The Clinton Healthcare Plan: The reviews are coming in and Kossacks speak out [UPDATE]

The deed is done. Senator Clinton has finally released a detailed health care plan.

My initial impression was favorable with many deep regrets and caveats. I suppose when you're expecting the worst, and get something better than you're hoping for, you breathe a huge sigh of relief.  This is how I felt and how I continue to feel.  As I wrote in an email to eugene, a Kossack I love for his deep commitment and wisdom  about healthcare reform, "I'm learning the importance of compromise in my old age."

But what I think isn't important. All that counts is whether the American people believe this plan or any plan will be good for them or is simply shoveling more money to the PAY OR DIE, MURDER BY SPREADSHEET, for-profit insurance industry.

Here is a sampling of opinion.

This is what eugene wrote to me. He was frankly very disappointed that in a comment in one diary I said that I would try to live with some version of Clinton's plan. Again, I was more relieved than pleased. But I'm big on compromise, I'm often the first person to throw in the towel and settle. Perhaps on this, I'm dead wrong.

I would say it's possible that eugene may be the canary in the mine.  We should consider listening to him, he may be the voice of the American people. The subject line of his email kind of sums up his reaction. "Hillary's disasterous plan". Don't keep your feelings all bottled up, eugene!

This is what he had to say.

I post as "eugene" over at Daily Kos and have long been a fan of your work on health care. Which is why I'm a bit surprised to see you giving props to Hillary's plan. I think it will be an unmitigated disaster, and as someone currently uninsured, I am worried about it instead of relieved.

The core problem is, of course, the individual mandate. There is little guarantee that I will be able to afford the cost of a health insurance plan. As I wrote about in February when attacking Arnold's individual mandate plan:

http://www.dailykos.com/...

Massachusetts has found that they were unable to keep the cost of such mandatory premiums under $3000 a year. That's $250 a month that I do not have. Would I qualify for a subsidy? No, Hillary instead offers "refundable tax credits" and limits based on % of income.

Those are an outrage. What she is saying is that we have to fork over the costs UP FRONT - with what money? - to buy coverage or pay for certain kinds of care, and we might get reimbursed later if we fill out the forms correctly. The problem, of course, is how are folks to pay those costs out of pocket? There's no way I can buy an insurance policy right now. Which means I have to turn to a credit card - furthering the reliance on debt of the health care system. (I wrote about that too, here:)

http://www.dailykos.com/...

There is the further question of what kind of care we will receive in return for these high premiums. Hillary, and WAY too many people in the diaries on her program, make the common mistake of confusing health insurance with health care. I also wrote about that one before:

http://www.dailykos.com/...

What kind of insurance will we be forced to buy? What will it cover? Will we be able to see a doctor anytime we wish, at an affordable price? Or will we have to wait for the usual delays of insurance runaround, denials, approvals, rescinded approvals, etc, etc? In short, what in her plan actually addresses, prevents, or outlaws the practice of "Murder By Spreadsheet?" Does she assume that can be taken care of by buying the Congressional plan? What will that plan cost, though? Doubt it will be all that affordable even WITH a refundable tax credit (again forcing people to pay out of their own pocket).

Her plan is a lot of smoke and mirrors. It relies on her employing the language of reform to coddle us into thinking she's on our side, but without the substance to back it up. As someone currently uninsured, I do not want to be forced to give what little money I have to the insurance bloodsuckers so they can jerk me around and deny me care.

I'm sure I will think of more problems with the proposal as the day passes and as I work through it in my mind. But as it stands now, I think this is a cure worse than the disease. It WILL bankrupt families, and apparently does not guarantee actual provision of care. I understand people's desire to get any kind of reform, but, a reform like this that will blow up in our faces will not only cause significant harm to people, but will sour the public - again - on major health care reform.

This plan needs to be opposed, as ALL individual mandate plans should be opposed.

This is from Matt Stoller someone I admire and look to for the political insight I often lack.

I thought Clinton's plan, like Edwards's and Obama's, was fine.  The problem is always political; just what is the new President willing to trade away to get some form of national health care?  That's the black box question you can't answer with a plan, since it's the outcome of a complex series of negotiations and arguments.  The proxy for the black box answer is 'trust' or 'experience' or a 'willingness to fight'.  I want to know how aggressive the candidates will be around pointing their fingers at the obstacles to health care reform, the insurance companies.  And here they are, threatening Clinton, and here she is, responding.

But Karen Ignagni, president and CEO of America's Health Insurance Plans, was unimpressed: "The new Clinton plan includes important ideas to make coverage more affordable; unfortunately, some of the divisive rhetoric seems reminiscent of 1993."
Addressing GOP criticisms, Clinton said, "They're attacking me before I even put my plan out there. And I frankly carry that like a badge of honor. Because we're right and they're wrong."

I am deeply skeptical of Clinton's political judgment, but this is great.  Opposition from insurance companies should generate political capital for progressives, since insurance companies are so widely loathed.  It sounds like Clinton gets this.

http://openleft.com/...

Here's an excellent analysis from Ezra Klein. Ezra credits John Edwards as the true champion of bold healthcare reform.

I believe if when the United States joins the rest of the civilized world in making guaranteed and affordable universal healthcare a basic human right, historians will recognize that John Edwards was the guiding hand father of this reform.

Given Clinton's history, her record in the Senate, and the sense of caution that afflicts every frontrunner, it's hard to imagine she would have been so bold had Edwards not opened up the political space, and indeed created an electoral imperative, for boldness on health care reform. Edwards, in fact, met her new plan with a speech making an issue out of his commitment to passing his plan, even announcing legislation that would terminate health coverage for Congress if they failed to pass health reform by July 2009. The issue of health care, and thus Clinton's plan, will not be able to gather dust on a shelf while the candidates speak of safer things -- it will be brought up, and she will need to recommit to it, again and again.

http://prospect.org/...

