by PNHP Executive Director Dr. Ida Hellander with PNHP National Coordinator Dr. Quentin Young
Obama’s health plan, announced yesterday, is essentially the same as the Edwards’ health plan, continuing reliance on the employer-based system of private health coverage that has failed America and brought the health system to the point of crisis.
Key features of both:
* “pay or play” (that is, employers have to cover workers (“play”) or contribute to a fund to cover them (“pay”). This was the basis of Nixon’s health plan in the early 1970’s and Bill Clinton’s health plan in the early 1990’s. No details on what coverage employers have to provide, or what they might have to pay into the fund, are given by either)
* creates new public program individuals can buy into with tax subsidies, or they can use the subsidies to buy private coverage. Again, no details.
* new bureaucracy to buy and regulate private insurance – “health markets” (Edwards) and “national health insurance exchange” (Obama). Bill Clinton called them “health insurance purchasing cooperatives” in his plan
* expand Medicaid and SCHIP (admission that the tax subsidies won’t be enough to help low-income people buy other public or private coverage)
* individual mandate – that is, everybody must buy coverage (Edwards), only children must have coverage, presumably by mandating that parents buy them coverage (Obama)
The only substantive difference between the plans is that Obama also has the federal government pick up the cost of “reinsurance” for “catastrophic costs” for private health plans. No details given, but he notes that 5 percent of people use 49 percent of costs, so could be a significant windfall to private insurers (along with the tax credits and mandates that people buy coverage).
Finally, Obama references two papers by PNHP co-founders Dr. David Himmelstein and Dr. Steffie Woolhandler: Their seminal paper on medical bills as a contributor to bankruptcy (Health Affairs, 2005) and their groundbreaking study on the 31 percent administrative overhead in the US health system (New England Journal of Medicine, 2003). Unfortunately, he doesn’t show any understanding of the implications of either. For example, he continues to rely on private health insurance (75 percent of people bankrupted by medical bills had insurance) and insist (like Hillary Clinton) that computers can reduce administrative burdens in the health system (only a single payer can do that, as demonstrated in their research).
Overall, an unhealthy start on health policy by Obama and Edwards, but both candidates are aware that the single payer option for reform is better (Obama says he “personally favors it” and Edwards says his plan “may evolve into single payer”). Hearing from physicians and the public on the overwhelming support and preference for single payer national health insurance (“Medicare for All,” HR 676) could move both candidates from the Nixon camp of employer-based coverage to the Truman camp of support for genuine national health insurance before November of 2008. Polls show that 70 percent of likely democratic primary voters, and a majority of all likely voters, support single payer.
Is anyone besides long-shot candidate Kucinich listening?
