanism. There are two crises in American Health Care right now -- the uninsured crisis, and the escalating cost crisis. While they are to a degree inter-related, I suspect that they will have very different solutions and I actually prefer that they be addressed separately. It is irritating that despite creating a mechanism for universal coverage, the plan does not take the next logical step of eliminating Medicaid. Medicaid is an abomination of bureaucracy and a huge drain on federal and state budgets. Why not ditch it and roll in the indigent into the health plans, either through tax credits or some government subsidy? There may be some cracks in the universality of the plan, also -- what about those who for whatever reasons do not qualify for Medicaid but don't make enough for the tax-credit based private plans? A small gap, to be sure, but still a gap.

One of these days I'll try to put together a more comprehensive post comparing the details of the candidates' plans.


  1. I have to agree that it is a good step forward, and it's refreshing to finally hear some details. But the elephant in the room with all of the "universal coverage" plans is still the fact that covering everyone (even at a relatively basic level) will cost a lot of money...a lot more than they can squeeze out of the > $250K/year wage earners by restoring income taxes to Clintonesque levels.

    And if anyone thinks that docs are going to willingly suck it up and accept Medicaid level reimbursements, then they are in for a big shock.

  2. What do you mean doctors are not willing to suck it up? They surely would not like to suck it up, but if the system will only pay Medicaid level reimbursements, and everyone has that system, what will doctors do?

    Perhaps you'll move to a country were they don't have socialized medicine. A place where Clintonesque, Greenspan approved, income taxes are not in place. I wonder where such a place is. This Republican Shangra-La.

    I should not be so cute. The fact is, when the money paid to medical facilities is decreased, you'll all stop being doctors and we'll have to have terrorists from other countries come here an be our doctors. At that will totally suck.

  3. If "the system" won't pay appropriately for services rendered, I guess we'll end up like every other socialist country. Those who are willing to pay on the side or who have connections will get better care (although not as good as we have now), and everyone else will wait in endless lines for the few physicians willing to work for government slag.

    No matter what system we have, you will always get what you pay for.

  4. Medicaid is an abomination of bureaucracy and a huge drain on federal and state budgets.

    Are you under the impression that the other government programs are efficient?


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