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Just as in most policy areas, Clinton and Obama's health plans are much more similar than they are different.  But there is a real difference, and that difference will affect people's lives.  That difference is an argument about the fundamental beliefs of the Democratic Party.

This diary will explore my thoughts on that difference in three parts.  

In the first section, I'll explain the three reasons why we need mandates in the absence of a single payer program.  

  1. Broadening the risk pool.
  1. Preventing free riders.
  1. Elevating public health.

In the second section, I'll explain how Obama's argument against mandates is more than just flawed.  His public reasons for opposing a mandate are contradictory and false.  

Finally, I will explain why Obama's rhetoric and policy bother me so much.  I'll detail how I've seen his arguments in my personal experiences fighting for health coverage, and how they were coming from the other side.  

Health care is a right, and the only way that right can be secured is through universal coverage.  This is a fundamental aspect of my Democratic Party, and I hope yours too.

The Need for Mandates

1. Broadening the Risk Pool

Obama and Clinton both claim their health plans will make quality coverage affordable for everyone.  If this is accomplished, the only people who will not buy health insurance are the people who decide buying health coverage is a poor investment.  This group will be much healthier than the group who will choose to buy insurance, as the sick will always see the need for quality, affordable health care.

Insurance is based on pooling risk in a broad manner.  Without a mandate, the healthiest members of society will not be in the risk pool.  The pool thus contains a disproportionate share of medically needy individuals, spreads the risk over fewer and riskier people, and makes health care more expensive for those who are in the pool.

Clinton's plan mandates that everyone join the pool, bringing the healthy and less-than-healthy together to pool their risks.  Spreading the risk over both people who use medical services more often )or costlier medical services) with those who will likely use fewer medical services makes coverage more affordable overall.

Here's a quick breakdown, if that doesn't makes sense:

Person A: Middle aged woman with cervical cancer.
Person B: Man in his mid-30s with a history of knee problems.
Person C: Man in his mid-20s with no known health problems.

If the risk pool contains only A and B, as it likely would under Obama's plan, the price of coverage will be high.  Both of those people will likely require expensive care.  If C is brought into the risk pool, coverage for A and B becomes much more affordable.  The economic risk of insuring A and B is much greater than the risk of insuring all three people.

By mandating insurance, coverage becomes more affordable for the people who need care the most (A and B).  

2. Preventing Free Riders

Obama and Clinton both have strong measures in their plans to prevent insurers from discriminating against people who aren't healthy.  If someone with a health problem tries to get insurance today, at least one of three things happen:

A) No insurance is offered
B) The pre-existing health problem is excluded from coverage, making the coverage essentially useless.
C) The offer is extremely expensive insurance after underwriting criteria are applied.

Under Obama and Clinton's plans, insurers will not be able to do any of this.  They have to offer insurance to everyone, they cannot exclude pre-existing conditions, and they cannot underwrite on the sick.  These are all great changes.

However, without mandating coverage, a "free rider" problem is created.  Under Obama's plan, healthy people can choose not to buy health insurance until they experience a medical problem.  At that point, they can simply buy into a plan with no added cost concerning their sickness.  

In essence, they can free ride on the system while they're healthy, and they can just join up when they get sick.  They won't be added to the pool until they're high risk, themselves. This increases costs for all.

At one point, Obama suggested he might create a penalty for people who attempt this scheme.  There are two problems with this.  First, Obama hasn't actually proposed it.  Second, it's the same basic problem as underwriting--people will be charged more for coverage if they're sick, which makes it less likely that the people who need care the most will be able to afford it.

Could you imagine if we had a Medicare or Social Security system that allowed free riders?  The healthy and wealthy could opt out of the system until something bad happened to their health or their wealth.  At that point, they could buy into the system at the last minute and receive all of the same benefits as the people who have been buying into the system since Day 1.

3. Elevating Public Health

While the first two points are about how the people who opt out of the system are screwing the people who opt in, my final point is that people who opt out of the system are also screwing themselves.

Simply put, people are much less likely to go to the doctor for preventive care and general check-ups if they have to pay out of pocket for the doctor's visit. Going all the way back to the classic RAND study on health insurance usage, this realization has been universally accepted in health policy.

The people who opt out of the system under Obama's plan will be less likely to go to the doctor than they would be if they were covered.  Two related effects will flow from this, both of which would be avoided under the Clinton plan.

First, the people who opt out will have worse health outcomes.  That's obviously bad for them and their families and their communities.  Second, failure to receive preventive care means much higher health care costs going forward.  An ounce of prevention really is worth a pound of cure.

OBAMA'S CONTRADICTORY ARGUMENTS

Obama's defense of his lack of mandates and attack on Clinton for having mandates make no sense. Let's start with his defense.

Obama claims that he will make health coverage affordable for everyone.  He claims that no one would ever refuse to purchase health insurance if it's affordable.  Then what's his problem with having a mandate in his plan?  If he thinks every American will voluntarily sign up, why would he raise so much vitriol about mandates?

His attack suffers from the same logical disconnect.  He claims Clinton's plan will force people to buy coverage they cannot afford.  He claims his own plan will make coverage affordable, but he never explains why Clinton's wouldn't.  He never explains this, of course, because it's simply not true.  

There is absolutely no reason to think Obama's plan would make coverage more affordable than Clinton's plan.  In fact, the opposite is true.  Bringing healthy people into the system through mandates will make coverage more affordable for the people who are sick.

Obama sets up a false dichotomy between affordability and mandated coverage.  In reality, these two are not mutually exclusive.  We can make coverage affordable, as Clinton's plan does, while mandating coverage at the same time.  There's no contradiction here.

A PERSONAL EXPERIENCE

Obama's attacks on universal coverage strike a nerve with me because of the work I've done and the places I've heard his argument coming from.

A few years ago, I was working for a progressive nonprofit in Washington DC that was part of a coalition to stop a terrible health care bill introduced by Senator Enzi.  The bill, modeled after Association Health Plans but oh-so-cleverly renamed Small Business Health Plans, was designed to strip away virtually all state mandated consumer protections in the health insurance market.

Over the past 25 years, state legislatures around the country had passed bills mandating that certain benefits and services be included in all insurance sold in the state.  These benefits ranged from cervical cancer and mammography screening to alcoholism treatment to well-child care.  The point of the mandates is that if insurers were not required to include them, they could charge exorbitant rates for the people who wanted them included in their individual insurance.  Health insurance would be unaffordable for the people who need it most.

Enzi's argument was that we should not be forcing people to buy health coverage they cannot afford.  If healthy people want to buy a bare bones package that doesn't include diabetes care, they should be able to.  

The essence of Enzi's argument is very much the same as Obama's argument against mandates.  They're misleading, dispassionate, and in opposition to the ideals of the Democratic Party.  Health care is a right, not a privilege.  The only way to secure that right is to make it truly universal.

In case anyone's wondering, we defeated Enzi's bill in the Republican controlled HELP Committee.  It was long and hard fight, which is why it pains me so much to have to fight it within our own party.  Despite having the support of unions, consumer groups, and most state Insurance Commissioners, our outlook for success was looking grim.  But thanks to a strategy hammered out between us and Senator Ted Kennedy (the ranking Democrat on the HELP Committee), we managed to prevent the bill from moving out of committee.  

The winning strategy?  Forcing Mike Dewine, who was desperately trying to recreate himself as a moderate to hold onto his Ohio Senate seat, to take vote after vote on amendments against cancer, diabetes, asthma, and other benefits and screenings.  He, and other moderate Republicans, finally had enough, and the bill died.

When I see Obama's ads, it makes me angry.  I think of Michael Enzi.  I think of Harry and Louise.  I think of AHIP.  I think of the 50 million Americans who do not have health coverage.  I think of the additional 50 million Americans who are underinsured.  

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What does this make you think about?  Does it make you angry?

UPDATE: Thank you to all who have recommended.  This is an incredibly important issue, and one I care deeply about.  I'm honored that it's my first diary to make the list.

UPDATE 2: I accidentally used a portion of Obama's mailer instead of the whole thing. Hat tip to vejoaronda for pointing that out to me.  It's been fixed.

Originally posted to Partially Impartial on Sat Feb 02, 2008 at 02:17 PM PST.

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Comment Preferences

  •  Tips for Universal Health Coverage (148+ / 0-)
    Recommended by:
    jd in nyc, katiebird, Spit, al Fubar, sj, FlipYrWhig, Athena, Pacific John, hester, Sparhawk, cedubose, badger, musing85, markw, cosbo, catfish, Jim Riggs, RickWn, sara seattle, truthbetold, Wintermute, formernadervoter, Vico, seeker, sobermom, Matilda, Norwegian Chef, linc, Lisafr, geordie, dianem, magnetics, nyceve, crazymoloch, Kevvboy, ATL Dem, CoolOnion, otis704, SingularExistence, Larry Bailey, Jim Beard, BoringDem, Miss Blue, Terre, splashy, high uintas, PresentMoment, stacystace, jhwygirl, mrkvica, Kentucky DeanDemocrat, StuartZ, grannyhelen, CalbraithRodgers, notableabsence, CanadaWest, lambertstrether, noveocanes, Catte Nappe, tabbycat in tenn, greenreflex, hells kitchen, nasarius, eleanora, Kitsap River, Dawn Davenport, jim bow, tmendoza, mrmango, denise b, Gabriele Droz, andgarden, Flint, kuvasz, Clem Yeobright, J Rae, cackyp, Gary Norton, ofao, peteri2, wandering i, The Raven, hopefulcanadian, SignalSuzie, JanL, kathny, inanna9, Jim R, debedb, Montague, vigilant meerkat, WhyWhat, souvarine, smokeymonkey, kck, Eloise, nonnie9999, taters, Alkibiades, Jjc2006, CA Nana, Jiminy Cricket, elle de nola, Johnathan Ivan, cpresley, anna shane, DrSteveB, Lysis, indy2dem, DocbytheBay, Busted Flat in Baton Rouge, Owllwoman, owl06, pioneer111, RIP Russ, Rumarhazzit, keikekaze, Mark Wallace, Lena, BustaVessel, JDWolverton, Hairy Legs, Devsd, SaneSoutherner, wave of change, angry hopeful liberal, Liberal Pride, comstockgrants, lily15, devil, JedReport, valsagem, Bongobanger, priceman, Yashua, rigso, domma, NewHampster, Psychotronicman, emmabrody, ginnyh532, h bridges, Hypatica, Valhalla, MRGNTN, katz5, dhupp, Lilipons

    There is an enormous difference between state and federal mandates.  Obama's campaign doesn't seem to know this, but it's true.  What happened in Massachusetts is not representative of what a federal mandate will look like.

    Here are some of the differences:

    1. Massachusetts did not offer a public option to everyone, as Clinton's plan does.  This public option is modeled after Medicare and will be affordable, with subsidies, for everyone.  The administrative costs will be lower, which also saves money.  
    1. States cannot provide the level of funding the federal government can.  The feds can fill in gaps with Medicaid (and SCHIP), Medicare, and subsidies.  Many states are forbidden from running debts, while the federal government can if it's necessary.  Clinton's plan also provides subsidies to small employers, which the Massachusetts plan does not.
    1. The Massachusetts plan does not ensure affordability, and thus creates exceptions for the mandate.  The Clinton plan does ensure affordability through subsidies that guarantee people will never have to pay more than a specific percentage of their income (and lower income people will be fully subsidized).
    •  There's a big difference between state and (12+ / 0-)

      federal lobbyists too!! I'm sure Obama knows the principle.

    •  honest question (5+ / 0-)

      How does the government pay for the public option?  where does the revenue come from?  also is there a maximum income cutoff for that program? How many ppl would conceivably enroll?

      •  Anyone can enroll, but not everyone's subsidized (23+ / 0-)

        It's paid for by sunsetting Bush's tax cuts and by saving money in various areas in her program (Health IT, lower administrative costs...)

        •  That's not good enough for me (8+ / 0-)

          I am a reformed republican who still believes in balanced budgets.  You can't tell me that the public insurance option won't be essentially extended to the 47M who aren't insured, plus some who just have bad plans to begin with and don't want to pay premiums.

          I read her plan in detail and the thing that left me questioning are:

          1- How can you pay for Public and still have private without tax increases well beyond bush's tax cuts above $250k. The truth is, she'd have to repeal ALL the tax cuts and / or the tax cut on dividends, and the resistence to that will be calcified

          2- How does eliminating risk discrimination keep people like me, 29, Male, Single, well insured, with cheaper premiums.  I get great care through my job and if you extend the pool to also insure people who have high care costs at the same premium price as me, then my premium will have to rise to meet theirs in the middle.  As a voter, away from Party, I reject this....  I think if I'm a democrat who rejects this, once clearly explained by McCain, then votes will line up hard.

          The fact is the Public Option provides for the Socialized Medicing Arguement.  That has huge destructive power.

          •  No doubt about it: you're going to get screwed. (38+ / 0-)

            But when you are in your 50s and 60s, you will be on the other side of the equation.

            There are many people who utilize more health care than their total lifetime productivity can justify. We have to deal with that.

            Personally, I feel very fortunate for my good health and don't begrudge anything to my fellow-citizens not so fortunate as I.

            You kids behave or I'm turning this universe around RIGHT NOW! - god

            by Clem Yeobright on Sat Feb 02, 2008 at 02:51:02 PM PST

            [ Parent ]

          •  Socialized Medicine? Yikes... (52+ / 0-)

            First, we're all already paying for the uninsured.  We pay for their emergency room care, which is much more expensive than the preventive care that would prevent such catastrophes.  It's far less expensive to subsidize preventive care than emergency care.

            Second, you're making a Republican/Libertarian argument.  Why should you have to pay into social security if you don't want to?  Why do you have to pay taxes for social welfare programs you won't use?  Why do you have to pay into Medicare when you can afford your own insurance when you get old.

            Why?  Because we're Democrats.  Because we care about each other, our country, and our planet.

