Princeton prof, MIT, & others team up on why only the Hillary-mandate will work

[Thorgrim]

The principal policy division between Hillary Clinton and Barack Obama involves health care. It’s a division that can seem technical and obscure — and I’ve read many assertions that only the most wonkish care about the fine print of their proposals.

But as I’ve tried to explain in previous columns, there really is a big difference between the candidates’ approaches. And new research, just released, confirms what I’ve been saying: the difference between the plans could well be the difference between achieving universal health coverage — a key progressive goal — and falling far short.

Specifically, new estimates say that a plan resembling Mrs. Clinton’s would cover almost twice as many of those now uninsured as a plan resembling Mr. Obama’s — at only slightly higher cost.

Let’s talk about how the plans compare.

Both plans require that private insurers offer policies to everyone, regardless of medical history. Both also allow people to buy into government-offered insurance instead.

And both plans seek to make insurance affordable to lower-income Americans. The Clinton plan is, however, more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies.

But the big difference is mandates: the Clinton plan requires that everyone have insurance; the Obama plan doesn’t.

Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.

After all, we already have programs that make health insurance free or very cheap to many low-income Americans, without requiring that they sign up. And many of those eligible fail, for whatever reason, to enroll.

An Obama-type plan would also face the problem of healthy people who decide to take their chances or don’t sign up until they develop medical problems, thereby raising premiums for everyone else. Mr. Obama, contradicting his earlier assertions that affordability is the only bar to coverage, is now talking about penalizing those who delay signing up — but it’s not clear how this would work.

So the Obama plan would leave more people uninsured than the Clinton plan. How big is the difference?

To answer this question you need to make a detailed analysis of health care decisions. That’s what Jonathan Gruber of M.I.T., one of America’s leading health care economists, does in a new paper.

Mr. Gruber finds that a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion. Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.

That doesn’t look like a trivial difference to me. One plan achieves more or less universal coverage; the other, although it costs more than 80 percent as much, covers only about half of those currently uninsured.

As with any economic analysis, Mr. Gruber’s results are only as good as his model. But they’re consistent with the results of other analyses, such as a 2003 study, commissioned by the Robert Wood Johnson Foundation, that compared health reform plans and found that mandates made a big difference both to success in covering the uninsured and to cost-effectiveness.

And that’s why many health care experts like Mr. Gruber strongly support mandates.

Now, some might argue that none of this matters, because the legislation presidents actually manage to get enacted often bears little resemblance to their campaign proposals. And there is, indeed, no guarantee that Mrs. Clinton would, if elected, be able to pass anything like her current health care plan.

But while it’s easy to see how the Clinton plan could end up being eviscerated, it’s hard to see how the hole in the Obama plan can be repaired. Why? Because Mr. Obama’s campaigning on the health care issue has sabotaged his own prospects.

You see, the Obama campaign has demonized the idea of mandates — most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the “Harry and Louise” ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care.

If Mr. Obama gets to the White House and tries to achieve universal coverage, he’ll find that it can’t be done without mandates — but if he tries to institute mandates, the enemies of reform will use his own words against him.

If you combine the economic analysis with these political realities, here’s what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance — nobody knows how big — that we’ll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won’t happen.

NYT

Let's knockout a few questions here:

Why not single payer?
A: Conservative Democrats and Republicans would never go along with it...the right wing has done an excellent job highlighting that poorer countries with much smaller GDPs and medical facilities have a problem with single payer, therefor we must (oddly enough, differences in countries means the difference when we talk about banning guns like Japan does and has such an amazingly low murder and crime rate...yet when it favors the right winger, every country is alike)

For the foreseeable future, there will not be 60 democratic senators, let alone 60 progressive senators...the Nelsons, Pryor, etc know it would get them voted out of office, and the GOPers know they'd get primaried or lose their base...they simply won't commit political suicide

Why is it such a risk, because so many right wingers HATE the idea of changing from their currently stable private insurance to something new...which isn't exactly illogical

Okay, so we have to include private insurance companies if anything is to be done, why don't I show you my new theory...
A: Once you get to the idea that private insurance companies are included, the two big deal stoppers are mandate or no mandate, any other solution has been worked on by progressives, moderates and conservatives for at least 16 years...everyone has been rejected by all sides except for basically the Obama and Clinton plans

