The Washington Post
November 21, 2007
“When Senator Clinton or Senator Edwards say they’re going mandate health care, but they haven’t talked about either how to enforce it, or how to make it affordable to people, then it’s not really a mandate. Anymore than if we mandate that people get car insurance. But (if) they can’t afford it, they just don’t get it,” (Sen. Barack) Obama said.
“Senator Clinton’s health care plan covers every single American. Senator Obama’s does not. Any health care plan that leaves 15 million Americans uninsured cannot be considered universal,” said (Clinton spokeswoman Kathleen Strand).
http://www.washingtonpost.com/wp-dyn/content/article/2007/11/21/AR2007112101034.html
And…
Bill Richardson Talks Up Health Plan
Associated Press
November 21, 2007
Speaking at Rivier College, which offers nursing degrees, (Gov. Bill Richardson of New Mexico) said he isn’t completely opposed to the kind of government-run, single-payer system used in Canada and many European countries, but prefers to give consumers a choice.
“I’m starting to warm up to it a little bit because I get very frustrated with insurance companies. … They tick me off, and I wish I could say, ‘You’re out of this business,'” he said. “The problem with that is, fundamentally, I believe every American deserves choice.”
Richardson said he’d rather control the insurance companies and force them to do the right thing. He also said he worries that a single-payer system would create an overwhelmingly complex bureaucracy.
“I hate bureaucracy,” he said.
“If you hate bureaucracy, how can you like HMOs and insurance companies?” Richard Ingram called out from the audience.
“That’s called a left hook,” Richardson joked.
http://ap.google.com/article/ALeqM5gNrYvAi-WwpRBCdw1Ry9fxZ2as4QD8T1O61G0
Comment:
By Don McCanne, MD
There seems to be a consensus that the Democratic presidential candidates are leading on the issue of health care reform. But what are they leading with?
Except for Dennis Kucinich who advocates for a single payer national health program, all of the candidates support choice in the private health insurance market (albeit some would also include a competing public insurance program that would fail due to adverse selection). The well-recognized fundamental flaw of using private plans is that the insurance industry can no longer provide reasonably comprehensive plans that are affordable for average-income individuals (without resorting to near-fraudulent underinsurance programs).
Sen. Clinton ignores this and pretends that you can simply require individuals to buy bona fide plans that they cannot afford. Sen. Obama does acknowledge this problem but pretends that tweaking our system will make plans so affordable that everyone will want to buy them. Neither approach can possibly provide affordable, comprehensive care for everyone. By rejecting the single payer approach of creating an equitably-funded universal risk pool, they have both abandoned any hope of achieving affordable health care for everyone even before the real process for reform has begun.
Gov. Richardson also uses the conservative/neo-liberal framing of “choice” (phony choice of private marketplace health plans that take away your real choices in health care) because of concerns about political feasibility of the progressive framing of “choice” (real choice of health care professionals and facilities under a universal, publicly-financed system). But he does seem to understand the line between politics and policy as he let slip his actual views about single payer, and about the private insurance industry about which he wishes he could say, “You’re out of this business.”
And his comments about hating bureaucracy? Maybe it’s time to give all of the candidates a left hook – not a knock-out blow, but just enough to shock them into reality.