            •  Yes but Socialized Insurance ... (7+ / 0-)

              I think that is a decent description of what we're moving toward. The physicians and facilities (hospitals) stay private.  

              HR 676 or California's SB-840 - the only health reform proposals worth my vote.

              by kck on Sat Feb 02, 2008 at 03:39:18 PM PST

              [ Parent ]

              •  And? (18+ / 0-)

                In my experience with National Insurance in Israel, it was a very good.  It was paid out of your paycheck with government paying for those who didn't have jobs or make enough money.  You had a choice of four systems.  

                My husband had pneumonia and finally agreed to see a doctor on Shabbat; we had to go to the ER.   We were there for less than 45 minutes, walked out the door with prescriptions and medicines.  We spent 100 NIS... ~$23.

                It was cheaper, faster and better than seeing our primary care physician here in the U.S. and this was on Shabbat when only the hospital, a pharmacy and the movie theater was open.

                How did I live without him?

                by Pumpkinlove on Sat Feb 02, 2008 at 04:30:48 PM PST

                [ Parent ]

              •  Canada is socialized health Insurance not medicin (5+ / 0-)

                Is national health insurance "socialized medicine"?

                No. Socialized medicine is a system in which doctors and hospitals work for the government and draw salaries from the government. Doctors in the Veterans Administration and the Armed Services are paid this way. Examples also exist in Great Britain and Spain.  But in most European countries, Canada, Australia and Japan they have socialized financing, or socialized health insurance, not socialized medicine. The government pays for care that is delivered in the private (mostly not-for-profit) sector. This is similar to how Medicare works in this country. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage their medical practices or hospitals.

                The term socialized medicine is often used to conjure images of government bureaucratic interference in medical care. That does not describe what happens in countries with national health insurance. It does describe the interference by insurance company bureaucrats in our health system.

                http://www.pnhp.org/...

                Repug critics of Universal Health care will dredge up stories about the horrors in the English health care system.That is socialized medicine and not socialized health care insurance.

                In socialized health care insurance systems, the docs work for themselves and you are free to choose your own physician.

                Docs are regulated in how much they can charge for a procedure but not by the government. In the Canadian system each province has a review board made up of physicians and they decide what a fair price is for any given treatment or procedure. This has worked very well for the Canadian system.

                Socialized medicine is not what is being proposed by Hillary or Obama. They are talking about types of socialized health insurance, while giving people the choice of keeping the private insurance if they wish or enrolling is a government health insurance plan.

                This is not a "single payer system" but may be a gateway to it.

                If we are to really get rid of our crushing health care costs it will have to be a "Single Payer" system as they have in Canada where they pay about $3000 per capita as opposed to $7500 per capita here in the US, yet their system is comparable to ours.

                The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 47 million without health coverage and millions more inadequately covered.

                This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

                http://www.pnhp.org/

                The figure of $350 Billion dollars in savings comes from an extensive study done by Harvard University and is supported by independent studies that were done separately by the CBO and the GAO.

                HR 676 is a "single payer" system and is languishing in the House with only 70 co-sponsors. The lobbyist have done their work well and squashed support for this initiative already.

                The real question is do the plans offered by Hillary or Obama leave a pathway to a single payer system? Edwards plan did and he was very open about it. Ezra Klein critiqued Obama's plan and said it does not and Hillary hasn't made a clear statement about it in regards to her plan.

                This is the real strategic point for those who have really studied the issue of health care. There is no other way to get out from under the crushing costs of health care in this country.

                You need to be very careful when you debate health care systems to be sure that what is being discussed is an "apples to apples" comparison.

                http://www.pnhp.org/

          •  Let's get rid of the "socialized medicine" term (20+ / 0-)

            Nobody is proposing socialized medicine. Clinton and Obama aren't even proposing socialized insurance (that would be a full single payer system).
            One of the reasons "socialized medicine" freaks everybody out is they are picturing a government they don't much trust suddenly taking over hospitals, clinics, and doctor's offices; hiring the staff, organizing the treatment plans. Yeech.

            "Sir, you are giving a reason for it; but that will not make it right." Samuel Johnson

            by Catte Nappe on Sat Feb 02, 2008 at 03:14:30 PM PST

            [ Parent ]

            •  Ummm! Let us all see what passes through (2+ / 0-)
              Recommended by:
              highacidity, Clem Yeobright

              our Congress.  From what I have studied,  Obama's plan is more feasible by experts and can be converted to a "single-payer" plan more easily in the years to come.  Sheesh!  Can we be more concerned about electing Obama in the "primary" so that he beats McCain in the general election.  (disclosure: mom of a "Independent" National Guard SSG that totally supports Obama, along with his military friends, and Obama's Middle Eastern policies)

            •  and that's the problem (5+ / 0-)
              Recommended by:
              sj, highacidity, mrkvica, hells kitchen, kyril

              socialized medicine is the only thing that will work.  Giving more money to the current greedheads will pad some corporate bottom lines as the economy bottoms out and basically help nothing without massive spending increases.

              The middlemen must be taken out of the equation.

              We must start with the premise that market based solutions and profiting off human suffering are fundamentally immoral and likely criminal.

              We start with RICO investigations of the current health care industry, make it a big fucking production.  Let's get footage on TV of how these scumfucks live while people sit and watch their uninsured family members die.

              •  No. No, no, no. (6+ / 0-)
                Recommended by:
                acquittal, RickWn, otis704, splashy, Flint, echatwa

                We don't need socialized medicine.
                We need socialized insurance.
                There is a huge difference.

                Socialized medicine - government owns and operates the medical care facilities and offices. Please, everybody, get rid of this term. We don't want it, we don't need it. It gives the right a nasty frame to scare people with.

                Socialized insurance - the government handles the processing and payments - what we generally refer to as "single payer". You can still pick your own doctor and your own hospital. They work for themselves, just as they always have.
                We need to be educating people to what this means, and what it will do for them, and how it is not "socialized medicine".

                "Sir, you are giving a reason for it; but that will not make it right." Samuel Johnson

                by Catte Nappe on Sat Feb 02, 2008 at 05:12:57 PM PST

                [ Parent ]

                •  fuck insurence (2+ / 0-)
                  Recommended by:
                  RickWn, incompleteness

                  We need to have a public buyout of the whole health care industry.  Health care workers should be public employees, just like the Police and Fire departments.  They can even have snazzy uniforms.

                  Buy out pharma and put research back in the hands of the Universities where it belongs. Create a cabinet level agency to oversee them like the DOE does with the present national labs.  The universities own the patents and use profits from sales to other nations to provide free medical education to anyone interested.  Expand the current residency system to include free clinic in all disciplines.  Require new minted physicians to work in free clinics to pay off their education.  

                  We must stop producing new MDs with six figure student loans and no sense of public service.  Right now the medical education system is set up to favor greedheads who go into the profession to make money.  Get them the fuck out of it and make it easy for people who want to help people to get into it.  

                  Doctors and lawyers are often negatively referred in the same breath.  This isn't because there is anything wrong with either profession.  It's because both profession presently attract the worst kinds of human barnacles.

                  •  The Facts don't support that... (3+ / 0-)

                    There are severe problems in the English and Spanish health care systems that are "socialized medicine" that do not exist in the Canadian system which is socialized health care insurance.

                    Another example of socialized medicine in this country is the Veterans Administration system, which has severe problems although it is inadequately funded.

                    For reason having to do with choice of physician and other issues, that would be an almost impossible sale to the American population.

                    •  How many people get to chose now? (0+ / 0-)

                      The uninsured don't.  People on Medicaid don't.  Most HMOs charge absurd out of network premiums that make physician choice a luxury for people with disposable income.  

                      Frankly, I think people who worry about physician choice are spoiled.  

                      Sure there should be ways to get second opinions or to get refereed to another physician if you don't like the one you're assigned to.  

                      The "physician choice" mantra is something that most benefits hypochondriacs who like to go doctor shopping until they find one who will agree to diagnosis them with whatever it is that will get them the drug they saw advertised on television.  The fact that physicians are forced to compete for buisness in our society is not always a good thing.  It often forces them to override their own best judgment in favor of a "the customer is always right" approach to their practice.  The doctor/patient relationship is thus reduced to a buisness transaction, something that fundamentally alters the practice of medicine from it's intended role.  They are supposed to be getting paid for their knowledge and expertise, not for the service of writing prescriptions.

                      There's another approach to cutting health care costs that is seldom mentioned.  Increase the power granted to pharmacists and drastically increase what's available over the counter.  Already uninsured people are forced to take their chances and order prescription medications from overseas pharmacies.  I've got an abscessed gum I've not been able to get taken care of for going on a couple years now.  I've been treating it with cephalexin I got from a pharmacy in India.  

                      If we're going to continue with a system that rewards physicians who dole out whatever rx a patient demands, we might as well eliminate the physician as middleman and let consumers get medications directly.  

                      •  You have to be very young... (4+ / 0-)

                        I'd like to think that you are simply young and attribute your comment to youth and inexperience rather than the alternatives.

                        The "physician choice" mantra is something that most benefits hypochondriacs who like to go doctor shopping until they find one who will agree to diagnosis them with whatever it is that will get them the drug they saw advertised on television.

                        I just did four years of hospice care for my dad and I'm currently caring for my mother who has an "undiagnosed motor neuron" disorder that caused her to lose the use of her legs in six weeks.

                        There is a world of difference between docs and it has nothing to do with getting any trendy medication. In fact it more often has to do with getting rid of them.

                        When I started caring for them they my mother was on 15 medications, none requested by her, and my dad was on about 20. After a year of arguing with their doc and citing chapter and verse from PDRs and The Nurses hand book I got them down to 4 medications for my mom and six for my dad.

                        These days the docs are part of a vertical marketing scam with rows of pharmaceutical reps standing in line in their offices with cases of smaples, free catered lunch for the office staff, and tickets to the islands for the docs to go to "educational seminars."

                        Not all docs are like this, but many are only too happy to dole out the latest "silver bullet" drug to their patients and use one drug to treat the side effects of another. They wind up with their patients being severely over medicated unnecessarily, when changes in life style would go a lot further.

                        There's another approach to cutting health care costs that is seldom mentioned.  Increase the power granted to pharmacists and drastically increase what's available over the counter.  Already uninsured people are forced to take their chances and order prescription medications from overseas pharmacies.  I've got an abscessed gum I've not been able to get taken care of for going on a couple years now.  I've been treating it with cephalexin I got from a pharmacy in India.  

                        I'm half way inclined to agree with you in part on this one.

                        First, not all docs are equal... not by a long shot. As I have moved around the world fo rmy job the first thing I do is call the best hospital in town and ask to speak to the Nurse Practitioner in charge of the Intensive care unit. Then I ask who would she take her mother to see.

                        These gals are usually all business and handle one life threatening case after another. They know which docs know their stuff and which ones bury their mistakes.

                        My dad's doc almost killed him once by prescribing an antibiotic that had a drug interaction with the type of insulin that he was on. I called him when I spotted the interaction warning in the PDR but he said it wasn't statistically significant. I then called CVS pharmacy and the pharmacist was a giggling girl who said go with the docs instructions.

                        Three days later his blood sugar was 40 and he was on the verge of a diabetic coma, blood and tissue fluid were seeping out of every mole and birth mark on his body, he continued to hemorage at the hospital and lost 2.5 pints of blood internally and they almost had to put him on life support.

                        On discharge the doc wanted to put him back on the same medications and I refused. Ten minutes later the head pharmacist from Medco called and said that there was an interaction warning and I told him what the doc had said.

                        He replied, "i don't care what your doc says... it is statistically significant and I'm calling you because your dad is in danger and further if he dies we don't want to get sued."

                        I asked him about the symptoms from an interaction and of the eight he clocked off... my dad had all eight. I called the doc and told him what he had said and he gave me another antibiotic to use wiht him.

                        Most docs don't get enough training in pharmacology so that part of your argument is correct, but the average person doesn't know enough to prescribe for themselves and not all pharmacists know what they are doing either.

                        The real cost reduction that needs to happen is in lowering the inflated mark-ups that the drug companies use.

                        Case in point... Cipro and the anthrax scare. If you remember this the manufacturer of Cipro said that they wanted $13.50 per dose for the antibiotic that treats anthrax.

                        The Canadian government said bullshit! We can produce a generic form for .40 cents a tablet. The Company said we'll sue for patent infringement and Canada told them that they weren't going to rape their citizens in an emergency and they threatened to abrogate all treaties with the United States for patents.

                        The company thought about it and came back with $1.40 a tablet and the Canadian government said deal! There in is the problem... inflated mark-up on drugs where the Feds paid the money for development and the studies, but the companies mark-up exorbitantly!

                        •  pharma companies spend a fortune on marketing (0+ / 0-)

                          Direct to consumer pharmaceutical advertising is a blatant attempt to subvert the authority of physicians by encouraging patients to shop for physicians who will give them what they see advertised regardless of if they need it or not.  

                          Giving the FDA some fangs and a budget would be a good start too.

                          Physicians can't say "no" to patient demands without losing their buisness.  

                          •  Yes... that should be bannedd (2+ / 0-)
                            Recommended by:
                            Catte Nappe, Clem Yeobright

                            Advertising prescription drugs to consumers should be banned. No Argument.

                            The FDA has fangs... what it doesn't have is the will. They are controlled by a corpratist administration that has the attitude that corporations can do no wrong, hence they don't take issue with anything that the drug companies do.

                            Physicians can say no quite easily to give out prescriptions... what they have is an economic incentive to hand them out.

                            .
                            .

                            Most Doctors Have Financial Relationships With Pharma
                            A new study finds that the vast majority of doctors have some kind of financial relationship with the pharmaceutical industry. Who's getting what? And what impact does it have on patient care?