Okay why not Obama's?
A: Read the article, Clinton's is the only way, with people doing regular quick checkups more than once in a lifetime, the preventive medical problems that could require massive time and money will be stopped short, aka the cost of insurance companies (public and private) will go down

Also, making everyone a part of the plan makes it not a simple "entitlement program for the poor" and particularly appealing to moderates is that there are no free riders and no abusers

Complaints from the left and right can be parried the easiest by far...Insurance companies project it will make them all bankrupt, we do year-by-year subsidies and see how much it costs us, and have heavy hitting auditors making sure we aren't getting scammed

If people claim it will make their already worsening financial lives...worse...we increase personal tax rebates to cover all the expenses...basically by filing your taxes, the ink in the pen is the only "payment" you make

If the CBO says it's going to be so huge its...ridiculous...the GOP won't support it, and we start to mold the mandated plan until it's affordable, but again, 16 years of looking at the numbers has shown there is no reason to think the CBO would come back with such a number, and if they did we'd work to find the missing piece that was found...and fix it

However, conservatives will complain this is just Medicare for everyone if it's not mandated, liberals will complain we're not covering everyone and horror stories would follow...conservatives will say we are driving insurance companies out of business by letting the healthy get off scott free, while liberals will complain that people simply too busy, as in the past, will not sign up for free benefits, it happens all the time...doctors will tell you stories of kids who come in with conditions related to malnutrition only to find out their parents never applied for foodstamps they qualified for...whether because they were stupid, prideful, ignorant, or simply busy

[bheld]

Single-payer isn't impossible. This broken system isn't inevitable.

[Thorgrim]

Originally Posted by bheld

Single-payer isn't impossible. This broken system isn't inevitable.

It's a simple fact that currently 41 Republicans would filibuster such a move...my god these were the same people who argued it was too nice to restore college loan rates TO THEIR ORIGINAL LEVELS that was too communist for them, to have college loan rates at the level the GOP Congress had earlier set them at...god forbid you help struggling middle class families

You expect them to adopt a plan that is reviled by republicans across the country?

It would never...ever ever ever ever pass in the next presidential term...ask anyone who knows Senators and their position, they'll all agree

And there is a good speculation that many conservative Dems in the Senate would vote against it as well

[bheld]

This plan will never work, period. I don't see how you can say single payer is impossible when this plan is a disaster. It's not going to work. It's not going to work. It's not going to work.

There are too many conflicting interests. How are you going to:

1. Squeeze insurance company margins by making them take everybody?
2. Squeeze insurance company margins by forcing them to pay out for every claim?
3. Keep costs down for the consumer who is now forced to take one of the limited plans available?
4. Keep this from forcing even more costs on the government?

[Thorgrim]

I've already answered those questions...does anyone else have anything they want to discuss?

[bheld]

Please at least direct me to the post where you answered those questions because I still don't have an understanding of your reasoning.

[DosEquis]

Personally I think healthcare should be affordable and available to everyone. We should do something about its costs so that people who want and need it can get it. There is no reason why we should refuse health services to people.

However, I disagree with it being a mandate because in this free country I should be able to choose if I want to be insured or not. Its out of principle. Right now there are some people who can't make that choice simply because they can't afford to get it. Flipping the script the other way is not the answer either. The goal shouldn't be to get everyone covered, the goal should be to make it affordable to everyone who wants it.

[Thorgrim]

Dos, if the DMV turned you away because they didn't like something about the way you dressed, or something stupid, even though it's a right written into the consitution, you do feel that able-minded and skilled drivers should be allowed to safely drive, I would consider that a right

Anyway, my state mandates drivers to get insurance, it works out better for everyone, its common sense that accidents happen to even the most careful person

The last thing I'd want is "more freedom" by hearing some guy who just hit me go "oh man, I've driven so safe my entire life...oh well looks like I made my one mistake, I have no insurance, looks like you're screwed!"