Another hero.

Rose Ann DeMoro, the executive director of the California Nurses Association has a rather scathing review in the Huffington Post.

In the days leading up to the announcement of her latest, much anticipated health plan, Sen. Clinton threw around the word "consensus" a lot. In this case, the consensus she was seeking was with the same industry that so savaged her prior experience with healthcare.

This time, she apparently wants to soften them up in advance with a proposal that will generate hundreds of millions of dollars in additional profits for the insurance giants. It's probably not a coincidence that she is also the top recipient of healthcare sector contributions to her presidential campaign.

Looking past the bells and whistles -- which do at least include some good sound bites on retiree health and giving regular Americans the same health plan options as members of Congress -- the Clinton plan seems to rest on three shaky legs:

1. Forcing all Americans, who do not have current coverage and do not qualify for public assistance, to buy and maintain insurance;

2. Mandating large employers to either provide health benefits or contribute to the cost of coverage

3. Tax credits for just about everyone

http://www.huffingtonpost.com/...

But you are the most important voices in this discussion. So it's time to weigh in.

What do you think?

You also might want to check out this diary from the incomparable shum at the California Nurses Association.

Is ClintonCare SchwarzenCare?

http://www.dailykos.com/...

Update [2007-9-19 10:5:37 by nyceve]: Just received an email which explains the reason for the change in the title of the diary.

I hope you don't mind me emailing you, but I wanted to see if you'd consider re-naming the headline of your diary about Hillary's health care plan.  "Hillarycare" is a right-wing meme that came about to fight her in the 90s and is still being used by the GOP candidates today in a very negative and derisive manner.  Whatever squabbles one may with her plan, I think it's best not to frame it using the words of the right-wing.  

After all, at least she's trying to get us to universal health-care, unlike those jokers.

•  Trust me, people are going to read . . .

  what you say.

  Now's the time to tell them what you think.

  by nyceve on Wed Sep 19, 2007 at 05:09:26 AM PDT

  •  In the streets...people really keep

    saying how 'low quality Canada's insurance is' and how there's a wait and they'd rather have what we have.

    And I've been responding, "So... just because a friend of a friend says it's low quality there, isn't low quality better than NO INSURANCE at all? And isn't a wait to get seen better than waiting forever because you have no insurance to be seen?"

    What I don't understand is why people seem to think that Canada is so bad when at least they've got something.  The grass is always greener...?

    by Silence is Complicity on Wed Sep 19, 2007 at 05:21:00 AM PDT

    •  Well

      Canadian health care insurance is generally great, rarely do you have to open up your wallet for anything at a Dr's office. Medications, however, aren't covered by insurance, nor are dentists, optometrists, etc.

      The biggest problem with Canadian health care isn't the insurance; it's the shortage of practitioners. Long wait times aren't uncommon when booking an appointment with a specialist. Even getting a family Dr can be difficult in many areas.

      by jay w on Wed Sep 19, 2007 at 05:55:10 AM PDT

      •  yeh, but there's 3-4 month wait times in the US

        too for seeing a specialist.  And often I can't see my own physician without waiting two months.  (Unless I can squeeze in where there's been a cancellation.)

        by Silence is Complicity on Wed Sep 19, 2007 at 06:02:46 AM PDT

        •  The complaints about the Canadian system

          are propogated by those who either have cadillac insurance coverage or by the insurance industry.  I have many Canadian friends.  No one would trade their system for the US system.  No one is denied care or lives in fear of becoming ill or having an accident. No one pays up front.  Premiums are deducted through income tax forms and are scaled according to ability to pay.  At a certain point one does not pay premiums.  

          There are no insurance companies to deny care.  More problematic is dental care but that is seen as more affordable than regular health care and people can get care if needed.  That is now being looked at in some regions.

          Complaints about the Canadian plan are a distraction.  We need to focus on what we want and have everyone be able to get the health care they need.  Hillarycare is not it.  It is the way to NOT get universal health care.  She know how to not get a plan passed.

          by pioneer111 on Wed Sep 19, 2007 at 06:26:34 AM PDT

          •  Not necessarily

            I don't necessarily think that

            Complaints about the Canadian plan are a distraction.

            I think it's worth looking at other systems to see what works and what doesn't. I'd rather be objective about things.

            by jay w on Wed Sep 19, 2007 at 06:33:52 AM PDT

            •  Hey, let's get to where Canada is first.

              Then we can think about how to improve on it. At least a few thousand people will not have to die needlessly.

              by horatius on Wed Sep 19, 2007 at 08:17:53 AM PDT

            •  did you read

              Dr. A’s World Tour of Health Care Systems:

              49 Percent of Americans Unprepared to Pay For Medical Emergency
              World Health Care Tour I: The Top Down Approach
              Housekeeping  (not dusting and washing dishes)
              World Tour of Health Care II: In the Top Ten
              World Health Tour III: A Bottom Up Approach
              France Revisted
              World Tour IV: Viking Medicine
              The "Death by a 1000 Cuts" Bill
              Readers Digest Version of the Health Care Cooperative Act

              by SarahLee on Wed Sep 19, 2007 at 10:59:29 AM PDT

              •  Yes! That is a GREAT series, well worth the time!

                I read every one of them and linked to it from a group where we have been having these discussions for quite some time. It shows the good, the bad, and the ugly of a lot of systems.

                We should be able to look at them and see what is working well, and what is not, and create our own that works for us!

                by splashy on Wed Sep 19, 2007 at 11:11:25 AM PDT

          •  Missed this the first time

            The complaints about the Canadian system are propogated by those who either have cadillac insurance coverage or by the insurance industry.