                            By Anne Underwood
                            Newsweek
                            Updated: 5:29 p.m. ET April 25, 2007

                            April 25, 2007 - Who hasn't been to a doctor's office and seen drug logos decorating pens, clocks, sticky notes? As one health-industry expert puts it, "It's the medical equivalent of NASCAR advertising." Almost every doctor in the country has some type of relationship with pharmaceutical manufacturers, whose clear goal is to influence physicians to prescribe the company's newest, most expensive drugs. The companies offer physicians everything from scratch pads to trips worth thousands of dollars to attend medical conferences. But which doctors receive the biggest perks?

                            A new study appearing this week in the New England Journal of Medicine reveals that it varies with the type of practice, the medical specialty, the patient mix and the doctor's professional activities. The study—the first of its kind—was led by assistant professor Eric Campbell and Dr. David Blumenthal, both at the Institute for Health Policy at Massachusetts General Hospital. NEWSWEEK's Anne Underwood spoke with Campbell.

                            Excerpts:

                            NEWSWEEK: How did you conduct the study?

                            Eric Campbell: It's based on a survey of 1,662 practicing physicians in late 2003 and 2004. We focused on six specialties—family practice, internal medicine, pediatrics, cardiology, general surgery and anesthesiology. We also looked at whether these doctors worked in hospitals, universities, HMOs, group practice or solo or two-person practice. And we looked at gender.

                            Were you surprised at the findings?

                            I was surprised at the sheer percentage of physicians who have financial relationships with the drug industry. Ninety-four percent of all physicians have these relationships. Most commonly, it's things like receiving free samples of drugs or receiving food and beverages which may be consumed by their staffs. But a third of physicians are reimbursed for costs associated with professional meetings or CME [compulsory classes in "continuing medical education"]. About a quarter are paid to serve on advisory boards, work as consultants or enroll patients in clinical trials. Those are the big-ticket items, versus getting free Chinese food for your staff on Wednesdays.

                            In recent years, the American Medical Association, the American College of Physicians, and the Pharmaceutical Research and Manufacturers of America (PhRMA) have all been promoting voluntary codes of conduct that set limits on these relationships. What effect have these had?

                            The most egregious examples have been reined in. PhRMA recommends that gifts not exceed $100 in value and be limited to items that are for the patient's benefit. There's really no benefit to the patient if the doctor receives free tickets to a Giants game, so you don't find much of that any more. Only 7 percent of doctors reported this type of payment. On the other hand, the drug companies now meet with physicians more frequently.

                            In 2000, it was 4.4 meetings a month on average. Now family practitioners report an average of 16 meetings per month, followed by internists at 10 per month and cardiologists at 9 a month. All specialties except anesthesiology seem to be meeting more frequently with industry. What we don't know is how long these meetings last.

                            What fascinates me about this study is that I had assumed there were equal-opportunity handouts for all doctors. But you say that pharmaceutical manufacturers are actually fairly selective in who gets the best treatment.

                            Drug samples and gifts of free food are widely given. But other types of relationships—serving as consultants, on boards, receiving speakers' fees—are concentrated among "thought leaders" in a specialty.Those are the doctors who develop guidelines for clinical practice, who publish the leading papers in big medical journals, who run large residency programs in major health centers. They have the potential to influence the prescribing practices of other physicians. The industry appears to form tighter relationships with these doctors.

                            And who is least likely to have these tight relationships?

                            Women physicians are significantly less likely to receive payments than their male counterparts. Also physicians with a high percent of patients who are uninsured or covered by Medicaid. There are a number of potential explanations, but our study did not address those.

                            http://www.msnbc.msn.com/...

                        •  Any state (0+ / 0-)

                          could pass a drug discrimination law based on the housing discrimination laws.

                          Sec. 804. [42 U.S.C. 3604] Discrimination in sale or rental of housing and other prohibited practices
                          ...
                          (a) To refuse to sell or rent after the making of a bona fide offer, or to refuse to negotiate for the sale or rental of, or otherwise make unavailable or deny, a dwelling to any person because of race, color, religion, sex, familial status, or national origin.
                          (b) To discriminate against any person in the terms, conditions, or privileges of sale or rental of a dwelling, or in the provision of services or facilities in connection therewith, because of race, color, religion, sex, familial status, or national origin.

                          Discrimination in sale of lawful prescription drugs and other prohibited practices
                          ...
                          (a) To refuse to sell after the making of a bona fide offer, or to refuse to negotiate for the sale of, or otherwise make unavailable or deny, a lawful prescription drug to any person because of race, color, religion, sex, familial status, state residence, national residence, or national origin.
                          (b) To discriminate against any person in the terms, conditions, or privileges of sale of a lawful prescription drug, or in the provision of services or facilities in connection therewith, because of race, color, religion, sex, familial status, state residence, national residence, or national origin.

                          Drugs given away or sold below manufacturing cost to poor third world countries shall not fall under the scope of this act.

                        •  I am having to argue with my doctors like (1+ / 0-)
                          Recommended by:
                          Clem Yeobright

                          I do with people on message boards. You have to watch and do tons of searches and reading and common sense.

                          I need the bastards but I have less tolerance for them. Most nowdays are in it for the money and waiting rooms are full for even high end doctors.

                          They really need a little reality jolt.

                •  what we need to do (1+ / 0-)
                  Recommended by:
                  sj

                  is take back the good name of socialism

                  I'm pretty moderate when it comes to revolution, violence as the absolute method of last resort, but I'm definitely a socialist.  My basic read on Marx is that classless society is inevitable and what we don't get at the ballot box we'll have to get the hard way, sooner or later. I give it a couple hundred years until global civil war between classes.  I'm not sure who is worse, the people who want to hurry up and get it over with or the people who want to prolong the suffering, and everyone falls into one of the two categories.

          •  First off, under the HRC plan (14+ / 0-)

            you keep your current insurance if you want.  Having the public option out there might have the effect of increasing competition, thus lowering the premiums that are paid on your behalf in your job.

            If you read Krugman's Conscience of a Liberal, he goes into detail about how much money is wasted in our system, and HRC wants to address that waste and eliminate it.

            Also, you are 29 now but one day will be old and infirm.  You'd best hope by that time the system has been fixed, or you may wind up being screwed.  And unless we start NOW, the system won't get fixed in time for your retirement and eventual physical decrepitude.  

            Another point I like to make is that you may one day wish to be self-employed.  It's one aspect of the American dream.  If that happens, wave goodbye to your employer-provided insurance.  You'll be on your own.  Unless we get universal healthcare, which will actually be a huge boon to entrepreneurship.

            •  Heck, if you get SICK (10+ / 0-)

              you'll lose your employer-provided insurance.  Stay sick long enough, you'll lose your job, and the insurance goes with it.  Even if the illness is relatively short-term, and you hold your right to return to the job under the Family Medical Leave Act, you still won't get paid.  How many people have enough money in the bank to keep paying those premiums?  Not to mention the co-pays, etc., that you'd be paying for medical care in a long illness.

              Jesus, employer-paid health insurance is about as false as "security" comes.

              And I know far too many people who hang onto jobs they hate (and give up other opportunities, including striking out on their own) because they're working for the health insurance.

              This system is not only morally bankrupt, it's economically counterproductive.

              •  Thanks for including those details (6+ / 0-)

                As for this:

                And I know far too many people who hang onto jobs they hate (and give up other opportunities, including striking out on their own) because they're working for the health insurance.

                ...

                [I]t's economically counterproductive.

                Bingo.  I finally got up the nerve to quit the job, take COBRA (it's very expensive) and set up my own business.  I give myself two years to make a go of it or go back to the same old job.  So much for supporting  small businesses.

              •  Raises hand. (3+ / 0-)
                Recommended by:
                high uintas, eleanora, Clem Yeobright

                And I know far too many people who hang onto jobs they hate (and give up other opportunities, including striking out on their own) because they're working for the health insurance.

                That would be me.
                I work in a job that numbs my mind and barely pays the bills, because I need health insurance to pay for my prescriptions.

                Just got a letter from my Prescription service that lists all my scripts and what the pharmacy charges, how much I paid and how much they saved me.  
                My birth control alone-$99 per month retail.  I paid $15.
                Thyroid med-$57 retail.  I paid $8.
                Prescription Strength Aleve-$260 retail.  I paid $8.
                Prescription allergy eyedrop-$124 retail.  I paid $25.

                That adds up to $540 a month in scripts at retail price if I didn't have insurance.  That's about 45% my take home pay for the month.

                $56 is better than $540 so I continue to work at the crappy job.

                "It is not depravity that afflicts the human race so much as a general lack of intelligence."--Agnes Repplier

                by faction on Sat Feb 02, 2008 at 08:28:03 PM PST

                [ Parent ]

            •  You better think about this... (4+ / 0-)

              Another point I like to make is that you may one day wish to be self-employed.  It's one aspect of the American dream.  If that happens, wave goodbye to your employer-provided insurance.  You'll be on your own.  Unless we get universal healthcare, which will actually be a huge boon to entrepreneurship.

              We are at the beginning of a recession and the jobs report just showed that 17,000 jobs disappeared last month. Normally it takes about 120,000 to 150,000 jobs simply to keep pace with new workers entering the workforce and immigrants entering the country.

              You may find yourself being downsized and self employment or consulting positions are your only option for a while if not permanently.

              Better you should leave yourself some options rather than play the hard ass who thinks lay-offs only happen to other people.

              The older you get, with more experience you have, the higher your salary goes and this makes you being laid off more likely.

              •  I spoke to my neighbor (0+ / 0-)

                this afternoon.

                She's a landlord and owns a large building almost paid off from the 1980s.

                She is now working a regular job to help pay her bills.

                Her building is half empty and she said she already cut her rents by $30 a week.

                She says the restaurants have cut back even though it is prime season here in Florida.

                The construction workers that used to be the bulk of her tenants have left town.

                Yet all these low-income workers(?) and their struggling bosses are going to be expected to come up with mandated premium money.

          •  Your premium only has to rise (9+ / 0-)

            because you are paying for the overhead of corporate "health" "care".

            Almost half the money spent on health care goes to profits for insurers and pharma companies. If we eliminated corporate health insurance and negotiated for drug prices using the entire country as the pool, we'd save money enough to cover everyone. Your costs would be lower. The cost to American business would be lower (as it is when they move their jobs to Canada, which incidentally has the second highest per capita expenditures, and still saves the auto companies money)

            This is well understood by anyone not in complete denial about our dysfunctional system and the dysfunctional proposals to fix it.

            Those who live in cloud fairy land will continue to believe that government subsidies to Aetna and Cigno and Kaiser will magically fix the problem.

          •  Wonderful argument (20+ / 0-)

            Let's apply that to property taxes and the education system:

            Only those with children in the public school system should pay taxes for supporting the school system.  After all, if I don't have a child in public schools, why should I pay?

            It's called a societal benefit trumping the "me" benefit.

            Here's another:

            Why should my taxes go to support a vast and expensive to maintain Interstate highway system?  (yes, I know that transportation companies pay much higher usage taxes - but the fact remains that some of my tax dollars go to pay for this also).  Why should I pay for the building and maintenance of roads for which I do not use?

            Try another:

            Police.  If I haven't been the victim of a crime, why should my tax dollars go to support a bloated and inefficient police department?

            The "me" factor is sometimes trumped by the "society" factor.

            And finally...

            The "Me" argument.  You won't always be a healthy 29 yr old male.  At some point, you will require medical attention which will prove expensive.  Your insurance company knows this.  And, at the appropriate time to ensure continued profitability, your rates and coverage will be adjusted appropriately to ensure the insurance company's "me" factor is satisfied over your "me" factor.

            2008's Big Question: Can the Democrats snatch defeat out of the jaws of victory?

            by Johnathan Ivan on Sat Feb 02, 2008 at 04:29:15 PM PST

            [ Parent ]

            •  Let's apply it to war ... (1+ / 0-)
              Recommended by:
              sj

              If I don't believe there are weapons of mass destruction then my tax dollars should not go towards the war ... this much I can support.

              Obama '08: Because its time to move beyond the politics of personal destruction

              by Bronxist on Sat Feb 02, 2008 at 04:50:44 PM PST

              [ Parent ]

          •  single payer is the only way (4+ / 0-)

            no candidate other than Kucinich has a workable plan.

            They will all fail, suck up a lot of money, and eventually give the balance of public opinion on the matter back to the republicans.

          •  Look at the premiums the same (2+ / 0-)
            Recommended by:
            RickWn, Kentucky DeanDemocrat

            as you would whole life insurance premiums with the paid up date the day you die!  Most everyone will get their pay out to some degree eventually, but the amount you pay in yearly will be the same.

          •  It's the notion of community (7+ / 0-)

            I hope you stay health the rest of your life.  But just because you are young now and healthy doesn't guarantee this.
            True life example.  

            I was working (on a campaign) with a young guy....early thirties, former military and quite fit.  I am an older female.  
            We were putting up a sign that had to hang off the top of the building.  We needed a small ladder to go from one roof to the next. Coming back, I climbed carefully down the ladder. He jumped off at third step and unfortunately did not see there was a dent, and he went over and hurt his knee.  At first it was not a big deal.  It started swelling. He was in pain.  He had no insurance.  Went to the ER.  He had a cracked knee cap and needed surgery.  He had the surgery.  About three weeks after the surgery, he got sick one night and luckily he called 911.  He had a blood clot from his knee go to his lungs.  He spent three weeks in the hospital.  

            So there you are...a young healthy man, ends up needing the help of others.

            Community means EVERYONE.  That is why dems are different than republicans.  We don't resent others having needs.  We assume that what goes around can come around.

          •  Maybe you should (2+ / 0-)
            Recommended by:
            high uintas, Clem Yeobright

            go back to being a republican. I'm not changing for you.

      •  We could afford to hike corporate taxes (5+ / 0-)

        They'd save billions in comparison to what they're paying out now for healthcare (those that do). We'd also be considerably more competitive than we are now for multinationals--lots of companies that looked at locating in the U.S. went elsewhere when they couldn't find a way to ensure they'd have a healthy workforce that didn't involve them taking millions or billions from the bottom line each year.

