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In BlogHer’s Voter Manifesto, we asked, “How do you intend to make sure that everyone gets health insurance?” Here I try to explain how. You can also skip to the bottom where there's a handy side by side table.
The other day my mother went to the emergency room to have her sore throat looked at. I exploded. A middle class Jewish woman in Miami can certainly find a GP! But she hadn’t yet, and so she went to the emergency room to get antibiotics. Now, my mom has health insurance; I guess she had her own reasons for going to the ER. But in my mind, this episode is an example of why our rules on insurance in this country need to be very, very clear. There are millions of middle class Americans who cannot afford health insurance, or to whom it does not feel urgent enough. There is always the emergency room. And yet this system is bankrupting us, because the cost structure of ER care is inflated by insurance companies and by a wasteful system. So even if you don’t have insurance, when you go to the ER, you’re availing of services whose prices are inflated by the health insurance companies.
There’s no free lunch. To make sure the cost of lunch is spread out and more equitable, Hillary Clinton supports a health care policy that enforces a requirement that everyone have health insurance, or mandates. Obama’s plan supports mandates for children only, but he proposes lowering the cost of health insurance and, like Hillary, proposes a new health care plan similar to that of Congresspeople's, with lower premiums, in which no one is turned away for pre-existing conditions. John McCain wants to lower the cost of care, so that more Americans can buy insurance. Three very different approaches.
Both Clinton and Obama follow a model like this:
If you have private insurance and you want to keep it, you can. You can stay with the doctors you trust and the coverage you choose. Costs will be lowered and quality of care improved through the modernizing of our health care system. Those covered by Medicare, Medicaid, or the Children’s Health Insurance Program, will keep their coverage, and holes in the health care safety net will be mended and reinforced. If you don’t have health insurance or are unhappy with what you have, you’ll gain access to the wide variety of private plans in the Federal Employees Health Benefit Program, the same plans that members of Congress receive. You’ll also have the choice of a public plan that will provide a stable, competitive alternative to private insurance.
But Hillary's plan includes mandates. So why did Barack Obama use mandates as an attack against Hillary, saying “In order for you to force people to get health insurance, you’ve got to have a very stiff penalty, and in order to do that, you’ve got to go after their wages?” He’s wrong here. Mandates are all about meeting deadlines. If you do not sign up for health insurance by a deadline, you may have to pay back monthly premium costs. In Massachusetts, for example, where mandates came into play this year, the state only charged $219 to those who did not sign up for health insurance by the deadline. Hardly a big stick, and only half the state’s uninsured signed up by the first deadline. Hopefully Clinton will learn from this lesson.
This weekend, Hillary Clinton retorted, “Shame on you, Barack Obama” in Ohio for his "Harry and Louise" esque attacks on her plan. Because Hillary’s point is that “the only way to make the marketplace fair and efficient, is to require that everyone have insurance.” Subsidies, government intervention, corporate compliance, and group efficiencies will ensure people find the level of health insurance they need and can afford, she says. Indeed, because health insurance companies now only make money by being able to pick and choose who they cover, charging huge premiums to employers and the self-employed, and by minimizing benefits, the argument is that when they have to cover everyone, companies’ priorities must reset. My view is that insurance companies continually lose money, the state will have to step in and we will eventually move to a single payer system.
Clinton’s program is most closely linked to the current Massachusetts model; it aims to be universal healthcare but it is NOT single payer healthcare. It is not the same as Clinton’s 1993 “Hillarycare” experiment. Clinton