Neither do I want a perfectly healthy person to go "I'm fine, I never liked the doctors and never really needed one" and people like him to fill up the ER when they realize their self-medication isn't so bright and my fiance really needs immediate medical attention and we've paid our insurance

Nor do I want to live like a pauper when we're both healthy, because people like you decide they can "risk it" and fuck over the entire insurance industry

I mean, come on, in this age...city police and state police are more than enough to combat and defeat the Canadian and Mexican armed forces, probably at the same time

Do we really NEED any military...at all? Many could argue we don't

If I say we don't need it...why can't I have a choice, if the US gets invaded, the military doesn't have to protect my home, I can risk it, and just me

It just wouldn't work it...it's impossible to do, and it just end up screwing up the entire system...I'm "losing a freedom" because I don't want to spoil it for the vast majority of Americans

[motivez]

Originally Posted by DosEquis

Personally I think healthcare should be affordable and available to everyone. We should do something about its costs so that people who want and need it can get it. There is no reason why we should refuse health services to people.

However, I disagree with it being a mandate because in this free country I should be able to choose if I want to be insured or not. Its out of principle. Right now there are some people who can't make that choice simply because they can't afford to get it. Flipping the script the other way is not the answer either. The goal shouldn't be to get everyone covered, the goal should be to make it affordable to everyone who wants it.

I thought the idea was that people who weren't able to afford it would get tax credits and essentially not have to pay anything out of their own pockets?

The only penalties would be for people who can afford it, but don't.

[motivez]

Also, the whole idea of any of these plans is shared risk among a large group of people

Obama's plan lets people stay out of that shared risk as long as they need to, and then hop in if / when they ever get sick, it's writing financial instability into the program before it gets started

Now, he said people would be forced to pay back premiums or fines or whatever, but if that turns out to be less than the amount that they would have paid had they been insured and paying into the system, they've just gamed it.

And really, if someone isn't able to afford whatever the dollar amount is with Obama's plan, doesn't get insurance, and then a few years later gets sick with something and is able to add on and get insurance.. how are they going to be expected to pay the back fees if they couldn't pay the monthly premiums to begin with?

You still end up in a situation where wages have to be garnished to get that money.. so it's not really any better than Hillary's plan in that regard, and even worse since the system would be potentially unstable from the start

I don't agree that everyone would get insurance if they could only afford it. I mean, maybe if it's like a buck a month, but once you get up into the $50+ range, healthy (especially young) people will wonder if it's worth it for them when that 50 dollars or whatever could be spent on something they can see an immediate benefit from.

[DosEquis]

Originally Posted by Thorgrim

Dos, if the DMV turned you away because they didn't like something about the way you dressed, or something stupid, even though it's a right written into the consitution, you do feel that able-minded and skilled drivers should be allowed to safely drive, I would consider that a right

Anyway, my state mandates drivers to get insurance, it works out better for everyone, its common sense that accidents happen to even the most careful person

The last thing I'd want is "more freedom" by hearing some guy who just hit me go "oh man, I've driven so safe my entire life...oh well looks like I made my one mistake, I have no insurance, looks like you're screwed!"

Neither do I want a perfectly healthy person to go "I'm fine, I never liked the doctors and never really needed one" and people like him to fill up the ER when they realize their self-medication isn't so bright and my fiance really needs immediate medical attention and we've paid our insurance

Nor do I want to live like a pauper when we're both healthy, because people like you decide they can "risk it" and fuck over the entire insurance industry

I mean, come on, in this age...city police and state police are more than enough to combat and defeat the Canadian and Mexican armed forces, probably at the same time

Do we really NEED any military...at all? Many could argue we don't

If I say we don't need it...why can't I have a choice, if the US gets invaded, the military doesn't have to protect my home, I can risk it, and just me

It just wouldn't work it...it's impossible to do, and it just end up screwing up the entire system...I'm "losing a freedom" because I don't want to spoil it for the vast majority of Americans

None of what you just said is really applicable. You are comparing apples and oranges. Motor vehicle insurance, or liability insurance, is not anything like health insurance. Car insurance is required because of the possibility of someone else being wreckless and damaging you or your property, and to provide fiscal compensation to replace the property and pay the bills involved if injured.