    •  And knowing a 33 yr, old (44+ / 0-)

      person who was perfectly healthy until he contracted a nearly fatal and severely disabling disease overnight, I know that the free-rider problem would exist.  That particular illness required two months in a hospital and lots of at-home care after that.

      The "young and healthy" are only one accident, virus, bacterium, what have you away from tremendous health care expenses.  

      All must be covered before they need care.  

    •  Overton Window & Congress (15+ / 0-)

      I am not a big enthusiast for either of their plans.

      Per my pre-debate diary on this topic Clinton & Obama are both right and both wrong

      You do capture the essence of why Obama is wrong.

      It is also the case that so long as one does leave the private for-profit insurance industry in place as the completely unneeded and counter-productive middle men, then mandates are indeed a forced subsidy to them.

      My hope is to elect either one of them, and I am overall an Obama leaner, though not on this particular issue, AND a more progressive Democratic congress. That way, we can HR-676 pulling from the left against whatever comes down from the Whithouse.

      •  Obama's plan is much more likely to pass Congress (1+ / 0-)
        Recommended by:
        Great Uncle Bulgaria

        Obama's plan is much better than Hillary's full coverage plan that can't get passed in the Congress.

        •  But Obama's plan will end the issue (8+ / 0-)

          And we still won't have solved the problem.

          Obama aims high in his rhetoric but low in his actual proposals.

          The danger is that once it's addressed, and his approach is really bad, it won't be revisited for a decade, minimum.

          He will have blocked real reform

          Obama used to be for single payer before he came out against it.

          by formernadervoter on Sat Feb 02, 2008 at 04:37:04 PM PST

          [ Parent ]

          •  I think ANY health plan enacted WILL (1+ / 0-)
            Recommended by:
            Great Uncle Bulgaria

            be revisited.

            Whether this is because of impending national bankruptcy or as a result of tens of millions of families finding they can't afford rent and insurance at the same time while making a bit too much to qualify for the public plan or both is an interesting question.

            Though it's quite possible that the great majority of Congresscritters who will have voted for that the first time around will watch the next health care debate on TV, since they'll have been pitched out of office by angry voters.

            I really think that mandates are going to be a deal-killer for the Democratic Party itself and will turn our next Democratic President into a one-termer.

            I think we get a Democratic victory in 2008 based on low-information voters mistaking "mandated insurance for all" for "health care for everybody", but once people get the bills, they're going to know what happened and which idiots did this to us.

            Looking for intelligent energy policy alternatives? Try here.

            by alizard on Sat Feb 02, 2008 at 06:18:27 PM PST

            [ Parent ]

            •  Politicians should avoid a Take Two (0+ / 0-)

              of Maggie Thatcher's Community Charge.

              This was a fixed tax per adult resident, hence a poll tax, although there was a reduction for poor people. This charged each person for the services provided in their community.

              People with jobs had to pay 100%, students and the unemployed paid 20%.

              Protesters complained that the tax shifted from the estimated price of a house to the number of people living in it, with the perceived effect of shifting the tax burden from the rich to the poor. It did not help that Thatcher, close to the end of her period in office and losing popularity, chose to champion the Community Charge herself and apparently chose to be both ruthless in imposing it and adamant that there would be no "U-turns" (reversals in policy).

              Additional problems emerged when many of the tax rates set by local councils proved to be much higher than many earlier predictions.

              Owner-occupiers paid because they couldn't hide, and it cost less for them than rates had; renters didn't pay because they knew they would be long gone when the bills arrived. Councils of towns with highly mobile populations, e.g. university towns, were faced with big store rooms of un-processed "gone-aways".

              As the charges began to rise, large numbers of people refused to pay the tax (up to 30% of former ratepayers in some areas according to the BBC), enforcement measures became increasingly draconian, and unrest mounted and culminated in a number of Poll Tax Riots.

              http://en.wikipedia.org/...

              An anti-poll tax rally in central London has erupted into the worst riots seen in the city for a century.

              Forty-five police officers are among the 113 people injured as well as 20 police horses.

              A total of 340 people have been arrested in the heart of London's West End, popular with musical and theatre goers, as cars have been overturned and set alight.

              Four tube stations have been shut for safety reasons as police try to clear the streets, with much of central London now cordoned off.

              Demonstrators have attacked police with bricks and cans.

              Fire fighters attempting to extinguish the blazes have been hit with wood and stones.

              Restaurants have been forced to close early by the violence which left shop windows smashed and many businesses with their contents looted.

              Eyewitness reports describe a cloud of black smoke over Trafalgar Square.

              http://news.bbc.co.uk/...

    •  This is one of the best diaries on this topic. (28+ / 0-)

      As you probably know, I'm leaning towards BO, but you're absolutely right about this issue, and at the very least, the people who support Obama really need to wrap their minds around the extent to which his HC plan doesn't quite hit the mark.

      Moreover, he seems to concede this point with his hackneyed efforts to backfill around the lack of a mandate (the 25 year old being covered under parents' plan, the "back premium fine" issue).

      Coming soon: JohnMcBush2008.com | Edwards Democrat

      by JedReport on Sat Feb 02, 2008 at 02:55:34 PM PST

      [ Parent ]

    •  From an Edwards supporter (21+ / 0-)

      Thank you so much for this. This is the first time I've emailed out a Daily Kos diary to family and friends.

      Please please keep writing about this. This issue is a deal-breaker for me and many other people I know.

      It's like Apple and Microsoft. Without Apple, Microsoft wouldn't have anything to copy. Edwards is the idea factory. -demwords

      by Jiminy Cricket on Sat Feb 02, 2008 at 03:30:11 PM PST

      [ Parent ]

    •  Universal coverage is not Hillary's plan (6+ / 0-)

      It's universal pick pocketing of the working class to feed the stock options of greedy insurance CEOs.

      Here's a comment worth repeating which I posted yesterday:

      I'm 28 and have been chronically ill with Crohn's Disease for 3 years now. Believe me, I know what's wrong with the medical system. And a mandate, which just forces everybody to abide by HMO's rules and doesn't actually do very much to reduce costs is the absolutely worst answer there is the the problems in the medical system.

      Here's what a mandate will do: it'll force people to buy catastrophic insurance ($5,000 deductibles) and it'll take about $100 a month out of their net earnings. For a $15 an hour worker with a kid that is a big deal. Who profits? The insurance company which gets the $100 a month and never has to pay a claim because the deductible is so high that don't go to the doctor. Further because the $100 a month is out of the family's budget,  people can't even afford the yearly physicals they could get without insurance. A mandate is bad news for everybody but UHC stock holders..

      •  No, that won't happen (14+ / 0-)

        For a $15 an hour worker with a kid that is a big deal.

        That person will be subsidized, probably fully.

        •  No, not fully (7+ / 0-)

          10%. Hillary's plan is a raw deal. It's corporate welfare for the insurance industry. It does nothing to address the real problems--the high cost of premiums. Full subsidies under her plan=<$8.00 per hour (the current Medicaid cap, which is a complete joke). And even at full subsidies what are we getting for our tax dollars? Nothing, a plan that still makes most people pay 100% out of pocket for going to the doctor. No improved catastrophic care. No limits on insurance industry profits, no regulations on HMOs (let us never forget that it is Hillary Clinton herself who is pretty much solely responsible for the rise of the era of HMOs).</p>

          Add to that the fact that Hillary's plan is probably unconstitutional (I don't see how the government can force a citizen to buy a private good) and you see why it's a raw deal for patients. Obama has the better plan because he's approaching things from the right angle--reducing costs and expanding access, which will increase the insured roles and make universal coverage more feasible. His plan still sucks, but it sucks less than Hillary's corporate welfare for AETNA plan...

      •  Not if the mandate is to enroll (9+ / 0-)

        in the public option.

        HR 676 or California's SB-840 - the only health reform proposals worth my vote.

        by kck on Sat Feb 02, 2008 at 03:50:53 PM PST

        [ Parent ]

        •  That just won't work (3+ / 0-)

          It'd never pass the Senate. What would come out of a Hillary Presidency is a mandate to buy private insurance. People would be forced to buy Piece of Crap plans with high deductibles and low premiums, and all of the problems in the medical system would remain. In fact, they'd likely get worse...This is the health insurance version of the prescription drug benefit donut hole...

          •  The enrollment penalty ... (1+ / 0-)
            Recommended by:
            Clem Yeobright

            ... was what Edwards proposed.  It's an excellent idea.

            The doctor said I wouldn't have so many nose bleeds if I kept my finger outta there. - Ralph Wiggum

            by jim bow on Sat Feb 02, 2008 at 04:22:37 PM PST

            [ Parent ]

            •  I assume you have employer-paid (0+ / 0-)

              health insurance.

              Would you feel the same way about EdwardsCare if your employer dumped your health coverage on the basis that 'the government fixed health care!' and you had to pay $2K/year out of your own pocket per family member for junk health insurance?

              I have no objection to seeing your wages garnished as Edwards proposed to pay for this.

              BTW, that's why I didn't vote for Edwards in the primary, despite my liking his rhetoric and campaign better than his competitors.

              Looking for intelligent energy policy alternatives? Try here.

              by alizard on Sat Feb 02, 2008 at 06:28:06 PM PST

              [ Parent ]

              •  Nope and for several reasons. (5+ / 0-)
                1.  If my employer dropped my plan (HMO Blue of Blue Cross/Blue Shield of Massachusetts), my employer would -- in order to be competitive with other organizations -- have to increase my wages.
                1.  Under the Edwards plan, I would also receive a subsidy for purchasing private insurance.  That would offset some of what I paid for private insurance.

                In other words, higher wages and a federal subsidies would offset much of my health insurance costs.

                1.  Finally, and here's the major benefit -- even if I paid a higher premium, by allowing me to buy into the Federal Employee Health Benefits Program (and as a federal employee, I had BCBS Standard Option of FEHBP), enabling me to have my insurance independent of my work.  I could change jobs, and wouldn't have to worry about what kinds of health benefits my new employer offered.

                The doctor said I wouldn't have so many nose bleeds if I kept my finger outta there. - Ralph Wiggum

                by jim bow on Sat Feb 02, 2008 at 07:16:05 PM PST

                [ Parent ]

                •  FYI: After reading your comments, I quickly went (1+ / 0-)
                  Recommended by:
                  jim bow

                  to see if you had rec'd my 'actuarial' comments (the 'Yep. Your're screwed' ones).

                  It was a great relief, I will tell you, that you had done so! Please don't tell me if those were professional or 'pity' recs - let me enjoy them for the moment! :)

                  You kids behave or I'm turning this universe around RIGHT NOW! - god

                  by Clem Yeobright on Sat Feb 02, 2008 at 07:53:18 PM PST

                  [ Parent ]

                •  I think you're in a pretty small minority (0+ / 0-)

                  Most people have to settle for what they can get in terms of benefits and salary from employers.

                  Looking for intelligent energy policy alternatives? Try here.

                  by alizard on Sun Feb 03, 2008 at 04:22:04 AM PST

                  [ Parent ]

                  •  As wrote before, I also think ... (1+ / 0-)
                    Recommended by:
                    Clem Yeobright

                    ... that many people would love the idea of having their health insurance independent of their work -- even if it means higher premiums or higher cost sharing.

                    Also, we shouldn't penalize people -- as we do now -- for purchasing insurance on their own if their employer does not provide them health insurance.  Because the federal tax code rewards people who get health insurance through their employer (the employer contribution health deduction), people who purchase insurance on their own -- often expensive individual insurance -- are penalized, or at least aren't helped, through the tax code.

                    The doctor said I wouldn't have so many nose bleeds if I kept my finger outta there. - Ralph Wiggum

                    by jim bow on Sun Feb 03, 2008 at 11:51:46 AM PST

                    [ Parent ]

          •   To me it seems intuitively obvious (2+ / 0-)
            Recommended by:
            Clem Yeobright, Lena

            I'm from the corporate sector, HMOs, it does work, today, with MedicAid for foster children and the impoverished uninsureds. People with money can pay a small MedicAid premium.

            HR 676 or California's SB-840 - the only health reform proposals worth my vote.

            by kck on Sat Feb 02, 2008 at 04:24:35 PM PST

            [ Parent ]

    •  I happen to agree with Clinton on this. I also... (6+ / 0-)

      .... dislike the mailer. I guess we saw an uproar with Hillary's deceptive mailers on Obama's 'present' votes and his social security position. This is definitely a fair line of attack on Obama. We should get him to change his mind.

      Rec'd.

      Charlie Young: "Sir, I need you to dig in now. It wasn't a nightmare. You really are the President."

      by crazymoloch on Sat Feb 02, 2008 at 03:46:41 PM PST

      [ Parent ]

    •  Gave you a rec (4+ / 0-)

      Just because you're still my favorite Clinton commentator.  You're 100% wrong, though. ;-)

      Barack Obama. Because we can do better.

      by poblano on Sat Feb 02, 2008 at 03:50:45 PM PST

      [ Parent ]

    •  Great diary, P.I. This is the best description (5+ / 0-)

      of the important differences between the two plans I've seen anywhere. Outstanding job. True universal health care - another reason to vote for Hillary '08!

      I proudly support Hillary Clinton for President...

      by Rumarhazzit on Sat Feb 02, 2008 at 03:51:25 PM PST

      [ Parent ]

    •  Hard to argue (6+ / 0-)

      with logic like this.

      I was born a millworker's daughter.....

      by cackyp on Sat Feb 02, 2008 at 04:04:59 PM PST

      [ Parent ]

    •  Don't forget about ERISA preemption of state law. (6+ / 0-)

      Another reason why state mandates will be insufficient is that self-pay plans provided through employers are exempt from state insurance laws via ERISA.  That means that employer self-funded plans can get around state procedure coverage mandates and thwart some of your universal public health arguments, assuming that ERISA law is not changed!