            That is quite ignorant to say. I'm not bashing the Canadian system, just pointing out that it's not a Utopian paradise. Does it work better for the people than the US system? Without a doubt. Does it still have some problems? Without a doubt.

            Are you inferring that I'm some sort of corporate plant, or am so rich that I can afford great health care? You assume too much.

            by jay w on Wed Sep 19, 2007 at 06:37:35 AM PDT

            •  no--I think he was talking to me--since I brought

              up the subject.

              But I brought it up because that's what I hear when I bring up the subject of universal health care.

              by Silence is Complicity on Wed Sep 19, 2007 at 06:41:52 AM PDT

              •  I'm not so sure

                As far as I can see I'm the only one who has pointed out anything negative about the Canadian system here, maybe I'm missing something?

                by jay w on Wed Sep 19, 2007 at 06:45:09 AM PDT

                •  What you are pointing out is very important

                  Like many - probably most - Americans, I do not have to wait to see a physician.  I can get an appointment for an emergency immediately or I can go to the emergency room and my insurance bills $50.  I can get a specialist appointment very quickly once my doctor gives me a referral.

                  And thats the problem people who advocate single payer don't see:  Why should I give up what I have to get less and pay more?   Why?  I should do it to be "good" to my fellow Americans?  Well, why are we limiting this goodness to just giving away health insurance benefits?  Its going to be very, very hard - impossible - for our millionaire pols to insist on that sacrifice from the majority of Americans and thats when it all falls apart as it did in '93-'94.  

                  Same thing with mandating health insurance.  Theres a link to Edwards plan on another thread that says $4,000/year premium.  Thats more sacrifice.  The healthy uninsured are not the problem causing healthcare costs to go up.  Thats a canard that politicians try to use to avoid the real problems, which, if they addressed them would involve denial of service.  

                  by Lois on Wed Sep 19, 2007 at 07:03:06 AM PDT

                  •  Location location location.

                    Where you are (which is usually a function of how much money you have) has a huge effect on your quality of health care service in the US. Suburbs chock full of white professionals are overflowing with doctors, hospitals and MRI clinics. Cities are often a different story so are (poorer) rural areas. That's what you get when you have a system where those with the money get the service, there's lots of competition for and options for the people with money. The rich suburban people are much better off and therefore just don't see the problem.

                    I have a so-called 'gold plated' health insurance plan through my employer. I could easily turn a blind eye to all this as I don't often wait in lines or worry about coverage. If I didn't begin my career as a lowly hourly employee with poor insurance that the company downgraded right before my three year old son was diagnosed with type one diabetes I probably wouldn't be here at all. Sicko helped a lot in this regard, getting the message out that the insurance companies, due to their constant search for increasing profits are starting to deny more and more rich suburban whites their care. In essence the insurance companies are slowly selling us the rope to hang them by. We need to make sure we use it and don't let them convince us to use the rope on ourselves (or rather the sick who cost them money)

                    by Serpents Sorrow on Wed Sep 19, 2007 at 07:51:17 AM PDT

                  •  Good point... I have the same cadillac service

                    and I understand that national single payer is an improvement becasue everyone would have the same golden care for less cost.

                    I get same day appointments in my gold standard on profit HMO, I get same day mammograms, for instance, and self referral for most issues.  No one is talking about lowering standards but to increasing access.

                    Edwards plan on another thread that says $4,000/year premium

                    I agree, this is a solution in search of a problem. Americans who can't afford care can't be forced into it. I'm not concerned so much about the healthy un/under employed single grad student, but the working poor. Hillary's plan has an OK approach to the working poor.  

                    by kck on Wed Sep 19, 2007 at 08:16:11 AM PDT

                    •  link? for the $4K per year

                      by annefrank on Wed Sep 19, 2007 at 11:02:04 AM PDT

                      •  You'll have to ask the author

                        Lois

                        by kck on Wed Sep 19, 2007 at 11:07:29 AM PDT

                        •  Lois also didn't provide a link for her assertion

                          by annefrank on Wed Sep 19, 2007 at 11:18:35 AM PDT

                          •  My link is to Lois

                            I never create a link to text in the comment I'm replying to but might in the future if it's not clear.

                            by kck on Wed Sep 19, 2007 at 11:30:11 AM PDT

                            •  I'm just letting you know -

                              I still don't know the basis for her comment.
                              But I've asked - perhaps she'll respond.

                              by annefrank on Wed Sep 19, 2007 at 11:47:37 AM PDT

                  •  Mainly because the present system

                    is unsustainable.

                    It's not even being good or bad.

                    47 million uninsured today, and only going up.

                    And those numbers run contrary to the idea of healthcare as a right instead of a class privilege.

                    If you want the status quo, then you must make your peace with watching fellow citizens die in the streets.

                    18,000 a year alone.

                    by Ozzie on Wed Sep 19, 2007 at 08:43:21 AM PDT

                    •  Then no multi-million $ homes for pols, OK?

                      You're talking REAL sacrifice for ordinary Americans who have health insurance coverage now that they feel comfortable about or who feel they can live with the risk of not having health insurance vs the cost.  

                      Massive healthcare reform is not going to happen; it is, if anything, wrong for politicians to campaign on it because they are not dummies and they know the realities of why such reform will not become law.  It was not some diabolical insurance/pharmaceutical industry effort that killed the '93-'94 Clinton healthcare plan.  It was, in this order:

                      (1) The Clintons overreaching in search of a "legacy" that was absurd for a 43% president to aspire to and
                      (2) The public and Congress did not trust a government system not to make losers of the majority of Americans.  The public AND Congress.

                      by Lois on Wed Sep 19, 2007 at 09:05:55 AM PDT

                      •  re:

                        2. The public and Congress did not trust a government system not to make losers of the majority of Americans.  The public AND Congress.

