Edwards' private/public blended approach to universal health care leads to single-payer public care

[Stop Cornyn]

"Is it the right prescription?" by Rob Christensen for The News & Observer:

The public-sector {component of Edwards' health care} plan would resemble Canada's single-payer system, in which insurance is publicly funded to control costs but doctors and hospitals remain private.

"The idea is to determine whether Americans actually want a private insurer or whether they would rather have a government-run ... single-payer plan," Edwards said. "We'll find out over time where people go."

The mix of market and government initiatives makes Edwards' plan much harder to attack than Clinton's early 1990s plan, said Leif Wellington Haase of the Century Foundation, a liberal-leaning think tank.

"In this plan, the changes happen much more gradually," Haase said. "Each element has a market element that deflects the attack. I think it's a very smart political document."

'A slippery slope'

Although Haase thinks the Edwards plan does not go far enough, conservatives fear it would take the country too far toward government-run care.

"It sets up a slippery slope to move toward a single-payer, government-run health care system," said Mike Tanner of the Cato Institute, a conservative-leaning think tank. "He realizes that Americans are not going to take that in one bite."

Tanner contends that under Edwards' parallel system, private insurance would be unable to compete with a taxpayer-funded system.

[MNDemNY]

1. I like that slope.

[asdjrocky]

2. This is a man looking out for ALL Americans.

[Yael]

3. This is my #1 reason for supporting him. I think it's brilliant.

[Tejanocrat]

4. Me too. If I can't have Dennis, Edwards comes nearest to my progressive populist ideal, but Obama's

pretty good, too. If Iowa, New Hampshire, Nevada, and South Carolina narrow the field I'll choose the most progressive electable candidate between Edwards and Obama and if neither Edwards nor Obama has a chance to stop Hillary, I'll come back to Dennis and vote on ideology alone instead of a blend of ideology and electability.

[LynzM]

9. Same here

I love Dennis on ideology, but Edwards seems more likely to actually win - "electability" or whatever. Ugh. I agree that it seems more likely for Americans to swallow this whole than a full-scale shift to single-payer. I've personally talked to several people whose health care has never been at risk and they can't understand why anyone would want what Dennis is pushing for (I'm not included in that group!), but they're ok with an Edwards-style plan. I just realized that this might come across as bashing DK in favor of Edwards, which is not at all what I mean to do!

[asdjrocky]

5. I agree,

Now if we can just get the haters to tone it down a little.

[Tejanocrat]

6. The haters approach their candidate with all the logic and intensity of a sports fan. Just like

there is nothing you can say or explain that will make a Yankee fan into a Red Sox fan, there is nothing you can say or explain to the haters to make them approach the candidate selection and debate process rationally because their preference isn't based on ideology and wasn't formed through a logical process but is an irrational emotional response.

Most of them come around after the primary, and those who don't were never our votes to win anyway.

[mmonk]

7. It presents the possibility of a shift.

The downside is that politicians on the take can work to damage the public one.

[Qutzupalotl]

8. Does anyone know if Hillary's similar plan includes competition?

I think Edwards' plan is brilliant, and it was what initially pulled me away from Obama. So I'm undecided but have not heard how Clinton's plan compares. Edwards said it was similar to his, but I haven't seen a definitive statement from the Clinton camp about private insurance competing with what I'm certain will be a cheaper publicly-funded plan. If anyone here knows, I'd appreciate it. Thanks in advance.

[Stop Cornyn]

10. HillCare does not appear to have the transition to single-payer through competition part of Edwards'

plan.

HillCare has

* no overall increase in health spending or taxes.

* stressing prevention and a focus on efficiency and modernization to lower costs.

* Relying on the government alone to fix the system has unintended consequences, like scaled-back coverage or limited choices.

* Providers will work collaboratively with patients and businesses to deliver high-quality, affordable care.

* tax credit to help afford high-quality health coverage.

* half the savings generated from agenda to modernize the heath systems and reduce wasteful health spending.

That doesn't sound overwhelmingly similar to the Edwards plan.

I think HillCare gets compared to a watered down version of Edwards' plan because he would open up the same care plan that congress members have to citizens who want to buy into that plan.

[rinsd]

11. Elizabeth Edwards has called the Clinton's plan remarkably similar to Edwards

“I guess you could slip a piece of paper between what Ms. Clinton and what John proposed in February, but that’s about it. It’s remarkably similar,” Ms. Edwards began.

“We’re of course glad to have her company, and to the extent that this is an endorsement of his proposal, we’re happy to have that."

http://www.ajc.com/metro/content/shared-blogs/ajc/politicalinsider/entries/2007/09/19/elizabeth_edwards_hillary_clin.html

"I think HillCare gets compared to a watered down version of Edwards' plan because he would open up the same care plan that congress members have to citizens who want to buy into that plan."