    •  PI-excellent diary, and a few questions (if you (7+ / 0-)

      know the answers):

      1. Regulation. Edwards had talked about putting insurers in a highly regulated environment, which included capping profits. What does Hillary's plan do vis a vis regulating insurers?
      1. Has anyone considered another revenue source for paying for govt subsidies of health insurance (along the lines of CT DAS - in CT if an individual has received benefits from the state and receives a windfall - i.e., winning the lotto or personal injury settlement - a portion of that money goes back to the state to make up for the subsidies paid out).
      1. The assigned risk pool is the way the state regulates the free market vis a vis high risk folks for auto insurance. Is there going to be something like a federal assigned risk pool for health insurance (or would these folks just be enrolled in the govt program)? Or would they assign these risks across private insurers?

      Again - I understand if you don't know some or all of these questions, but any info would be helpful :-)

      "The revolution's just an ethical haircut away..." Billy Bragg

      by grannyhelen on Sat Feb 02, 2008 at 04:18:27 PM PST

      [ Parent ]

    •  I agree. He's dead wrong this... (9+ / 0-)

      and that's big deal to people like me. Still not voting Clinton. But not for Obama either. Sticking with Edwards...the real deal.

      But he's wrong and it does piss me off also. It also makes me wonder what else is he willing to sell out in order to win I concur wholeheartedly.

      Spears/Hilton '08

      by cosbo on Sat Feb 02, 2008 at 04:18:40 PM PST

      [ Parent ]

    •  scholarlly report (5+ / 0-)

      and also heartfelt, you're a terrific reporter, thanks for putting it together like this.  I've gotten bits of this from you in comments, and it's very useful to have it all spelled out.  

    •  Thank you for this (6+ / 0-)

      I like and respect Alegre very much and commented in her diary that she took the wrong tactic in trying to lure Edwards voters with her diary last night.  I suggested exactly this type of diary.  Edwards supporters aren't homogeneous but Hillary supporters have a real chance to reach out to those who chose John based on health care.  Just like Obama supporters have a real chance to reach out to those who chose John for anti corporatist reasons.

      This diary is exactly the kind of thing Edwards supporters like.  We're very wed to our issues and like details.  This diary wasn't mean toward Obama but it did point out crucial differences in policy.  

      Thank you very much.

      Speak out for those who have no voice...Do not turn away from the great struggles before us. Do not give up on the causes that we have fought for. John Edwards

      by sobermom on Sat Feb 02, 2008 at 04:55:19 PM PST

      [ Parent ]

    •  Partially Impartial, this is . . . (13+ / 0-)

      an incredibly good diary.  Your points are excellent. I think you're correct about mandates, though the word "mandate" now has a negative connotation due to the what's happening in Massachusetts.

      I think if Obama gets the nomination he will fine tune his health plan--let me tell you something we will hold his feet to the fire, we will hold Clinton's feet to the fire.

      Frankly neither plan is great, it's better than what we have (which is nothing), but both plans are weak.

      As I said in my diary yesterday, we don't even have a definition of "affordable". We don't know if we can buy into FEHBP (which is a centerpiece of both plans,) at the same price as federal employees and members of Congress.

      Look, the only solution is single-payer, all the rest is tweaking a collapsed system on the margins--window dressing.

      What Clinton and Obama propose are desperate stop gap measures, they certainly don't address the real problem. Hence long term, they are destined to  fail.

      We need to remove the predatory and murderous for-profits from the equation.

      Great diary, though.

    •  You might be shocked to hear this from me (7+ / 0-)

      But I think you did an excellent job on this diary and I salute you.

      As someone without a candidate, but someone who appreciates a better health plan, I think you laid everything out clearly and succinctly.

      I will fight forever onward, for I am a fighting Edwards Democrat!

      by priceman on Sat Feb 02, 2008 at 06:21:49 PM PST

      [ Parent ]

      •  Thanks (3+ / 0-)
        Recommended by:
        RickWn, grannyhelen, priceman

        I hope everyone here will be agreeing with each other much more in a couple months.

        And I know I've made it hard for people to express agreement with me, so I thank you for your open mind.

        •  np :-) (2+ / 0-)

          I'm in a bit of a transition; I am mentally and emotionally wiped out. I put everything I had into the Edwards campaign, so it will take me awhile to get over watching that struck down before my very eyes, but I have always respected you, despite fervently disagreeing with you and all of the competition, at times. And who's to say who made things harder on people to express agreement with them. I know I made it hard for a lot of people at times, but we all are physically, mentally, and emotionally invested in which candidate we think will bring us a better future and we all fight for them.

          You are a good writer/diarist and you have caught my attention, as our differences turned out to not be so stark after all; not surprisingly on health care in this instance.

          Anyway, I'm rambling like I tend to do at times(it's my thing.lol.) but I do have an open mind, and though I still need to do some unraveling, I give you a lot of credit, here, and I will keep track of your diaries from now on.

          Congrats on the 'Recc' list!

          priceman

          I will fight forever onward, for I am a fighting Edwards Democrat!

          by priceman on Sat Feb 02, 2008 at 06:57:02 PM PST

          [ Parent ]

    •  Mandated health insurance.... (0+ / 0-)
      ....  might require an action such as a Constitutional Amendment...  not an easy thing to achieve... There have been 27 of them since the document was written.  

      The Equal Rights Amendment has failed to pass despite nationwide support.

      Why would this be necessary....?  Because, arguably, you have the right to be uninsured.  This is not like car insurance, which is mandated because the burden of payment could fall on the person you hit in an accident... it is not like home owners insurance because the mortgage holder requires it...  If you buy your house outright, you are not required to purchase insurance for it.....

      But healthcare costs are generally the burden of the person who receives the care.

      The cost factors alone for providing mandated health insurance would prevent its institutionalization.  Unless it is Federally provided.  So called socialized medicine...  given that demonized name by opponents of the plan.

      I would love nothing more than for every man, woman, and child to have access to quality healthcare, but mandating it will not work in my opinion.  It is dead on arrival in Congress, even with a Democratic majority.... it would fail a Constitutional test in the Supreme Court, and does not have enough support in Congress for a Constitutional Amendment to pass.

      "Set fire to the room. Do it now." CJ Cregg

      by Jen K in FLA on Sat Feb 02, 2008 at 07:37:19 PM PST

      [ Parent ]

    •  Thanks for your work in a difficult environment. (2+ / 0-)

      DKos is a pretty tough room these days, if you're not for Obama.

      The hungry judges soon the sentence sign, And wretches hang, that jurymen may dine.

      by magnetics on Sat Feb 02, 2008 at 09:11:51 PM PST

      [ Parent ]

  •  "Harry and Louise at the ER" would be (19+ / 0-)

    funny, showing what happens when the freeloaders seek treatment.. heh:)

  •  btw McCain is easily defeatable... (4+ / 0-)
    Recommended by:
    hester, catfish, bwintx, Clem Yeobright

    His wife is tangled up in the organized crime that goes on here in AZ. Joe Bananas and That crowwd. So no worries with him.

    He's never been grilled either.

    I will make them have it. I will stuff their mouths with Gold!--Aneurin Bevan (on the NHS)

    by Salo on Sat Feb 02, 2008 at 02:22:25 PM PST

  •  When they come to (9+ / 0-)

    arrest me for not buying my insurance I am going challenge the constituionality of forced compliance.

    This is a sure loser in the fall. Americans are not sheep and do not like to be told that they cannot have abortions or must pay insurance companies their hard earned money.

    •  you mean selfish (18+ / 0-)

      liking to stick it to their fellow American because they are too 'independent' to pay their part- that is what is typical about Americans.  Americans are sheep- we are selfish, lazy, easily bought and easily frieghtened- all as one big group.  

      Universal HC policies and similar are not some sort of evil socialist mandate, they forward thinking policies that make all healthcare expenses cheaper for everyone!

      Why do you think it is that every other developed nation on earth has Universal Health Care of some form, pays less than we do per capita on health care, and they all live longer (mostly)?

      Give me a f'ing banana - Eddie Izzard

      by linc on Sat Feb 02, 2008 at 02:32:53 PM PST

      [ Parent ]

      •  yep (4+ / 0-)

        and it will probably be paid for as a new FICA item or similiar and come right out of your paycheck as a very progressively scaled tax- it will be a beautiful thing.

        What will also probably happen is that employers who choose to stop giving private insure will have to pay a portion, just as they do on other FICA items and then give their employers a raise with another portion of their savings- a win, win for everyone.

        God, if the auto industry could just pay half of what it is paying out in health benefits, we would probably have a competitive auto industry again.

        Give me a f'ing banana - Eddie Izzard

        by linc on Sat Feb 02, 2008 at 02:39:28 PM PST

        [ Parent ]

        •  this is NOT Hillary's plan n/t (5+ / 0-)
        •  That's not her plan (2+ / 0-)
          Recommended by:
          highacidity, Mardish

          Her plan is an individual mandate: Pay up for care, and if you're poor enough we'll give you a tax credit at the end of the year. Not sure what happens if you're so poor you don't pay taxes.

          During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

          by kyril on Sat Feb 02, 2008 at 03:33:26 PM PST

          [ Parent ]

          •  What if you're too poor to front the bill until (4+ / 0-)
            Recommended by:
            slinkerwink, highacidity, karpaty, kyril

            you get the tax rebate?

            Hillary's plan SCREWS the poorest people who already can't afford health care, and that's why I can't support it. Yeah, mandating care will lower overall costs by spreading risks. Hillary's plan lowers health care premiums for middle and upper class families on the backs of the people who can't afford insurance to begin with.

            I don't have health insurance right now. Because I can't afford it. How is it fair that I have to now buy health insurance so the rest of you pay lower premiums, even if I get a "rebate" a few years down the road. And how am I supposed to know, as a low income voter, how much of my mandated health care coverage Hillary proposes to pay?!

            This is not a liberal/progressive health care policy. As far as I can tell, it's a highly convoluted strategy to hand more customers to for-profit insurance companies.

            (-8.00, -5.08) "Chase after truth like hell and you'll free yourself, even though you never touch its coat-tails." - Clarence Darrow

            by Mardish on Sat Feb 02, 2008 at 03:44:36 PM PST

            [ Parent ]

            •  It's a refundable tax credit. (1+ / 0-)
              Recommended by:
              splashy

              There is no basis for your comment, except that it would be a poor system if you had to wait a year to get your subsidy.

              OTOH: There is a huge plan underway to deliver checks to millions of people as 'stimulus'. Don't you suppose the same system could be utilized to jump-start this program?

              You kids behave or I'm turning this universe around RIGHT NOW! - god

              by Clem Yeobright on Sat Feb 02, 2008 at 04:47:52 PM PST

              [ Parent ]

              •  What is with you people, (1+ / 0-)
                Recommended by:
                kyril

                putting new initiatives into her plan that she hasn't even brought up. You can't just say "she might do this!" and turn me into a believer; because she hasn't. She has crafted this bill with a specific purpose in mind, and that purpose does not seem to be to help people who don't already have health care. It's to help the people who are paying to much, rather than the people who can't afford it.

                If she were concerned about my vote, and people like me, she would have emphasized how it would be made immediately affordable to low income Americans. She hasn't, and I think I have a legitimate reason to be concerned that she's touting mandates as the cure-all, while seemingly ignoring how low income Americans are going to afford that mandate.

                (-8.00, -5.08) "Chase after truth like hell and you'll free yourself, even though you never touch its coat-tails." - Clarence Darrow

                by Mardish on Sat Feb 02, 2008 at 04:58:53 PM PST

                [ Parent ]

                •  It is a re-fund-a-ble tax cre-dit. (2+ / 0-)
                  Recommended by:
                  Great Uncle Bulgaria, Lena

                  That means it will be administered through the IRS system, and that, just like EITC, it is 100% available to everyone regardless of income tax liability.

                  Your questions are all answered with regard to years 2 through eternity; your 'quibble' is how it will be administered in year 1.

                  Sen Clinton has not promised 100% coverage if she does not intend to make it workable.

                  You kids behave or I'm turning this universe around RIGHT NOW! - god

                  by Clem Yeobright on Sat Feb 02, 2008 at 05:08:16 PM PST

                  [ Parent ]

                  •  But... (1+ / 0-)
                    Recommended by:
                    kyril

                    "Sen Clinton has not promised 100% coverage if she does not intend to make it workable." What gives you that confidence? Has she said something or did she provide some detail in her plan that I've overlooked?

                    (-8.00, -5.08) "Chase after truth like hell and you'll free yourself, even though you never touch its coat-tails." - Clarence Darrow

                    by Mardish on Sat Feb 02, 2008 at 05:20:53 PM PST

                    [ Parent ]

                    •  Are you asking about year 1 or year 2? (0+ / 0-)

                      You kids behave or I'm turning this universe around RIGHT NOW! - god

                      by Clem Yeobright on Sat Feb 02, 2008 at 05:22:13 PM PST

                      [ Parent ]

                      •  In the first year. How does her mandate work (1+ / 0-)
                        Recommended by:
                        kyril

                        in the first year for people, like me, who live paycheck to paycheck. How are we supposed to add a new health care premium into our already stretched budget?

                        You know, I hadn't read either plan in a while, but I'm looking at hers again, and I really don't see how she can win any debate on the issue of mandates. She doesn't even use the word "mandate" in the entire document, like it's something she has to hide. She simply says, if you don't have insurance, you only have two options (both of which require paying for insurance: a public or private plan).

                        Reading through this, and the information she has on her site, it isn't even clear that she's mandating coverage; the only way I know is by the discussions that have occured in public debates. How is a regular voter supposed to find out that her health care plan will mandate they purchase coverage? Why doesn't she draw attention to this, quite obviously, controversial point?

                        I am so sick of deception like this. You can't just wave your hands and comfort me that Clinton will take care of all this once the plan is made real. I, and other voters, are looking for information now on how she will make this work. All I see is that she has mandates in her health care plan, but she doesn't really have the nerve to say as much.