                        Single payer universal health care's advantage is that Medicare has 1/10th the administrative costs of private insurance. So wringing those enormous profits out of the system would help fund the 45+ million people who are uninsured.

                        If that administraive cost is removed and otherwise the health care system stays as it is now, your concerns should be taken care of.

                        One question that was addressed in "sicko" was whether doctors in Britain earn as much as doctors here. The doctor interviewed said he earned about $200,000 (I assume $American) and he has a nice home, a family and two expensive cars.

                        We are on an unsustainable course wrt the extremes in income in this country. Whether that ties into the health insurance question or not, I don't know but perhaps it does and perhaps it ties in with every poor policy we have.

                        by eve on Wed Sep 19, 2007 at 10:05:21 AM PDT

                      •  Sacrifice?

                        You're talking REAL sacrifice for ordinary Americans who have health insurance coverage

                        I'm an American, currently living in Canada. My wife and I pay $96 a month for medical insurance. That's the top rate; lower-income people pay less, or nothing at all--sliding scale. No insurance company dictating my choice of doctors. No co-pays. This doesn't cover drugs, though (of course, drugs are inexpensive here).

                        So, where's the sacrifice?

                        by tacet on Wed Sep 19, 2007 at 10:39:27 AM PDT

                      •  Then think economy

                        companies need a break from the insurance costs in order to compete.

                        by SarahLee on Wed Sep 19, 2007 at 11:04:45 AM PDT

                  •  You are very short sighted

                    about what you think you have.  

                    I'm thrilled you can get in to see a specialist a few weeks ahead of when you might in Canada.  Congrats.

                    But have you thought about how you are going to be punished by the insurance industry for seeing that specialist?

                    Do you think that visit won't effect your premiums?  Sure it will.  Maybe you work for a large company and you won't see that effect.  Maybe you won't notice that the cumulative effect for big companies reduces their hiring and increases your work responsibilties - for no increase in pay (well actually lots of people have noticed this going on), or maybe it reduces the amount available for bonuses or maybe it will lead your employer to cease to offer coverage or reduce your job to part-time so they won't have to give you benefits.

                    If you work for a small business or purchase individual coverage - you probably have a pretty good idea how you will be punished for actually using your insurance - and probably refrain from doing so.  Even those of us with what we think is good coverage are punished by the insurance companies for actually using that coverage - whether you see it or not.

                    Do you have any idea that every time you go to a specialist, have a test done, etc. that it is on "your permanent record" for insurability purposes.  If you lose your job with your cadillac coverage, that specialist visit may come back to haunt you in the form of a "pre-existing" condition that won't be covered under your new coverage or that may make it prohibitively expensive, etc.

                    You can't ask a company to simultaneously maximize profits by not providing benefits and provide benefits at the same time.  "For-profit health insurance" is a logical impossibility.

                    by trillian on Wed Sep 19, 2007 at 08:45:47 AM PDT

                    •  No offense but you are fear-mongering

                      That comes at me like Saddam Hussein might have developed the capacity to make nuclear weapons.  Yes, lots of bad things might happen but a normal thinking person will not make huge sacrifices in order to prevent the possibility that they might happen.  No, you weigh costs and risks.  You can get insurance for lots and lots of bad things that might happen to you and spend yourself poor on insurance.

                      These big reforms are not going to happen because the public does not have confidence in our political and elite leadership and why should they?  We just got lied into a war, for goodness sakes and the people who did it are running for President!  They don't hold themselves accountable and they live like princes but they want the American public to see the virtue of sacrifice.  I hear that all the time.  They want all the young people doing "some form of national service."  

                      by Lois on Wed Sep 19, 2007 at 09:17:49 AM PDT

                      •  It's not fear mongering

                        when you are describing something genuinely frightening.

                        The reality is that there is no way that even well off Americans can afford, out of pocket, cancer treatment, or heart surgery, lifetime treatment for a chronic illness or even the expense of a moderately serious household accident.  Since we don't know who is going to get to dodge the bullet and who is going to get hit by it - it makes sense to spread the risk.

                        So yes we have to buy insurance, the question is from whom.  There are really only two choices - the health insurance industry or the government.

                        Maybe you haven't, but millions of Americans have had experience with paying premiums to the health insurance industry and getting screwed in return. That is why many people who are insured are still worried sick that their coverage will be dropped, their coverage won't pay, they will be labeled "uninsurable" or as having "pre-existing condition" and they know that having coverage right now is no guarantee you'll be able to get coverage in the future.  This are very real fears.  I'm glad for you that you haven't yet experienced them, but they are very real.

                        Likewise millions of Americans have had the experience of paying Medicare premiums to the government and having coverage they can rely on - no matter what happens, even if they get sick.  

                        by trillian on Wed Sep 19, 2007 at 09:52:15 AM PDT

                        •  Yes the choices are single payer or universal

                          health insurance.  I don't see single payer being an option realistically, although I believe it would be the best.  There are two many people who are just fine where they are and will not support any plan the Dems put out that mandates new paradigms.  I think a gradual easment int an alternative to private insurance has the best  chance of working regardless of which candidate proposes it.

                          by hairspray on Wed Sep 19, 2007 at 10:45:54 AM PDT

                      •  It's not "fear mongering" if it's true

                        But, hey, "fear mongering" got us into a war, so maybe we can use the same tactics to get universal healthcare.  Whatever it takes, y'know.  I'm certainly not too proud to steal tactics from the rethuglicans.