If I do not get health insurance and I break a leg working out, my action did not affect your property nor did it hurt you in any way. Car insurance is about liability. My eating habits that cause high blood pressure will not accidentally give you a heart attack. That is why I do not feel it should be mandated. If i want to take the risk and go without health insurance it should be my choice. If i choose to turn in to fat ass it will no way cause any direct damage to you or your property.

Some people are going to go to the doctor regardless if they have insurance or not, regardless if it was their choice to be insured or not. In fact, the more that are insured, the more likely that your ER is going to be clogged preventing your fiance from being treated as soon. There are more people now to avoid going to the ER if they do not have insurance because it can be extremely expensive.

Should we take action to make it more affordable, absolutely.

As far as the rest, I don't really understand why that has been brought up. If someone invaded it would still be your choice to defend or surrender your home. Thanks to people who volunteer and train to defend our homes for us, we still actually have that choice. Military service is not mandated like it is in other countries.

[bheld]

The problem is that you're creating another free rider situation in your solution to the mandate problem.

Why should I be forced into the same medical pool with somebody that treats their body like a garbage disposal? An equal distribution of cost isn't necessarily a fair distribution of cost.

[Thorgrim]

Originally Posted by DosEquis

None of what you just said is really applicable. You are comparing apples and oranges. Motor vehicle insurance, or liability insurance, is not anything like health insurance. Car insurance is required because of the possibility of someone else being wreckless and damaging you or your property, and to provide fiscal compensation to replace the property and pay the bills involved if injured.

If I do not get health insurance and I break a leg working out, my action did not affect your property nor did it hurt you in any way. Car insurance is about liability. My eating habits that cause high blood pressure will not accidentally give you a heart attack. That is why I do not feel it should be mandated. If i want to take the risk and go without health insurance it should be my choice. If i choose to turn in to fat ass it will no way cause any direct damage to you or your property.

Some people are going to go to the doctor regardless if they have insurance or not, regardless if it was their choice to be insured or not. In fact, the more that are insured, the more likely that your ER is going to be clogged preventing your fiance from being treated as soon. There are more people now to avoid going to the ER if they do not have insurance because it can be extremely expensive.

Should we take action to make it more affordable, absolutely.

As far as the rest, I don't really understand why that has been brought up. If someone invaded it would still be your choice to defend or surrender your home. Thanks to people who volunteer and train to defend our homes for us, we still actually have that choice. Military service is not mandated like it is in other countries.

If you are a diseased person and can not get treatment even though its uncomfortable beyond any reservations about seeing a doctor...so you stick around in your diseased state and spread your germs and filth throughout my city, you are absolutely exposing other people to risk

[DosEquis]

Originally Posted by Thorgrim

If you are a diseased person and can not get treatment even though its uncomfortable beyond any reservations about seeing a doctor...so you stick around in your diseased state and spread your germs and filth throughout my city, you are absolutely exposing other people to risk

Risk for what? The common cold? The flu? There is no cure for the common cold and in many areas flu shots are free. I actually skip my flu shot even when it is free. Most people stay home and do not require a doctor visit for such a basic illness. Any significant disease or pain a person is in, they will just suck it up and get treatment regardless, simply to not deal with the pain anymore.

Other diseases like HIV, herpes, you should probably screen your booty calls a little better.

[Thorgrim]

Originally Posted by DosEquis

Risk for what? The common cold? The flu? There is no cure for the common cold and in many areas flu shots are free. I actually skip my flu shot even when it is free. Most people stay home and do not require a doctor visit for such a basic illness. Any significant disease or pain a person is in, they will just suck it up and get treatment regardless, simply to not deal with the pain anymore.

Other diseases like HIV, herpes, you should probably screen your booty calls a little better.

The flu kills people, and flu shots are not 100%, and that's one example

the fact is people are full of germs and many of them can lead to serious health problems

[DosEquis]

Having insurance is not going to prevent disease. Flu or otherwise.

[A_C_E]

I'd just like to say that I've missed you, Thorgrim.

[Thorgrim]

Originally Posted by A_C_E

I'd just like to say that I've missed you, Thorgrim.

que?