                        (-8.00, -5.08) "Chase after truth like hell and you'll free yourself, even though you never touch its coat-tails." - Clarence Darrow

                        by Mardish on Sat Feb 02, 2008 at 05:51:58 PM PST

                        [ Parent ]

                        •  Interesting point of view. (2+ / 0-)
                          Recommended by:
                          splashy, Mardish

                          Many have criticized Sen Obama for constantly telling us 'I won't explain this here, go to my website' but you are complaining that Sen Clinton makes clear commitments in public comments and in the debate but does not have as much detail on her web-site as you would like.

                          If seh were promising 'a car in every garage', I guess you would be asking 'but would there be wheels on the car?'

                          You kids behave or I'm turning this universe around RIGHT NOW! - god

                          by Clem Yeobright on Sat Feb 02, 2008 at 05:59:04 PM PST

                          [ Parent ]

                          •  Was Clinton the first to bring up the issue of (0+ / 0-)

                            mandates, or was Obama or Edwards the first? I've only ever heard it brought up in debates, but I'm a little hazy on who brought it up first.

                            As for your second point, a car is not health insurance legislation, and health insurance legislation is not a car.

                            (-8.00, -5.08) "Chase after truth like hell and you'll free yourself, even though you never touch its coat-tails." - Clarence Darrow

                            by Mardish on Sat Feb 02, 2008 at 06:10:42 PM PST

                            [ Parent ]

                          •  Mandates are a question in any health (0+ / 0-)

                            care system. Can't be avoided. A major topic among 'theorists' of the field.

                            Mandates were a central component of the Edwards plan, which Sen Clinton has essentially copied.

                            Apparently Australia removed mandates from its system for three years in the 80s. Different countries have different requirements. It would be nice if the U.S. were willing to benefit from the experiences elsewhere in the world.

                            You kids behave or I'm turning this universe around RIGHT NOW! - god

                            by Clem Yeobright on Sat Feb 02, 2008 at 06:45:31 PM PST

                            [ Parent ]

          •  As opposed to Obama who penalizes people as soon (2+ / 0-)
            Recommended by:
            Kentucky DeanDemocrat, priceman

            as they access benefits. That isn't a whole lot better.

            "The revolution's just an ethical haircut away..." Billy Bragg

            by grannyhelen on Sat Feb 02, 2008 at 04:51:01 PM PST

            [ Parent ]

    •  No, no, no...let them arrest you... (3+ / 0-)

      at least then you'll have quality health care with no copays.

      ~Doc~

      My job is not to represent Washington to you, but to represent you to Washington. --Barack Obama

      by EquationDoc on Sat Feb 02, 2008 at 02:52:17 PM PST

      [ Parent ]

  •  Nothing short of single payer will ensure (13+ / 0-)

    universal coverage. I think that's a painfully obvious fact.

    I'll have to return to go over your arguments, but I'd like to point the readers to Obama's side on this matter (which quotes mostly independent sources):

    From Obama's Fack Check site:

    15 Million and Mandates
    January 31, 2008

    MANDATES DON'T LOWER COSTS

    15 MILLION IS A "DUBIOUS STATISTIC" TO USE WHEN DISCUSSING OBAMA'S PLAN

    80 Health Care and Legal Experts: Universal Coverage and the Presidential Candidates’ Health Care Proposals
    February 01, 2008

  •  Recommended (12+ / 0-)

    Thanks for a detailed examination of the features of any serious health care policy.  Obama may be counting on general ignorance regarding the need to make a plan universal, and he's taking the safe route out.  Hillary Clinton and John Edwards both understand the necessity for true universality - and are more politically courageous.

    •  This raises an interesting question (11+ / 0-)

      Does Obama really believe his rhetoric against mandates?

      Or is it all politics for him?

      Obama aides argue that people fail to buy insurance because they cannot afford it, not because they do not want it, so the senator from Illinois has not included a similar mandate in his proposals, focusing instead on reducing costs. Political caution in part motivated the decision, concede some Obama advisers who worry that such a mandate might be politically difficult for a president to enforce.

      Is he making up for his "political caution" by launching right wing attacks?

      •  How can he believe it? (7+ / 0-)

        Obama does have mandates in his plan - but only for children.

        Yet he has the audacity to attack mandates. It's dishonest and hypocritical. And I don't like how he pushes the overtone window on universal healthcare to the right.

        In particular, it's disturbing to see his supporters (which includes half my family) adopting and accepting these arguments when if they came out of a republican's mouth 4 years ago they would of been against it.

        More and more, I am worried the arguments used to attack mandates (i.e., government forcing people) will shift to issues like Social Security and Education.

        It's like Apple and Microsoft. Without Apple, Microsoft wouldn't have anything to copy. Edwards is the idea factory. -demwords

        by Jiminy Cricket on Sat Feb 02, 2008 at 04:05:28 PM PST

        [ Parent ]

        •  You're right to fear that. (1+ / 0-)
          Recommended by:
          Clem Yeobright

          Because there is absolutely no principled resaon to oppose universal healthcare that doesn't also apply to universal social security and universal education.

          Gasp!  Did you know that if parents don't make sure their children are schooled they can be ARRESTED for it????

          Thank God our ancestors understood the importance of community better than we do.  They worked hard to build a system of common schools to which everyone had access, to create a better society.  I suspect they'd have done the same thing with medical care if faced with anything like the issues we see today.   "Healthcare" in those days was a midwife or doc in a buggy making house calls for a pittance.  It never occurred to the people who built this nation that so basic a humanitarian service would be denied to so many.

        •  Parents have long been mandated (0+ / 0-)

          by law to seek needed medical care for their children.

          Children are also comparatively cheap to insure.

    •  So you're trying to have the best of both (3+ / 0-)
      Recommended by:
      Christin, highacidity, kyril

      worlds--it's "politically courageous" because people will hate the idea of mandates, yet they're still a good idea?  I like Obama's plan more because it addresses the main problems WITHOUT creating lots of backlash in the meantime.

      Never give up! Never surrender!

      by oscarsmom on Sat Feb 02, 2008 at 02:44:28 PM PST

      [ Parent ]

  •  Yep, yep, and yep (8+ / 0-)

    but no, Obama is the progressive- he wouldn't recycle right wing talking points and positions that have been shown to be fruitless!  He is the progressive- he talks about change and how he is not a clinton- isn't that enough for you!

    Give me a f'ing banana - Eddie Izzard

    by linc on Sat Feb 02, 2008 at 02:24:33 PM PST

    •  On this particular topic (1+ / 0-)
      Recommended by:
      highacidity

      Not being Hillary Clinton is a HUGE advantage.

      Never give up! Never surrender!

      by oscarsmom on Sat Feb 02, 2008 at 02:45:30 PM PST

      [ Parent ]

      •  Only if you are afraid of the big bad MSM (4+ / 0-)

        and you don't think those adds the insurance industry ran in the 90s against Hil won't be run against anyone else working towards the same?

        Give me a f'ing banana - Eddie Izzard

        by linc on Sat Feb 02, 2008 at 02:53:20 PM PST

        [ Parent ]

        •  obama already wussed out. (6+ / 0-)

          his plan is the timid person's approach to health care. he didn't make it universal because he didn't want to offend anyone. looks like he didn't want to insure anyone, either. or at least, not the 15 million people his plan won't cover.

          Hillary 2008 - Flying Monkey Squadron 283

          by campskunk on Sat Feb 02, 2008 at 03:24:59 PM PST

          [ Parent ]

        •  You guys are delusional (4+ / 0-)

          It has nothing to do with "being afraid of the MSM," it has to do with political reality.  Are you really not aware of the hatred, the insane vitriol that exists out there against Hillary?  And the health care issue is the big banner for those people.  I'm darned if I want to sacrifice our chances at improving our health care system because half this country has an irrational vendetta against this particular person.

          I want to MOVE ON and get some things DONE for a change!

          Never give up! Never surrender!

          by oscarsmom on Sat Feb 02, 2008 at 03:46:37 PM PST

          [ Parent ]

          •  Pardon me, but all your posts are the same (5+ / 0-)

            People hate Sen Clinton and therefore we must not vote for her because she might win and those people will be so disappointed and upset.

            We hear you. We disagree.

            You kids behave or I'm turning this universe around RIGHT NOW! - god

            by Clem Yeobright on Sat Feb 02, 2008 at 03:52:42 PM PST

            [ Parent ]

            •  Hardly my point (0+ / 0-)

              I (and many others) simply believe that Obama has the capacity to bring in many more voters in November than Hillary does.

              You may believe the opposite, but I assure you you're in the minority.

              Never give up! Never surrender!

              by oscarsmom on Sat Feb 02, 2008 at 04:50:08 PM PST

              [ Parent ]

              •  A minority of comments here, for certain (0+ / 0-)

                Since you are posting this same one over and over and over and over ....

                Now, if we go to one person-one vote, I do believe I am in the majority.

                You kids behave or I'm turning this universe around RIGHT NOW! - god

                by Clem Yeobright on Sat Feb 02, 2008 at 05:26:18 PM PST

                [ Parent ]

            •  Then why have you failed to understand (0+ / 0-)

              Hillary's ceiling of GE voters is about 49% even against Ron Paul, but Obama's is higher, despite being ranked by NJ the "Most Liberal Senator" in 2007.

              •  What the fuck. Let's go ahead and vote anyway. (0+ / 0-)

                The funny part is that I will be working for Obama - if he is the nominee - to the end, when many of you will have abandoned him over one or another 'revelation' that the VRWC has made about him.

                Remember, Hillary also has a floor; Obama's is about 20%.

                You kids behave or I'm turning this universe around RIGHT NOW! - god

                by Clem Yeobright on Sat Feb 02, 2008 at 06:37:09 PM PST

                [ Parent ]

                •  I'm glad to hear you'll support any dem nominee. (1+ / 0-)
                  Recommended by:
                  Clem Yeobright

                  As an former employee of the DNC, I'll be happy to have you on my team, whoever is the nominee.

                  However, you just pulled 20% out of your butt and you know it. It is a bit nutty that you seem think that Obama is more susceptible to Rezcko and krypto-muslim claims than Hillary is to her own history and the unifying effect she has on republicans. Only Hillary's weakness's are proven to be potent stuff.

                  •  I'm a Democrat. (0+ / 0-)

                    And by November I will have everyone I know - including my own bad self! - believing my party's nominee was my personal first choice way back in January 2007. No matter who it is.

                    Rezko doesn't worry me at all. I worry about, and will wake up worrying about until election day, the unknown.  

                    Every voter will evaluate every newly-revealed (or -fabricated) datum about our candidate against his/her universe of previously 'incorporated' data. There is resistance against discarding old items in order to absorb new ones, and therefore: new charges against Sen Clinton will meet resistance (i.e., she is truly 'vetted') and new charges against Sen Obama will entail no such 'expense' for the ordinary voter (he is not vetted).  

                    For example, if someone should contend that Sen Clinton had taken her oath as senator on a book not the bible, the most vicious anti-Hillary wingnuts would likely shake their heads and conclude 'no stickabilty'; we've seen the response to a similar charge against Sen Obama. One datum compared to 10k data in Clinton's case; perhaps one compared to 3 or 5 or 10 in the Obama case.

                    This is my worry.

                    Remember Tom Eagleton: "You have to understand, if I had told the truth I never would have gotten the nomination."

                    How are you sleeping under those circumstances?

                    You kids behave or I'm turning this universe around RIGHT NOW! - god

                    by Clem Yeobright on Sat Feb 02, 2008 at 07:26:03 PM PST

                    [ Parent ]

    •  LOL (0+ / 0-)
      You made me laugh.
  •  Geez! Not another substance-based (16+ / 0-)

    diary.

    It takes a woman ... Hillary Clinton will kick ass instead of triangulating with Republicans.

    by Gabriele Droz on Sat Feb 02, 2008 at 02:26:57 PM PST

  •  Health care for all Americans is our mandate. (13+ / 0-)

    Our, meaning Progressive Americans.  The rest of the free world manages to do so.  Why can't we?  

    To begin, we may have to tone down Universal health care, as Congress may not go with it.  Yet when we have Health Care for

    ALL Americans

    we can then move the discussion to the left.

    It is SO very important that we have healthcare for all Americans as our starting point.  Please, take the time to understand the simplicity of that statement.

    Another day, another devalued Dollar. -6.00, -6.21

    by funluvn1 on Sat Feb 02, 2008 at 02:29:20 PM PST

    •  I worry that it's too simple (3+ / 0-)
      Recommended by:
      highacidity, kyril, marcoto

      It sounds great as a talking point, but believe me that goverment-required insurance bill is going to be a reality check for a lot of people.

      Hell, I'd be willing to pay anything in taxes for a non-profit health care system, but even I will balk at the idea of HAVING to send money to a health  insurance company.

      Never give up! Never surrender!

      by oscarsmom on Sat Feb 02, 2008 at 02:47:38 PM PST

      [ Parent ]

    •  No it's not your mandate. (0+ / 0-)

      Only those Americans should get health care coverage who want it.

      And your Hillary would force everyone to buy coverage even if they don't want it. That's unamerican. It's an outrage. I don't want Hillary of all people to tell me what I should do or what I shoudl pay for.

      •  I don't have a My Hillary, so lighten up, hater. (5+ / 0-)

        You are wrong on everything you've said, and it is simply because you cannot see things outside of the viewpoint you have assigned yourself.  

        Hillary means nothing to me.  America does.

        I'm not touting "Hillary's" plan.  I'm explaining how America, in the near future can achieve universal healthcare.

        Now, please, take the time to actually understand what the differences are.  Not to mention, what the future possibilities will turn into.