                        by CoolOnion on Wed Sep 19, 2007 at 10:37:09 AM PDT

                        •  Unfortunately, it will take a huge crisis

                          to implement any kind of health care reform in the US.  Stay tuned, we are very close to a deep recession and many people will lose their jobs and their health care.  

                          I believe like many of the reforms and regulations that came out of the misery of the Depression, we will need to see some terrible pain and suffering in our nation to get people on board with single payer, which is the only economically viable solution that exists today.  

                          by Do Tell on Wed Sep 19, 2007 at 12:48:07 PM PDT

                      •  I'm offended

                        because I would have said the same things you're saying 5 years ago.

                        Then my spouse developed a chronic illness and became uninsurable. Then I was in an accident and found out that the $50 visit to the ER, which I would have died without, actually cost me $1300 and counting.

                        You don't have the privilege you think you do, you just haven't yet had the crisis hit your own family.

                        So the political reality, folks, is that Lois is typical. She thinks she's covered, and if she's lucky she might be right all the way to her Medicare card.

                        What do we need to do to communicate more effectively with the Loises in this country, who are counting on luck and convinced that they're just the only ones nothign bad will ever happen to?

                        I thought Mike Moore made a darn persuasive movie. Any other ideas? I'm getting bored listening to myself talk about my experience going from Lois's opinion about how insured I am to the unpleasant reality...and I don't think we can insist that a majority of voters have a health crisis themselves.

                        What's it going to take?

                        by PhoenixRising on Wed Sep 19, 2007 at 11:17:48 AM PDT

                        •  No offense but your focus is narrow

                          Lots of people have lots of problems besides healthcare.  You had a healthcare problem so thats the most important thing to you and you think the government should make massive efforts to help your situation.  

                          by Lois on Wed Sep 19, 2007 at 04:43:58 PM PDT

                      •  Many people are content and arrogant

                        when they or their families are healthy, employed, and have almost totally free healthcare.  It is when one loses  a job, is diagnosed with cancer or other expensive diseases, and is denied life saving treatment that some need to wake up to what millions face in America today.  

                        It is easy to disregard the crushing problems that many face, I hope that you or your family never have to face those problems.  

                        Until then, I am fighting for single payer.  

                        by Do Tell on Wed Sep 19, 2007 at 12:42:30 PM PDT

                        •  You're reading me wrong.

                          Politics is the art of the possible - I think thats an LBJ quote.  Single payer or personal mandates are not possible.  

                          I don't trust our politicians and elites to take over healthcare.  Five years later on, I might have a healthcare insurance situation under the government plan thats much, much worse than what I have now and then there's no going back, is there?  Thats at least as much a risk at least as that I'll lose the insurance I have now as a result of job loss and have a terrible illness.

                          Most people will not go for drastic change, and, in fact, the plans that involve the government (Clinton and Edwards) are not going to make it because people will be wary that eventually they will be funneled into the government plan one way or another.  When Bush wanted to turn Social Security into a mutual fund, he said that people could keep the option of staying with the current system but the reality was that there would be indirect pressures to get them into the new system.  

                          by Lois on Wed Sep 19, 2007 at 04:29:47 PM PDT

                      •  Lois, you need a new set of talking points

                        The health insurance companies are SUPPORTING Hillarycare. Better get back to your PR firm and find out why you support it, too before you return to astroturfing.

                        by alizard on Wed Sep 19, 2007 at 01:11:48 PM PDT

                        •  I don't care about the health insurance companies

                          I'm looking at whats good for most people and thats how Congress will look at it, too.  If most people are not better off with a massive healthcare reform, it will not happen.  It sure doesn't seem likely that most people will be better off and they might well be worse off and then theres no going back.  

                          by Lois on Wed Sep 19, 2007 at 04:37:48 PM PDT

                          •  having read some of your other comments

                            I believe you. Sorry about accusing you of astroturfing, I misunderstood your position.

                            If most people are not better off with a massive healthcare reform, it will not happen.  It sure doesn't seem likely that most people will be better off and they might well be worse off and then theres no going back.

                            Not to say that I agree with you. I think "reform" along the lines discussed here is going to happen whether we like it or not. When all three top-tier Democrats have substantially identical plans, the President attached to one or another can be expected to win. I also expect that getting this enacted will be one of the very first priorities in 2009, and with active support by the health insurance industry and Big Pharma, that it will win without substantial opposition. (the GOP will probably continue to oppose it, but so what?)

                            The people who will not be consulted about this are the people who can't afford health insurance now and won't be able to afford it when it's required by law. Tax credits don't mean much when one is barely breaking even and is in the lowest tax brackets.

                            by alizard on Wed Sep 19, 2007 at 06:26:01 PM PDT

                            •  From what I've heard, I lean to Obama's ideas

                              He's emphasizing how to make health insurance more affordable and let people buy into larger pools.  If that brings more people into the system voluntarily, thats good.

                              by Lois on Wed Sep 19, 2007 at 07:22:14 PM PDT

                              •  the health insurance industry IS the problem

                                and conscripting all of us to buy into it even at better prices (for what coverage?) is not going to help.

                                by alizard on Wed Sep 19, 2007 at 07:57:01 PM PDT

                  •  Here in Canada

                    you also have the emergency system, and you are put on a priority system.  Say, if you had an accident, you are seen right away, but if you had the flu and needed a note, you could wait for 3-5 hours.

                    It's not ideal.  We now have a shortage of family doctors in many places, but there are walk-in clinics that you go to. Almost everything is covered.  So if someone is diagnosed with having a tumor, they get surgeries, chemo, radioation, ... and all else they need.  Of course, it's becoming expensive, because everyone is covered for all medical needs (excepting drugs, dentist, eye exam, and eye care).