Umm Hillary's healthcare plan also opens up that healthplan to citizens.

The Same Choice of Health Plan Options that Members of Congress Receive: Americans can keep their existing coverage or access the same menu of quality private insurance options that their Members of Congress receive through a new Health Choices Menu, established without any new bureaucracy as part of the Federal Employee Health Benefit Program (FEHBP). In addition to the broad array of private options that Americans can choose from, they will be offered the choice of a public plan option similar to Medicare. "

If that is the main part of transition thru competition, than Hillary's plan also leads to single payer.

[Stop Cornyn]

13. How much does Hillary's health care plan cost? Here's how non-HillBots compare the health care plans

Democrats offer differing health care plans -- After previous experience, Clinton cautious on reform efforts:

NEW YORK - When it comes to health care reform, Hillary Rodham Clinton epitomizes the old adage, "once burned, twice shy."... "I still have the scars to show for it," she tells voters now, promising a more consensus-based approach to health care reform if she is elected president.

But that newfound caution has also come with a price. While rivals Barack Obama and John Edwards have both laid out sweeping health care reform plans with estimated costs attached, Clinton has so far proposed only modest changes to the existing system while avoiding the vexing question of how to provide coverage for all.

Hard lessons learned

With some 47 million Americans lacking health insurance, the issue has become an urgent priority for Democratic primary voters and for organized labor, a major party constituency. Activists say the time for caution is long past and they want answers from Clinton, the Democratic front-runner.

"One of the problems with being last out of a gate is that it's hard to be seen as leader," said Robert Borosage, president of Campaign for America's Future, a liberal think tank advocating universal coverage. "She has a lot of credibility for taking scars the last time, but she's got a lot of doubters, too. She needs to step up to the bat."

Clinton now says she's learned the hard lessons of 1993, when her husband ignored naysayers and tapped her to lead the President's Task Force on National Health Care Reform.... Burned by the experience, Sen. Clinton has since adopted what she calls "the school of small steps."... Whatever she proposes will be immediately compared to the Edwards and Obama plans, both of which have been generally praised by activists. But analysts say Clinton can take advantage of her late entry in the debate by combining the best elements of her rivals' plans while avoiding the points that have drawn criticism.... Central to Edwards's plan is a so-called "individual mandate," requiring everyone to have health insurance the way most states require drivers to have auto insurance. Employers would have to insure their workers or pay into a government program that would provide coverage.

Edwards has estimated his plan could cost as much as $120 billion per year, paid for by repealing tax cuts for individuals making more than $200,000. The hefty price tag has raised eyebrows and prompted Clinton to be openly skeptical about investing even more tax money into a dysfunctional system.

Like Edwards, Obama's plan retains the employer-based insurance system and creates a public plan to expand coverage. But his plan does not include an individual mandate, leading critics to say it falls short of offering truly universal coverage.

[rinsd]

15. Nice try but that article came out months before she released her healthplan.

Notice how they make little mention of her actual plan.

[mmonk]

27. Funny, but the present system is too expensive for the

buyer and it continues to rise.

[rinsd]

12. Yes it does. Hillary;s plan is nearly identical to the Edwards plan

Here's a summary of Hillary's plan with links

http://www.hillaryclinton.com/feature/healthcareplan/summary.aspx

[Stop Cornyn]

14. Where does HillCare have heath care markets to require private plans to compete economically against

public plans?

Here's the small excerpt of the Edwards plan that I'm referring to:

Third: New Health Care Markets. The U.S. government will help states and groups of states create regional Health Care Markets, non-profit purchasing pools that offer a choice of competing insurance plans. At least one plan would be a public program based upon Medicare. All plans will include comprehensive benefits, including full mental health benefits. Families and businesses could choose to supplement their coverage with additional benefits. The markets will be available to everyone who does not get comparable insurance from their jobs or a public program and to employers that choose to join rather than offer their own insurance plans. The benefits of Health Care Markets include:

* Freedom and Security: Health Care Markets will give participants a choice among affordable, quality plans. Americans can keep Health Care Market plans when they change or lose their jobs, start new businesses, or take time off for caregiving.

* Choice between Public and Private Insurers: Health Care Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan.

* Promoting Affordable Care: Health Care Markets will negotiate low premiums through their economies of scale so they can get a better deal than individuals and many businesses can get on their own. Health Care Markets will also hold down administrative costs by reducing the need for underwriting and marketing activities (two-thirds of private insurers' overhead), centrally collecting premiums, and exercising leadership to reduce costs on billing practices, claims processing, and electronic medical records. Finally, they will be able to work with insurers to adopt cost-effective approaches to health care like preventive care and to collect the data necessary to drive quality improvement. {Woolhandler et al, 2003}

* Reducing Burdens for Businesses: By assuming the administrative role of negotiating benefit plans with insurers and collecting premiums, Health Care Markets will minimize administrative burdens for participating businesses and other employers. Businesses that opt into the markets will only have to make financial contributions to the cost of covering their employees through markets, similar to their role in Social Security and Medicare.

