Health Care Proposals: What's Going On?
by DemFromCT
Sun May 04, 2008 at 07:52:29 AM PDT
smintheus wrote yesterday about the 71 year old Republican candidate's attempted smear of Democratic proposals, evoking big government socialized medicine (in McCain's day, that meant something, but these days, it's just a marker of whether you are a Republican or a Democrat. And, of 
course, there's fewer and fewer Republicans every day.)
Earlier in the campaign Mr. McCain made the accusation more explicitly. "There will be efforts to have a single-payer big government solution by the Democrats," he said at a debate in Orlando, Fla., in October. "They’ve already espoused those causes. If you believe them, please take a trip to Canada or England before you decide to support such a thing."
And in August when he was interviewed by Charlie Rose on PBS, Mr. McCain said: "Look at what the Democrats’ proposal is. It’s a government-run, single-payer system like they have in Canada and like they have in England."
Mr. Rose interrupted: "But I beg to differ. They will say that it is not that at all."
Certainly it is not, even if many wish it would be. But what we have here is something that's a good deal simpler than it seems, but no one wants to talk about. The simple fact is that neither Republican nor Democratic proposals put a great deal of extra money into health reform. Because of that, the only way to enact any of the candidates' stated programs (in the unlikely event they actually go forward as is – something Congress will have a major say in) is to redistribute dollars, or to put it more bluntly, figure out who the winners and losers are.
In the McCain proposal, the winners are the insurance companies, and to a lesser extent, business. He'd like to allow more 'freedom' for the companies to sell their product with higher deductibles and catastrophic insurance but less in the middle, and somehow he'd like to borrow Bush's magic wand (the one that lowers oil prices) to make a high deductible plan more affordable to average Americans (and hope they don't really need the coverage or medicine). The funny thing is that McCain doesn't really understand his own proposal.
As a result, McCain's aides have been scrambling to come up with ways to satisfy those who want more coverage without violating what they call McCain's conservative principles on the issue.
There's more here about McCain and his plan, and more references here about all the plans.
In the Democratic proposal, increased coverage is the goal, though the cost of such a system to both consumers and taxpayers in unclear. Winners are those who can't afford insurance now, but what the end result will look like is murky. That's partly because there's a great disparity across the country between states like TX and CA with high uninsured, and states like MA with much lower percentages of uninsured, so winners and losers are not evenly distributed geographically.
So, trying to figure out winners and losers, here's some very helpful advice from the CEO of the Kaiser Foundation, Drew Altman:
In listening to candidates at a series of presidential candidate forums in our Barbara Jordan Conference Center and sifting through the hundreds of hours of speeches, debates, and documents by Presidential candidates about health policy we have compiled on the web, here are three critical differences between the parties that set the stage for the next health reform debate.
First, there is a basic difference on whether guaranteeing universal or nearly universal health insurance coverage should be the primary goal of health reform. Democrats consistently say it should be, though the leading candidates’ plans differ somewhat on how to get there and whose plan represents a better approach. Republicans do not have universal coverage as their overarching goal. They believe it requires too big a role for government to guarantee universal coverage and will cost too much to pay for it. Instead, they want to make coverage more available in the private marketplace and give people a tax break to help those who want it afford it. The top priority they emphasize is to create a more efficient, and in their view, more affordable private health insurance marketplace based on individual choice and competition. This, they believe will expand coverage, but guaranteeing coverage for all is not their main goal. This difference reflects the greater priority their base gives to controlling costs over expanding coverage, as documented repeatedly in the tracking polls that Molly
Brodie, who heads our polling group, and her team conduct at the Foundation.
Altman rightly suggests focusing on the fundamental differences between the D and R plans, including the McCain's suggested move away from employer-based care, because that's what the discussion should be in the fall:
...there is also a fundamental difference in what the two sides see as the basic purpose of health insurance. Democrats favor comprehensive insurance with front-end protection, which in their view encourages more preventive care and protects people better from financial costs of an illness. Republicans generally promote plans with high deductibles on the front end and catastrophic protection on the back end, coupled with tax-preferred savings accounts people would use to pay for routine care. They believe this will encourage people to become more prudent consumers of health care and use less health care overall. Whether high deductible health plans with savings accounts are a forward-looking reform that will introduce market incentives and lower costs as advocates claim, or represent skimpier insurance surrounded by market rhetoric as critics believe, is an important question to debate and study as these new forms of insurance enter the marketplace. My purpose here is to characterize differences, not to referee these debates. There is no question, however, that the difference between the parties on the very nature and purpose of health insurance is a fundamental one that needs to be elucidated for voters.
Altman has further observations that can be found here. And, for a more blunt view of what's going on in the health debate, check out this half hour video from Henry J Aaron (Brookings) and Stuart Butler (Heritage) debating the uninsurance/underinsurance issue. Wonky, but very good. Aaron notes the winner-loser issue up front, and Butler talk about the limits <gasp> of the market (not bad from a conservative). He says "markets themselves cannot guarantee affordable and available access everywhere", and he's right. But he also brings up issues of rationing as an inevitable consequence. Both agree that state innovation (with Federal support) is key, which is exactly the opposite of Bush and McCain's attitude towards SCHIP.
McCain: Bush right to veto kids health insurance expansion
This is an issue that will be even more prominent come November, so take the time to study up a bit on how to define the issue. It seems that McCain is already trying to do that, and part of the reason is that he knows he loses on the universal coverage issue (see McCain rejects calls for universal health coverage), and because of his pre-existing cancer diagnosis, looks like a hypocrite to boot. And don't get me started on what recession means to all of the above. Check this out:
Almost Four In 10 Report Serious Financial Burden Caused By Medical Bills; 7 Percent Say Someone In Their Household Got Married So They or Their Spouse Could Get Health Benefits
Health reform is a problem that's not going away.
DemFromCT's Health Care Discussion Links can be found here.
- ::