                    From what I hear, medications are a lot cheaper around here than in the U.S.  In addition, you don't need prescription for things like anti-histamines, and I think you need to in the U.S.  So a box of 30 Claratin tablets costs you approx. $20.

                    by ghost2 on Wed Sep 19, 2007 at 08:56:53 AM PDT

                    •  Thanks

                      Thanks for that information.  I'm pretty sure you can buy Claritin in the supermarket in the US without a prescription; I think I've seen it.  

                      How about surgeries on elderly people or hospital care for elderly people?  I don't hear that from politicians running for office but its THE big health expense.  My mother passed away last spring and after 2 brief stays (3 days each) in the hospital, she was sent home and I agreed to "hospice" care, not really understanding what I was doing.  Thats one way that Medicare sees an opportunity to cut costs: send patients home. But if I was in a position to advise someone else, I would tell them to know your rights.  Sending a very, very, very sick patient home with the promise of "hospice" or "home health" care (which might not come every day) can be a very difficult thing for the family.  IMO, my mother should have been kept in the hospital and without this "hospice" alternative, she would have been.  

                      by Lois on Wed Sep 19, 2007 at 09:32:14 AM PDT

                      •  LTC

                        Sending very sick pts home is not a new thing, it has been happening for the last 15 year or so. The alternate to sending them home is Long term care otherwise known as a nursing home. If you are ever in a position where you cannot take care of your ill family member don't just let the hospital tell you that you HAVE to take them home. Speak with a discharge planner and tell them they must arrange for placement.
                        Be aware that you might not get your choice of homes if the hospital makes the arrangements, and if you refuse the homes that accept your ill relative you may be then required to take them home.

                        by J Rae on Wed Sep 19, 2007 at 09:55:24 AM PDT

                        •  In addition,

                          I think you are required to pay for nursing home out of pocket, and only if you can't afford it, the government comes in.  The actual requirements and spousal role varies depending on the province.  I am not sure on details, though.

                          by ghost2 on Wed Sep 19, 2007 at 10:05:43 AM PDT

                          •  Payment

                            Well over 80% of LTC residents have their bills paid for by the government either through medicaid/medi-cal or through medicare for rehab or medicare hospice benefit.
                            There are ways to shield a spouse living at home from losing homes/possesions/bank accounts ect. There are standard and generous allowances, I haven't seen a spouse sent into destitution anytime when the paperwork is filed.
                            One of the complaints that is most common and sad however is grown children complaining that paying for care is eating up what they might otherwise get when mom/dad is dead.
                            Children are not required to pay the bill for LTC unless there is a very special circumstance. I have seen very very wealthy children pay privately for care of a parent. I have seen well off children sell off a parents assets and then place the parent on public assistance. It all varies.

                            by J Rae on Wed Sep 19, 2007 at 10:31:22 AM PDT

                        •  It was a very difficult experience

                          The intravenous feeding that they were doing in the hospital actually built up in her lungs and she could not lie down from the discomfort of "drowning."  She had dementia and no capacity for understanding anything that would help in her care, even that she had to draw "in" to sip on a straw.  She passed away 36 hours after the second discharge.  She should not have been discharged.  

                          I saw something on an elderlaw website about a new Medicare regulation that went into effect over the summer about how you now have to be informed IN WRITING about your rights under Medicare regarding hospital discharge.  Yes, I think it should be a very serious, detailed conversation and not just being put on the spot to agreeing to something like "hospice" care.  I had questions and no one knew the answers, simple questions like the cost of a live-in caregiver or how to get her into a care facility or how to more visits from the hospice caregiver and pay for the extra visits.  

                          by Lois on Wed Sep 19, 2007 at 10:24:40 AM PDT

                          •  Bad

                            Bad discharge planning is a very sad thing. The fact is they should have had you meet with hospice while your mom was in the hospital. Then you could have had explanations about why the fluids were backing up into your moms lungs (and how the feedings were contributing to her discomfort), what could be done to make her more comfortable and the fact that she could have had hospice care while in a LTC facility.
                            Hospice is a wonderful thing and endlessly useful during very stressful times.

                            by J Rae on Wed Sep 19, 2007 at 10:38:22 AM PDT

                            •  Thanks

                              Maybe reading this exchange we've had will help someone with a situation like this sometime.  I liked the hospice people I met and they were very sympathetic but I should have been told all the possible options before she was discharged.  Clearly, a long term care facility made more sense than sending her home.  

                              by Lois on Wed Sep 19, 2007 at 04:11:38 PM PDT

                        •  So true, the hospitals try to buffalo you

                          into thinking that you need to make those arrangements, when in fact, they have the resources to do so, but won't tell you about them.  I had that experience with my mother when she was ill.  

                          by Do Tell on Wed Sep 19, 2007 at 12:50:46 PM PDT

                  •  Lois - where is the link to the $4K?

                    by annefrank on Wed Sep 19, 2007 at 11:17:08 AM PDT

                •  The complaints about Canada are fake

                  No one seriously argues that we shouldn't try to take the best from every healthcare system and try to eliminate the worst.

                  There are good metrics to use to compare various systems, and plenty of good academic studies.

                  But the anecdotal complaints about Canadians pouring over the border, or a cousin who had to wait six months with heart pains, or a work buddy who waited a year to see a urologist--they're all fake. Propaganda. They're put out there by US insurance companies, and you'd have to be blind not to see that.

                  by Smallbottle on Wed Sep 19, 2007 at 07:09:28 AM PDT

                  •  Excuse me?