        Another day, another devalued Dollar. -6.00, -6.21

        by funluvn1 on Sat Feb 02, 2008 at 03:32:27 PM PST

        [ Parent ]

      •  OK, here's a little though experiment for you... (5+ / 0-)

        You're driving down the road and you come across an accident.  The driver has been thrown from his car (because he doesn't want the insurance that seatbelts provide) and he's bleeding profusly.  You bend over him and ask him if he has health insurance.  He says "no."  At this point there are four possible outcomes:

        1. You say, "Oh, tough luck.  Seems like your own your own."

          a.  He says, "Yes, your right.  Just leave me here to bleed to death.
          b.  He says, "Are you out of your mind!!!  Call me an ambulance."

        1.  "Oh, that's OK.  I'll call an ambulance.  They will take you to hospital."

          a.  He says, "Oh, no thanks.  I don't have insurance.  I'll just have to bear the consequence."
          b.  He says, "Thank you.  You are very kind an generous."

        If you choose "1" I hope I never meet you in a dark alley.  If you know anyone who would choose "a" I'll vote for Huckabee.

        However, unless you can come up with anyone who would answer "1" or "a" then everyone wants health insurance, they'll just skip out paying for it if they can get away with it.

  •  i'm not mad at obama, because i know about him (2+ / 0-)
    Recommended by:
    linc, hopefulcanadian

    but i am irritated ar his supporters who thinks he shits rubies.

    i doubt seriously that a decent program to insure all americans will ever come from a guy who worships the free market like he does and i bet that he doesn't push for any health program as much as clinton or edwards would have, and likely he would just blame his failure to produce one on the GOP.

    he's a judas goat, no doubt about it.

    "There are many truths of which the full meaning cannot be realized until personal experience has brought it home." John Stuart Mill

    by kuvasz on Sat Feb 02, 2008 at 02:29:41 PM PST

  •  All the candidate healtcare plans (5+ / 0-)
    Recommended by:
    IvanR, oscarsmom, Blue Letter, kyril, costello7

    are dreadful but we shouldn't expect more from candidates because if they came out and said that they were going to make health insurance companies obsolete, they wouldn't have a chance to win.  The mandate question is only of interest because it suggests a political orientation.  Obama gets it that mandates solve nothing -- ordering people to purchase what they can't afford solves nothing. Hillary either doesn't get that or is being disingenuous in proposing it.  

    Nothing short of Medicare for all will work.

    What FDR giveth; GWB taketh away.

    by Marie on Sat Feb 02, 2008 at 02:31:24 PM PST

    •  make health insurance companies obsolete? (2+ / 0-)
      Recommended by:
      highacidity, kyril

      Any plan that's actually a path to single-payer will be opposed by the health insurance companies with the same rabid vigor and unlimited budgets they oppose single-payer with. The concept that we can 'sneak one by" the health insurance industry is believed only by extremely gullible Kool-Aiders.

      A "national health care program" that's worse than the current mess is quite possible, and I expect one from either President Obama or President Hillary.

      Looking for intelligent energy policy alternatives? Try here.

      by alizard on Sat Feb 02, 2008 at 02:57:44 PM PST

      [ Parent ]

      •  Again, insurance companies are already obsolete (7+ / 0-)

        in healthcare. They just haven't accepted it yet.

        Admit it, the 47+ million uninsured in the US are largely those who do not receive health insurance through their employer. So, the 250 million who do have health insurance are receiving it at least to some extent from an employer. And employers are moving more and more to self-insuring their health insurance planes, because it reduces costs. And the more health care costs rise--another 50% by the end of the next president's first term--the more companies will have to self-insure.

        So insurance companies are already well on their way to becoming obsolete.

        ~Doc~

        My job is not to represent Washington to you, but to represent you to Washington. --Barack Obama

        by EquationDoc on Sat Feb 02, 2008 at 03:38:53 PM PST

        [ Parent ]

        •  certainly (2+ / 0-)
          Recommended by:
          highacidity, Blue Letter

          Why do you think that there's so much candidate enthusiasm for mandates?

          The 47M uninsured are the only market segment that a private insurance industry can go to in order to expand their profit base. And they can't get our business unless the Federal government tells us "buy insurance or get massively fined".

          Looking for intelligent energy policy alternatives? Try here.

          by alizard on Sat Feb 02, 2008 at 03:43:20 PM PST

          [ Parent ]

          •  I'm not arguing for mandates... (0+ / 0-)

            I'm arguing for single-payer, government-run universal health care.

            Hillary and Obama want to keep doing what we've been doing, expecting different results. Mandates or not, both plans will fail catastrophically. It's silly to argue about mandating or not mandating people buy into a system that is designed to collapse.

            ~Doc~

            My job is not to represent Washington to you, but to represent you to Washington. --Barack Obama

            by EquationDoc on Sat Feb 02, 2008 at 05:05:24 PM PST

            [ Parent ]

    •  Did you know Obama mandates (2+ / 0-)
      Recommended by:
      grannyhelen, Clem Yeobright

      parents to cover children in his plan?

      Having incomplete mandates in your plan and then attacking universal mandates in another candidate's plan, is the epitome of disingenuous.

      It's like Apple and Microsoft. Without Apple, Microsoft wouldn't have anything to copy. Edwards is the idea factory. -demwords

      by Jiminy Cricket on Sat Feb 02, 2008 at 04:33:26 PM PST

      [ Parent ]

  •  John McCain's Plan (3+ / 0-)
    Recommended by:
    highacidity, oscarsmom, costello7

    Hillary's Mandates will be tough to stand up against McCains fairly extensive plan.

    Reform the tax code to eliminate the bias toward employer-sponsored health insurance, and provide all individuals with a $2,500 tax credit ($5,000 for families) to increase incentives for insurance coverage. Individuals owning innovative multi-year policies that cost less than the full credit can deposit remainder in expanded health savings accounts.

    Families should be able to purchase health insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business that will eliminate excess overhead, administrative, and excessive compensation costs from the system.

    Insurance should be innovative, moving from job to home, job to job, and providing multi-year coverage.

    Require any state receiving Medicaid to develop a financial "risk adjustment" bonus to high-cost and low-income families to supplement tax credits and Medicaid funds.

    Allow individuals to get insurance through any organization or association that they choose: employers, individual purchases, churches, professional association, and so forth. These policies will be available to small businesses and the self-employed, will be portable across all jobs, and will automatically bridge the time between retirement and Medicare eligibility. These plans would have to meet rigorous standards and certification.

    McCain in essence will provide a larger Subsidy/tax credit than Hillary, How do you counter that when he'll also argue you have total freedom to insure or not...

    You're arguement is not simple enough to beat back the problems seen in Cali and Mass, though it may be factualy correct.

    •  Tax credits don't do shit (6+ / 0-)

      for people who don't make enough to pay taxes to begin with.

      •  Which is the problem with Sen. Clinton's plan (2+ / 0-)
        Recommended by:
        Steven R, highacidity

        Her subsidies would come in the form of tax credits too.

        During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

        by kyril on Sat Feb 02, 2008 at 03:09:41 PM PST

        [ Parent ]

        •  So? (3+ / 0-)
          Recommended by:
          highacidity, splashy, kyril

          I don't like her plan any better than I like Obama's. But I like either of their plans better than I like McCain's. The only truly viable option, however, remains single-payer.

        •  Seriously, that is unimportant now. (1+ / 0-)
          Recommended by:
          hopefulcanadian

          It is about what will happen AFTER insurance companies are minimalized during this process.  Then tax credits will be replaced with the WANTS of all, including Republics, Americans needing universal healthcare without the this, that and the other thing getting in the way.

          I do not advocate for Hillary Clinton.  I advocate for Americans receiving the best health care in the world.

          We are the richest country in the world, right?  Why are we so behind other countries in this world regarding so many health related realities?

          Only one answer.  Profits and insurance companies.

          Another day, another devalued Dollar. -6.00, -6.21

          by funluvn1 on Sat Feb 02, 2008 at 03:39:11 PM PST

          [ Parent ]

          •  After... (1+ / 0-)
            Recommended by:
            highacidity

            And how many of us "unimportant" poor people have to be thrown under the bus first?

            Look, I want the health insurance industry to die just as much as you do. I just can't wrap my head around the idea that requiring people to give them money is somehow going to kill them. Even if that were the case, is it really worth turning millions of decent hard-working low-income people into lawbreakers because we can't afford to feed ourselves and pay up-front for health insurance at the same time?

            During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

            by kyril on Sat Feb 02, 2008 at 03:49:47 PM PST

            [ Parent ]

        •  You've got the stick by the wrong end, kyril (3+ / 0-)
          Recommended by:
          splashy, jim bow, hopefulcanadian

          Sen Clinton's plan provides for refundable tax credits, meaning they are available to all regardless of tax liability.

          Provide Tax Relief to Ensure Affordability: Working families will receive a refundable tax credit to help them afford high-quality health coverage.

          Limit Premium Payments to a Percentage of Income: The refundable tax credit will be designed to prevent premiums from exceeding a percentage of family income, while maintaining consumer price consciousness in choosing health plans.

          You kids behave or I'm turning this universe around RIGHT NOW! - god

          by Clem Yeobright on Sat Feb 02, 2008 at 04:06:31 PM PST

          [ Parent ]

          •  I know they're available to all (1+ / 0-)
            Recommended by:
            highacidity

            I quoted that part myself twice, once upthread and once downthread. Please listen to me - this is very important. It's not the amount of the subsidy that's a promelm, it's the mechanism.

            Most poor and low-income people like myself have absolutely no wiggle room in our budgets. None. We are not like the middle class. We don't have luxury purchases that we can put off if it turns out we have to pay for something vital. Unexpected or new expenses come out of our food, housing, heating or hygiene budgets.

            I see nothing in Sen. Clinton's plan that says we will not have to pay the same monthly premium as everyone else. It appears to me that we're expected to pay up-front and just get more money back than they do at the end of the year. It adds up to the same amount of money as an up-front subsidy, but it does not make those premium payments affordable. Even at an extreme low-ball estimate of $1-200/month, many of us would have to go without food in order to pay for it. The following year, after we get that credit, things will be a lot easier, but most of us don't have the willpower to go without food (or heat or housing) for a year first.

            During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

            by kyril on Sat Feb 02, 2008 at 04:14:30 PM PST

            [ Parent ]

            •  How about if it were in the withholding? (1+ / 0-)
              Recommended by:
              kyril

              and you got a piece every week?

              Sen Clinton knows well what you are describing. There will be a mechanism that does not tantalize you with something outside your grasp.

              You kids behave or I'm turning this universe around RIGHT NOW! - god

              by Clem Yeobright on Sat Feb 02, 2008 at 04:19:30 PM PST

              [ Parent ]

              •  I replied to you above (1+ / 0-)
                Recommended by:
                Clem Yeobright

                but just want to say thanks for engaging in dialogue with me :)

                During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

                by kyril on Sat Feb 02, 2008 at 04:21:50 PM PST

                [ Parent ]

                •  Well, you do have me scratching my head (3+ / 0-)
                  Recommended by:
                  Spit, splashy, kyril

                  over day-laborers and the underground economy in general.

                  Of course, the plan does not rescind Medicaid or SCHIP, to my reading, so those already benefiting from those programs will continue to do so.

                  Hell, we sent a man to the moon, I'm sure we can solve this one. :)

                  /head-scratching

                  You kids behave or I'm turning this universe around RIGHT NOW! - god

                  by Clem Yeobright on Sat Feb 02, 2008 at 04:32:07 PM PST

                  [ Parent ]

            •  There is the factor that Medicare and Medicaid (0+ / 0-)

              Won't be taken out any more, along with the health care part of Workman's Comp. Since you are already paying that, you may not pay anything more, or perhaps even less than you do now.

              "A common mistake people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools." Douglas Adams

              by splashy on Sun Feb 03, 2008 at 12:25:34 AM PST

              [ Parent ]

    •  Wow that's a good point (2+ / 0-)
      Recommended by:
      highacidity, kyril

      I knew nothing about McCain's plan--who knew any Republican even had one?  Thanks for posting!

      Never give up! Never surrender!

      by oscarsmom on Sat Feb 02, 2008 at 02:50:23 PM PST

      [ Parent ]

    •  That plan really sucks (9+ / 0-)

      so employers stop paying 8000+ a year for an employee's health insurance and the gov't give the employee 2500 in tax credits to pay for their own insurance?  Right, and I am sure Insurance companies would be gracious enough to extend group rates (paid for by employers in employer managed plans, generally) to single employees looking for individual plans.

      There is nothing about that plan that is good.

      Give me a f'ing banana - Eddie Izzard

      by linc on Sat Feb 02, 2008 at 02:58:35 PM PST

      [ Parent ]

    •  McCain doesn't understand the problem with (2+ / 0-)

      market-based health insurance any better than Obama.  When employees are grouped together by their employer and then delivered as a group to the insurance company, the insurance company can't cherry pick.  That is, the insurance company can't find a way to insure the low risk people while excluding the high risk people.  However, as soon as the group is unbundled, leaving everyone to seek out insurance on their own, the insurance companies will pick off all of the low risk people and leave the high risk people out in the cold.

    •  Sounds like a real mess that can be gamed (0+ / 0-)

      Heavily by those that would make money from the suffering of others.

      Any time there is talk of tax credits, I'm suspicious, especially if it comes from the Repubs. You can pretty much figure that those that are poor and near poor will be left out in the cold, once as usual. The Repubs hate the less well to do.

      "A common mistake people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools." Douglas Adams

      by splashy on Sun Feb 03, 2008 at 12:22:43 AM PST

      [ Parent ]

  •  But how does HIillary pay for her plan? (2+ / 0-)
    Recommended by:
    Glinda, oscarsmom

    Her website is vague at best.

    And you have some flawed logic, I belove here:

    Simply put, people are much less likely to go to the doctor for preventive care and general check-ups if they have to pay out of pocket for the doctor's visit.

    Do you think people on the government plan are not going to have to pay out of pocket co-pays for doctor visits?