We're specifically taking about whether HillCare has the mechanism to evolve into universal single-payer public health care. Can you find it? I can't.

[rinsd]

17. Ummm right here. She just doesn't call them "health markets"

# The Same Choice of Health Plan Options that Members of Congress Receive: Americans can keep their existing coverage or access the same menu of quality private insurance options that their Members of Congress receive through a new Health Choices Menu, established without any new bureaucracy as part of the Federal Employee Health Benefit Program (FEHBP). In addition to the broad array of private options that Americans can choose from, they will be offered the choice of a public plan option similar to Medicare.

Summary - http://www.hillaryclinton.com/feature/healthcareplan/summary.aspx

PDF - http://www.hillaryclinton.com/feature/healthcareplan/americanhealthchoicesplan.pdf

The American Health Choices Plan preserves existing health insurance and offers new choices to those
with insurance and to the 47 million people in the United States without insurance. It ensures
portability so that Americans do not lose coverage when they change or lose their jobs. Americans will
have three options:
1) Keep Current Health Care Coverage: Americans who are satisfied with the coverage they
have today can keep it. Nothing would interfere with their insurance or their relationship
with their health care provider. The only significant change they will see will be lower costs
and higher quality health care as the modernization initiatives to improve value in our
health care system take effect and as the achievement of seamless coverage reduces the
hidden tax on premiums that comes from current cost-shifting.
2) A Choice of Health Plan Options: Businesses, employees, and the uninsured will have the
option of buying group insurance through a new Health Choices Menu. This Menu will
give all Americans the same set of insurance options that their Member of Congress has.
Without creating new bureaucracy, the Menu will be part of the Federal Employee Health
Benefit Program (FEHBP), which includes numerous, high-quality private health insurance
options. The Health Choices Menu will have the purchasing power of millions of
Americans in securing high-quality and affordable insurance. States will also have the
option of banding together to offer the same type of choices in a region of the country if
they wish. The benefits will be as good as those offered to Members of Congress. Such
coverage includes mental health parity, and many plans offer dental coverage. In addition,
as a condition of doing business with the federal government, insurers must cover highpriority
preventive services that experts agree are proven and effective. This focus on
prevention will improve health and lower costs in the long run.
3) A Choice of a Public Plan Option: In addition to the array of private insurance choices
offered, the Health Choices Menu will also provide Americans with a choice of a public plan
option, which could be modeled on the traditional Medicare program, but would cover the
same benefits as guaranteed in private plan options in the Health Choices Menu without
creating a new bureaucracy. The alternative will compete on a level playing field with
traditional private insurance plans. It will provide a more affordable option, in part through
greater administrative savings. It will not be funded through the Medicare trust fund.


The only difference is Hillary leaves out the claim that this could become single payer but the methodology is the same. Broader exposure of gov't paid systems vs private insurers coupled with lower overhead costs will make the gov't system more popular in the market place.

[Qutzupalotl]

18. OK, thanks rinsd. I'll look into these.

[rinsd]

19. No problem.

Though I wish my candidate would embrace single payer coverage.

[Stop Cornyn]

21. Not even close! Where are the non-profit purchasing pools? That is the mechanism which drives down

prices in a manner that promotes evolution toward a single-payer approach.

You say it's the same and quote vague language but the part that's lacking from HillCare is the feature that makes the Edwards plan work.

What you're doing is like getting two new bright red cars and taking the motor out of one and then saying that they are still the same.

[rinsd]

23. Please continue reading

3) A Choice of a Public Plan Option: In addition to the array of private insurance choices
offered, the Health Choices Menu will also provide Americans with a choice of a public plan
option, which could be modeled on the traditional Medicare program, but would cover the
same benefits as guaranteed in private plan options in the Health Choices Menu without
creating a new bureaucracy. The alternative will compete on a level playing field with
traditional private insurance plans. It will provide a more affordable option, in part through
greater administrative savings. It will not be funded through the Medicare trust fund.

"You say it's the same and quote vague language but the part that's lacking from HillCare is the feature that makes the Edwards plan work."

How so? Both are offering options to buy into the Fed Health plan, both are offering a public funded option?

What do you think the America Health Choice Menu is? Its Health Markets by another name.

[Stop Cornyn]

24. Hillary has it 100% BACKWARDS from Edwards. Hillary's plan: "a public plan ... will compete on a

level playing field with traditional private insurance plans."

Edwards plan: "under Edwards' parallel system, private insurance would be unable to compete with a taxpayer-funded system."