                    I'm not talking about "anecdotal complaints". I've experienced it first hand. It isn't all "fake" or "propaganda":

                    Bed shortage forces couple to US for birth of identical quadruplets

                    Of course "livescience" is probably just bought and paid for by US insurance companies right? How about the government of Alberta?

                    Alberta Health Workforce Action Plan "Addressing Alberta's Health Workforce Shortages"

                    Or a direct quote from the (then:2005) Prime Minister of Canada Paul Martin?

                    "I don't think anybody should be under any illusions -- there is a shortage, the Health Council is right, and we are dealing with it," Prime Minister Paul Martin said from a Liberal caucus meeting in Fredericton on Thursday.

                    Martin said the federal government has already committed $41 billion to health care over the next 10 years, some of which will go toward training.

                    He added: "I think the shortage of doctors, shortage of nurses, shortage of paramedics, is an issue that should have been addressed and there was a view some years ago that perhaps the problem wasn't as serious as it is now."

                    I'm just saying that there shortages of services in Canada, just as there are in the US. Who is blind again?

                    by jay w on Wed Sep 19, 2007 at 07:42:44 AM PDT

                    •  Stop pretending

                      As if I didn't wait a full year to see a specialist in the US last year.

                      The soundbites are losing their effectiveness.

                      It's one thing to use data to describe ways a healthcare system can be improved. The Canadians themselves use data that way, and they're always working on their system.

                      But that isn't what the meme is for. It's designed to discredit single-payer healthcare.

                      And I'm quite sure you know that.

                      by Smallbottle on Wed Sep 19, 2007 at 08:18:21 AM PDT

                      •  Chill

                        This guy is talking about his own experiences, and you're being a jerk to him.  You're right that there's a lot of crap information put out by the American insurance industry, but that doesn't mean Canada's shit smells like roses.  

                        The poster you're responding to isn't "propagating memes," he's being reasonable and citing reputable sources.  He's also not taking the stance you think he's taking.

                        by Conservative Liberal on Wed Sep 19, 2007 at 08:26:32 AM PDT

                      •  I never said the US was any better.

                        If you would bother to read through my comments you would see that.

                        I simply stated that the Canadian system has problems as well, specifically the care itself not the insurance. I even went to the trouble of finding valid references to back up my assertions.

                        But that isn't what the meme is for. It's designed to discredit single-payer healthcare.

                        And I'm quite sure you know that.

                        I'm not trying to discredit anything.. And I wish you would see that.

                        by jay w on Wed Sep 19, 2007 at 08:35:50 AM PDT

                    •  look nobody's looking for perfection

                      we want something basic..so 18000 people who are documented to die because of the lack of basic care, don't.

                      You pointing out a few problems with the Canadian system is just a distraction.

                      It's like the time when we are pushing for a withdrawal of troops form Iraq...some people start raising concerns about how the kurds/shia/sunni will fight each other... I mean yes that's a good point and we need to plan for it. But first let's get to the point where we have a serious withdrawal bill passed first.

                      Same thing here. We could do better than the Canadian system. But this isn't the time to start picking it apart (and AHIP Hillary's plan is def. not like the Canadian plan).

                      by daddy4mak on Wed Sep 19, 2007 at 08:24:25 AM PDT

                      •  I see your point nt

                        by jay w on Wed Sep 19, 2007 at 08:38:45 AM PDT

                    •  Legitimate discussion or right wing talking point

                      Canadian healthcare may have its problems..what system doesn't have problems from time to time.

                      But what's happening here isn't a true assessment of problems that may exist in the Canadian healthcare system.  There is an organized campaign going on to discredit the entire system, using bullshit sprinkled with anecdotal evidence.  

                      I think we need to try to tell when someone is having a serious discussion of the pros and cons of different systems, and when someone is parroting right-wig talking points on healthcare, because sometimes the two can sound somewhat similar.

                      This thread started with a sort of "word on the street" report.  When you start talking about healthcare plans to people in the US, you will get a certain percentage of quick and forceful comebacks  -  Canada, Canada, Canada...HUGE wait times, substandard service, horror stories.

                      I know where these are coming from.  Discussing the candidates with my very right-wing family, I was shocked to get the comment that "I hope we don't get someone who wants a health care program!"  This was quickly followed by the CanadaCanadaCanada spiel, and the ever-popular welfare mothers rant.  Now my family aren't newsies.  They wouldn't be getting this stuff from newspapers or unbiased accounts.  Everything they need to know they get from talk radio..they're junkies for that crap, and this is where it's coming from.

                      So when someone starts ranting to you about Canadian Healthcare, you first need to find out if they're actually having a real discussion with you , or if they're parroting some idiot radio show.

                      That's where I think Silence is Complicity is coming from with that remark.

                      by Clues on Wed Sep 19, 2007 at 08:40:57 AM PDT

                      •  So to be completely clear

                        I'm a right wing robot spouting "talking points" or having a "legitimate discussion"?

                        by jay w on Wed Sep 19, 2007 at 08:45:36 AM PDT

                        •  Well, considering the fact

                          that your history shows you participate here on a number of different topics, I'd be willing to give you the benefit of the doubt and say you're having a legitimate discussion on the pros and cons of various healthcare systems.  You also haven't tried to whine about welfare mothers so that's a pretty good clue.

                          It's just good for people to know that there's an organized campaign out there that is perverting legitimate discussions to create talking points, and that people here might be discussing THAT issue as well.

                          by Clues on Wed Sep 19, 2007 at 08:57:50 AM PDT

                          •  I enjoy discussing things here

                            I do find though that people are very quick to jump on dissenting opinions. I understand that there is a lot of disinformation out there, but I do wish that people would try to keep more of an open mind. I try to.

                            Not everyone with whom you disagree is necessarily spouting "talking points" or just trolling for negative responses. Sometimes you can be on the same team, but still disagree over the details.

