Monday, September 17, 2007
The Good and Bad of the New Hillarycare
The former first lady says she has learned from the 1990s experience, which almost derailed Bill Clinton's presidency and helped put Republicans in control of Congress for years to come. Aides say she has jettisoned the complexity and uncertainty of the last effort in favor of a plan that stresses simplicity, cost control and consumer choice.
The centerpiece of Clinton's plan is the so-called "individual mandate," requiring everyone to have health insurance — just as most states require drivers to purchase auto insurance. Rival John Edwards has also offered a plan that includes an individual mandate, while the proposal outlined by Barack Obama does not.
Clinton's plan builds on the existing employer-based system of coverage. People who receive insurance through the workplace could continue to do so; businesses, in turn, would be required to offer insurance to employees, or contribute to a government-run pool that would help pay for those not covered. Clinton would also offer a tax subsidy to small businesses to help them afford the cost of providing coverage to their workers.
Of all the candidates, Rudy Giuliani seems to have the best health care plan for the moment.
This still smells to me like her trying to bring back the old system but in a more round about way.
What happens if an employee does not want the offered insurance from their employer... can they drop that and go with the government subsidized one?
My concern would be of what we've seen with programs like the State Children's Health Insurance Program where in some states people capable of paying for their own insurance, either through their employer or on their own end up switching to the state run system because it is more affordable as income limits and eligibility is raised.
Granted I haven't dug into it yet... however I would expect that under HillaryCare II, once the mandates and government pool are in place, income limits would be raised enabling and encouraging more and more people to leave their employee program and move to the pool where before to long we get back to what HillaryCare I was intended to be.
Posted by: Brendan | Monday, September 17, 2007
Right on TDAXP.
The private mandate idea is a good one and has been around for awhile.
I think de-coupling health care from businesses could add .5% of growth to the economy annually. Business is not optimized to deliver halth benifits.
To go with the private mandate you need to let insurance companies sell across state lines and open it up to unions and professional groups.
I also like a short-term quick fix suggested by Sen. Bradley when he ran for president in 2000: Let any small business buy into the current federal health plan. I say let anybody (or any company) buy into the federal health plan until a private mandate system is ready.
Posted by: PurpleSlog | Monday, September 17, 2007
Insurance only makes sense in the context of risk pooling, but as genetic screening falls in price (the cost of sequencing an individual's genome could conceivable be $10,000 or less by 2017) there's less and less of medical "risk" to pool. Either insurance companies will be allowed to screen genomes and use the information -- in which case they won't offer coverage to the possibly sick in the future -- or they won't, and high-risk individuals will opt-in while low-risk individuals opt-out.
The business-centric approach to health care locks a lot of people into jobs, substantially decreasing labor market fluidity, especially on the older (and more skilled/experienced) end of the pool.
Traditionally, health care in the United States was centered around the individual, the government, the employer, and the general hospital. The first two are still vital parts of the solution. The second two aren't.
Posted by: Dan tdaxp | Monday, September 17, 2007
From what I can gather, you wish for a universal healthcare system that is not single payer, one that sidesteps requirements for employers similar to Giuliani's plan, and one that is 100% tax dollar subsidized in order to avoid extra bureaucracy in the tax code (unlike Giuliani's plan) and also puts employers on an equal playing field, or did I miss anything. Sounds good to me so far...
There does remain the issue of the authority of private insurance companies in this plan. What would you suggest to prevent the denial of pre-existing conditions and the writing off of conditions all together in the fine print?
Posted by: Jeffrey James | Thursday, September 20, 2007
"From what I can gather, you wish for a universal healthcare system that is not single payer, one that sidesteps requirements for employers similar to Giuliani's plan,"
Yes, and yes.
"and one that is 100% tax dollar subsidized in order to avoid extra bureaucracy in the tax code (unlike Giuliani's plan)"
Not sure what you mean by "100% tax dollar subsidized," but I believe universal health care is a good that should be paid for out of general tax revenue. That doesn't mean there can't be individual plans, of course.
"also puts employers on an equal playing field,"
"What would you suggest to prevent the denial of pre-existing conditions and the writing off of conditions all together in the fine print?"
Probably allowing people to buy into the federal plan. The sun is setting on private insurance .
Posted by: Dan tdaxp | Thursday, September 20, 2007