Hillary is going to "level the playing field" so that the private insurance will be competitive with the not-for-profit public plan. Edwards is not going to level the playing field because if the private for-profit insurance can't keep up with the public not-for-profit plan, the public plans win out. THAT'S THE WHOLE POINT!

Hillary is artificially leveling the playing field so the public plan and private for-pRofit plans compete on equal terms, Edwards doesn't - IN FACT, EDWARDS DOES THE EXACT OPPOSITE!

Moreover, I have asked multiple times now, WHERE IS HILLARY'S PROVISION ESTABLISHING HEALTH CARE MARKETS AND NON-PROFIT PURCHASING POOLS?

You say "She just doesn't call them 'health markets.'" WRONG! She doesn't have any provision which establishes a non-profit purchasing pool no matter what she or you call it. It's not in there! In fact, she says the EXACT OPPOSITE: she says she will not create "a new bureaucracy." She's NOT creating a new not-for-profit pool.

Hillary's plan is just like Edwards' plan EXCEPT IN THE KEY FOR-PROFIT VS. NOT-FOR-PROFIT DETAIL THAT MATTERS!

[Qutzupalotl]

33. Good points, SC

I'm not sure HRC is *trying* to level the playing field (i.e., give insurance co's a fighting chance). Her statement is vaguely worded such that it could mean she's going to let them compete fairly (hands off), or that she would have a finger on the scale. Edwards' plan is clearer as far as his expectations and intentions, which I like.

Good catch about the NFP purchasing pools.

I love threads like this where you can actually *learn* something without the gratuitous candidate-bashing.

[Qutzupalotl]

20. Thanks for the links, SC.

Sounds like Obama should be listening to Edwards about this. Maybe Hillary did? :shrug:

[Stop Cornyn]

22. I think Obama and Hillary both took notes off of Edwards' plan, but they both watered it down.

To me the two biggest areas where Obama and Hillary watered down the Edwards plan is that

1. Obama's plan is not universal and

2. Hillary's plan does not have a non-profit purchasing pool where private companies have to meet or beat a Medicare-style public care plan (run as a nonprofit) or they will go out of business and we'll be left with a single-payer universal plan.

Obama's plan and Hillary's plan sound really similar, but the compromise on the really tough bits which are the very strengths of Edwards' plan.

[Nutmegger]

16. R&K!

:thumbsup::bounce::kick:

[eridani]

25. People's opinions about their insurers, public or private, are bullshit, unless--

--they have been expensively sick. Most people will never be expensively sick, just as most won't have their houses catch fire. Their guesses as to whether their private insurance will actually cover them in the event of serious illness are as worthless as their opinions about how good their local fire department is. If they stay lucky, they'll never know one way or another.

Making an informed decision about anything is flat out impossible without information. The point of health insurance is that 100% of everybody puts money into a pool, which is then used to provide health care. The majority of it will be spent by 20% of the population. The only reason private insurance exists at all is to make sure that they hardly ever issue policies to people in that 20%, thereby diverting money taken from the other 80% from provision of health care to profits. This is not acceptable, period, any more that it is acceptable for your fire department to do a survey of census tracts and refuse to serve those statistically most likely to have fires.

The notion that there can be any such thing as a "market" in health insurance is just plain idiotic.

[Stop Cornyn]

26. Actually, Edwards', Obama's, and even Hillary's plans would address the chief concern you raise

All three have a plan that would eliminate the practice whereby private insurance companies "make sure that they hardly ever issue policies to people in that 20%" who are at the highest risk of catastrophic illness.

[Hieronymus]

28. Hillary's plan would only be through private insurance companies ..

Their administrative costs are huge, compared to medicare.
Edwards' plan would give people a choice to have medicare or private. It wouldn't take long for most people to figure out that the single payer system is best.

[Stop Cornyn]

29. I agree that Edwards' plan would give people a choice to have medicare or private and people would

ultimately see the sense in choosing single-payer public universal care.

I think Hillary's plan has some elements of choice, but it's like she took Edwards plan and gave it to the private health insurance lobby and said "you can strike out 10% of the Edwards plan and leave 90% intact because I need to be able to say that my plan has got 90% of the same features as the Edwards plan" and then the private health insurance lobby struck the 10% of the Edwards plan that offers the most promising reform and gave her back the 90% that is good policy but doesn't have the engine for real reform.

[Hieronymus]

30. You got it right.

[asdjrocky]

31. Ever notice?

All the Hill-nippers run when confronted with actual facts?

[eridani]

34. I'm not seeing anything about what those policies would cost

If the plan removes the burden from sick individuals, it then turns around and places that burden on the taxpayers who have to subsidize the insurance companies. And even the huge subsidies offered in 1994 didn't work. We don't need a bunch of separate risk pools--put all of us in the SAME risk pool--that's the cheapest way to spread risk.

[Basileus Basileon]

32. That's a very nice slope. nt