                            by jay w on Wed Sep 19, 2007 at 09:26:05 AM PDT

                      •  That 20/20 episode last Sat. night

                        took special care to demonstrate the worst of Canada's system.  It will be a hard fight for Universal Single Payer here, but it is a fight the public really needs to get into - because the opposition is already hitting back hard and they are just warming up.

                        by SarahLee on Wed Sep 19, 2007 at 11:20:08 AM PDT

                        •  How about a 20/20 segment about the horrors

                          we face in the American health care system?  Ooops, can't do that program as the advertisers are UNH, Merck, and J&J.  

                          For every one health care horror story in Canada, I bet we can match them 100 fold.  

                          by Do Tell on Wed Sep 19, 2007 at 12:55:44 PM PDT

                    •  Canadian system

                      Yes, there is a shortage of doctors, nurses, and health care workers.  That's because a) there was a reduction in number of places in medical schools about 10-15 years ago, b) unfortunately, we lose some Canadian-trained doctors to U.S. because the money is better.  c) system covers everyone.  So if you have chest pain, your doctor typically orders ECG to make sure it's not heart problem, etc.  d) there isn't really anyway to monitor if you have a valid reason to go to doctor.  Is it just a flu, or something worse?? you can make an appointment and be seen by your doctor.    

                      You are still covered, and I don't know of a case when a person didn't get treatment when they needed it.  There are always emergency, walk-in clinics, etc as well.

                      Although you have many valid points, I caution you that just like U.S., we also have stories tainted by the color of political persuation.  For example, Alberta is a very conservative part of the country, and for years, the provincial government has been dying to privatize medicare.  

                      by ghost2 on Wed Sep 19, 2007 at 09:13:40 AM PDT

                    •  I wonder how much of that is underfunding

                      Since they pay about half what we do for health care?

                      Everyone is covered too, for half what we pay. Up the funding, and I bet those problems will lessen.

                      by splashy on Wed Sep 19, 2007 at 11:20:55 AM PDT

                  •  Question for Canada-bashers

                    When people start bashing the Canadian health care system, just ask 'em how many Canadian patients got dumped onto the streets last year.

                    Also, remind them that there's no such thing as a perfect system, but anything's better than what we have.

                    by CoolOnion on Wed Sep 19, 2007 at 10:40:15 AM PDT

            •  Canada - Utopian?

              I don't think anyone would class Canada's system as Utopian unless they had been through the hell of the US system with a Chronic disease. If they survived to talk about it and they weren't rich they would consider anything of substance Utopian by comparison.

              Nothing is perfect. But when I hear of wait times in Canada, I wounder if a diagnosis of a quickly metastasizing live threatening cancer would force someone who had a slow moving prostrate cancer to wait a few days for an oncologist.

              I think one has to qualify and define what people find  deficient in Canada's system before coming up with a all encompassing statements about wait times for specialists or even a General practitioner. I have never been able to call a General practitioner and  gotten  in less than a month if it wasn't an emergency.

              If it was an emergency, they would tell me to go to the emergency room to rack up thousands of dollars. I guess they want to make sure the Hospital has my $5,000 deductible covered before they start sending in bills.

              There are problems with any Universal system, but people need to get detailed about how they define those problems before claiming that it isn't a good answer to our system.

              Same for a R who is trying to defend the indefensible: our health care system. Make them get specific. If they are just parroting general negatives that they've heard about UHC, they 'll be doing a Gonzalez when questioned about the details of wait times, substandard care etc.

              Just recently , a general warning went out to people who have an acute potential life threatening incident. Make sure you take a friend to sit with you when you are in ICU as there aren't enough nurses. If you code, there may not be anyone near by to help you. The friend is there- preferable a big one- to grab the caregivers and corral them into your room. No one should assume anything when they get into Hospitals.

              That's a  problem before we talk about how many people who die in hospitals from contagious diseases because some medical personal are not bothering to change gloves, clothes or wash their hands. There are also problems with the The laundry system and the food preparation too. What if they have a cold or a low symptom flue. Are they allowed to work?

              People who are on drugs that lower their immune systems are especially vulnerable to something a simple as a cold. I don't see any universal standards for hygiene in US Hospitals with ass knocking fines and people fired who don't practice it.

              Bottom line, there is so much wrong now - not only with the insurance companies shabby treatment, but how for profit hospitals are watchdogged to make sure they practice impeccable hygiene. The reason of course is is a Dr or Nurse is scrubbing and they have to change clothes frequently, that's a hit on profit.

              Which potentially makes the hospitals for the well off just as bad as the hospitals for the poor. The difference being , non-profit hospitals for the poor just can't afford it.

              Those points should be brought up whenever some idiot starts sprouting bullshit about UHC he's heard and knows nothing about.

              by Dburn on Wed Sep 19, 2007 at 09:43:52 AM PDT

          •  Individual Mandate plans is a rediculous

            republican concept. It's truly sad to see democrats promoting them.

            They should be promoting democratic concepts and systems such as described in HR 676, that have already successfully been implemented in other civilized nations.

            by fayeforcure on Wed Sep 19, 2007 at 06:56:38 AM PDT

            •  Individual Mandate = Junk Insurance for All!

              Because what America really needs is more lousy insurance with high co-pays, long wait times, and denial of claims! And more rich insurance execs!

              We don't need "Health Insurance", we need access to quality Health Care!

              Medicare for All who want it.

              That said, this has good appeal for the middle class, who will know that they can no longer  be kicked off their insurance cover capriciously. The devil's in the details, though, isn't it?

              by means are the ends on Wed Sep 19, 2007 at 07:13:00 AM PDT