    And the one biggest thing you fail to mention is availability of health care.  How are you going to convince health care professionals to accept patients on the government health plan?  They are already closing their doors to new Medicare/Medicaid patients.  The government just isn't paying enough.

    The point I am trying to make is that everyone assumes universal health care is a given if Obama or Clinton are elected.  Personally, I highly doubt it can be done given the costs and logistical problems.

  •  I know this'll turn into a pie fight (3+ / 0-)
    Recommended by:
    grannyhelen, oscarsmom, kyril

    And I've been pie fighting as much as anyone; I'm not claiming to be free of that.

    But to make this, for this post at least, into a more substantive issue discussion, there really are two issues:

    1. Those made in the diary of broadening the risk pool by making the healthy buy in, but
    1. Ensuring that no one faces severe financial hardship as a result of a mandate.

    What I think is needed is a hybrid plan, in which there is a mandate to buy insurance unless one can show that it would be a legitimately major financial hardship.

    The ultimate goal would be to increase subsidies until no one could make such a hardship claim.

    So on the small differences between plans, they're both right and both wrong.

    Economic -3.50/Social -2.41

    by CenterLeft on Sat Feb 02, 2008 at 02:33:50 PM PST

    •  That, my friend, is the point. (8+ / 0-)

      That IS the plan that then leads to universal healthcare and throws the insurance companies out of the picture.

      Subsidies that make sure that ALL Americans have the ability to have coverage.  In effect, Universal Healthcare but with insurance companies.  Once insurance companies have be backdoored by the American people, the plan will evolve into universal.

      JRE had it down straight.  If we stay strong and INSIST on mandates WITH subsidies in Congress, we have only one more stepping stone to universal health coverage WITHOUT insurance companies calling the shots.

      Another day, another devalued Dollar. -6.00, -6.21

      by funluvn1 on Sat Feb 02, 2008 at 02:43:05 PM PST

      [ Parent ]

      •  if you think the US Treasury (2+ / 0-)
        Recommended by:
        highacidity, kyril

        can afford the built-in inefficiencies of using private insurance companies to deliver health care to insure tens of millions of Americans, I've got some real estate to sell you.

        The savings promised for national health care depend on reducing not only insurance company profits, but on reducing the clerical and administrative cost components of medical care based on one payer with one set of eligibility rules.

        The proposals simply codify the inefficiencies into Federal law. As long as the Treasury lasts.

        Looking for intelligent energy policy alternatives? Try here.

        by alizard on Sat Feb 02, 2008 at 03:04:45 PM PST

        [ Parent ]

      •  Edwards had a lot of things right (0+ / 0-)

        Which was why he was my first choice.

        With him out (actually, I admit I gave up on his chances before he did, but still think he'd be the best president of those who ran this year), I support Obama because he, like Edwards, has a chance to bring about a Democratic realignment and Obama won't put DLC hacks in all the key party positions.

        Economic -3.50/Social -2.41

        by CenterLeft on Sat Feb 02, 2008 at 05:48:04 PM PST

        [ Parent ]

    •  The poor and lower working class (4+ / 0-)

      will be fully subsidized. The upper working class will be partially subsidized.

      I will make them have it. I will stuff their mouths with Gold!--Aneurin Bevan (on the NHS)

      by Salo on Sat Feb 02, 2008 at 02:55:57 PM PST

      [ Parent ]

      •  I have yet to see anything from Sen. Clinton (4+ / 0-)

        promising that the poor and lower working class will not see any up-front costs - i.e. will be able to enroll immediately without paying anything, or paying only a token fee like perhaps $10/month. I discussed this in more depth downthread, but it appears to me from her own words on her own site that Sen. Clinton's subsidy will come in the form of a tax credit, which does not help those of us who are simply unable to squeeze any money out of our monthly budgets.

        During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

        by kyril on Sat Feb 02, 2008 at 03:07:11 PM PST

        [ Parent ]

        •  Tax credit? (3+ / 0-)
          Recommended by:
          highacidity, CenterLeft, kyril

          Oh, boy, that's not good, since it doesn't help people who don't earn enough to pay taxes.  I hadn't realized that before.

          •  do you have children? (1+ / 0-)
            Recommended by:
            splashy

            apart from an Olympian that is? Because you sound detatched from reality.

            The earned income child tax credit is a subsidy.

            I will make them have it. I will stuff their mouths with Gold!--Aneurin Bevan (on the NHS)

            by Salo on Sat Feb 02, 2008 at 03:13:04 PM PST

            [ Parent ]

            •  Someone who doesn't earn enough to pay taxes, who (3+ / 0-)
              Recommended by:
              highacidity, CenterLeft, kyril

              is going to get all of their taxes back as a refund based on their personal exemption and maybe some other credits like the child tax credit will not - I think - be able to benefit from an additional tax credit.  Please tell me if I am wrong!  But my sense is that you  might get a refund up to what was withheld from you, but you aren't going to get any additional credits once you hit that point.  So for really low income people, this credit may do nothing to help them with the cost of insurance.

          •  Yep (1+ / 0-)
            Recommended by:
            highacidity

            From her own site:

               Senator Clinton’s plan will:
                  * Provide Tax Relief to Ensure Affordability: Working families will receive a refundable tax credit to help them afford high-quality health coverage.

                  * Limit Premium Payments to a Percentage of Income: The refundable tax credit will be designed to prevent premiums from exceeding a percentage of family income, while maintaining consumer price consciousness in choosing health plans.

            That's the basis on which I've been arguing against her. It's not the mandate. Edwards had a mandate too, and that was just fine. The problem is in the mechanism for the subsidy.

            During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

            by kyril on Sat Feb 02, 2008 at 03:14:22 PM PST

            [ Parent ]

            •  Refundable tax credit. (1+ / 0-)
              Recommended by:
              tabbycat in tenn

              It can be calculated into withholding as well, you know, so that the benefit comes weekly, not just at the end of the year.

              You kids behave or I'm turning this universe around RIGHT NOW! - god

              by Clem Yeobright on Sat Feb 02, 2008 at 04:13:39 PM PST

              [ Parent ]

              •  Tax witholding (0+ / 0-)

                Most of the people I'm worried about either aren't subject to witholding at all because our income is from nontaxable or non-traditional sources duch as day labor or self-employment, or know that they won't owe taxes and claim enough exemptions that their witholding is at or near 0 already. I'm not talking about the middle class here. I'm talking about the under-$20k crowd. To my knowledge, there's no mechanism for negative witholding, and even if there were I don't see those of us living on the GI bill or student aid or work-study or Americorps stipends or working informally as handymen and constructionworkers and nannies and babysitters getting a weekly check from the government in expectation of our negative tax liability.

                During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

                by kyril on Sat Feb 02, 2008 at 04:20:23 PM PST

                [ Parent ]

                •  GI Bill doesn't pay monthly? When did that change (2+ / 0-)
                  Recommended by:
                  splashy, kyril

                  That's a bummer! I used to get my $130 check promptly on the first of the month.

                  This is not a show-stopper, kyril. The commitment is that you will not have to forego insurance to cover your bills.

                  There are a dozen ways this can be done.

                  You kids behave or I'm turning this universe around RIGHT NOW! - god

                  by Clem Yeobright on Sat Feb 02, 2008 at 04:24:44 PM PST

                  [ Parent ]

                  •  No, it does pay monthly (4+ / 0-)

                    There's just no withholding involved, because it's tax-free (same with my VA work-study). I'd love to see a bonus on my check dedicated to health insurance (better yet, I'd like to see healthcare included so I don't have to worry about it, and I'd like to see the new GI bill get through Congress and be signed into law before I have to transfer to a school that costs more than the current benefits cover, but that's neither here nor there).

                    I know there are ways it can be done. What I'm concerned about is that it doesn't seem that the issue has even been considered, from what I've seen from Sen. Clinton. If she is elected, this will become the issue for me: how does she plan to implement subsidies so that they help the poorest people, and how will that be implemented in a way that helps those of us who have no regular interaction with the tax system?

                    During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

                    by kyril on Sat Feb 02, 2008 at 04:37:27 PM PST

                    [ Parent ]

          •  People really misunderstand this (4+ / 0-)

            I have made too little to pay federal income taxes for most of my adult life, and still qualified for and received the EITC.

            I got back more from doing my taxes than had been taken out of my checks. Routinely. Refundable tax credits can and do take your tax balance under zero; the government cuts you a check in excess of what you paid in.

            That's the difference, so far as I'm aware, between refundable and non-refundable tax credits.

            •  So Hillary's plan makes the poor pay up front, (0+ / 0-)

              and then get paid back the following April? That sounds like bad news to me.

              •  Sen Clinton's commitment is that people will be (1+ / 0-)
                Recommended by:
                splashy

                able to afford health insurance without foregoing necessary expenditures. Kick-starting the program will entail that consideration.

                You imply that Medicaid and SCHIP - the programs that currently provide care to the poor - will be rescinded. That is not true.

                Are you looking for reasons or excuses?

                You kids behave or I'm turning this universe around RIGHT NOW! - god

                by Clem Yeobright on Sat Feb 02, 2008 at 06:29:45 PM PST

                [ Parent ]

          •  It's a refundable tax credit. (0+ / 0-)

            Just uses the IRS to distribute an entitlement.

            Nothing to see here. Move on.

            You kids behave or I'm turning this universe around RIGHT NOW! - god

            by Clem Yeobright on Sat Feb 02, 2008 at 04:10:21 PM PST

            [ Parent ]

        •  she's proposing about (2+ / 0-)

          150 billion to subsidize this.

          I will make them have it. I will stuff their mouths with Gold!--Aneurin Bevan (on the NHS)

          by Salo on Sat Feb 02, 2008 at 03:11:30 PM PST

          [ Parent ]

          •  Indeed (1+ / 0-)
            Recommended by:
            highacidity

            and how will that $150 billion be distributed? Her site says it will be through a tax credit. Unless she's made a statement clarifying that that will not be the only mechanism, I'm operating under the assumption that it will.

            During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

            by kyril on Sat Feb 02, 2008 at 03:16:09 PM PST

            [ Parent ]

            •  Kyril (1+ / 0-)
              Recommended by:
              kyril

              you are all about understanding reality, and I've always been cheering your ability to be introspective.  

              Take the time to read what I've read in this simple space of a diary and see if you don't really want to check this issue out a bit more.  If not, hey, its all good.

              Global warming is real.

              Mandated, with subsidies for those that cannot afford the mandated amount Healthcare is the beginning of Universal Healthcare.  This is where non-political Americans begin to understand that we are getting healthcare for a better PRICE, but we should not be paying for it out of our pockets to begin with.

              Another day, another devalued Dollar. -6.00, -6.21

              by funluvn1 on Sat Feb 02, 2008 at 03:48:40 PM PST

              [ Parent ]

              •  I completely agree with this statement (1+ / 0-)
                Recommended by:
                highacidity

                Mandated, with subsidies for those that cannot afford the mandated amount Healthcare is the beginning of Universal Healthcare.

                The problem I have is that unlike Edwards, Clinton was not bold enough to put subsidies in her plan in such a way that those who cannot afford to pay will actually be able to do so. I'm one of those people you folks are trying to help, and I'm trying to explain to you that the help has to come in a different form than tax credits.

                Mandate it. Make it universal. Please do, I'll be cheering for you! But first convince Sen. Clinton that she needs to adopt the part of Edwards's plan that actually makes it possible for us low-income Americans to walk into an office, sign up for a plan, and still buy groceries next week and pay our rent this month.

                If she can't do that, the mandate is a bad idea. There are millions of law-abiding citizens who will want to buy care but not be able to. Don't turn us into lawbreakers.

                During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

                by kyril on Sat Feb 02, 2008 at 03:55:10 PM PST

                [ Parent ]

  •  It doesn't matter. (4+ / 0-)

    Individuals can't be mandated to do anything.  Mandates apply to public officials.

    SOCIALIZE THE FUNDING--PRIVATIZE THE CARE

    How do you tell a predator from a protector? The predator will eat you sooner rather than later.

    by hannah on Sat Feb 02, 2008 at 02:34:58 PM PST

    •  oh, yeah? (2+ / 0-)
      Recommended by:
      highacidity, kyril

      Tell that to the people of MA.

      That said, I agree with

      SOCIALIZE THE FUNDING--PRIVATIZE THE CARE

      Good luck in selling this to the people who have their hearts set on giving our money out of our own pockets to the health insurance industry.

      Looking for intelligent energy policy alternatives? Try here.

      by alizard on Sat Feb 02, 2008 at 03:48:41 PM PST

      [ Parent ]

  •  Three things that worry me (4+ / 0-)

    about Hillary's plan:

    1. Let's presume the end goal is a single-payer system.  I worry that these mandates, just like in the ad you cite, will create a public backlash against the very idea of government involvement in health care.
    1. The government will also be deciding for people how much it thinks they can afford to pay for their required health insurance.  Again, I fear a backlash.  Plenty of people can't afford much more than they're paying right now.
    1. Hillary's past will come back to haunt her.  She was terribly burned by her last attempt.  First, the very introduction of her plan will cause Republicans to resist her, and try a replay of 1993.  Second, even if she does get something passed, she's already acting so timid about her proposals that we KNOW that's the most she'll do during her tenure.  In the debate she said over and over how "we couldn't do that" and "this isn't politically feasible."  Well maybe that's her perspective and maybe it's true if SHE is the one attempting it.

    In Obama we have the chance to move beyond the politics of the personal and maybe actually get a health care system.  And if he can get reelected with a good mandate, it's very possible he can get us further along the road to a single payer system.

    We agree on the end goal, but not on the best way to manifest it.  

    Never give up! Never surrender!

    by oscarsmom on Sat Feb 02, 2008 at 02:36:27 PM PST

  •  I think this is one of the best debates we are... (7+ / 0-)

    having. By that, I mean we all having a thorough and public discussion of this issue. And the longer it goes on, the more health care reform is no longer "if", but "what kind"?

    I don't argue about the details, because I don't pretend to know enough about all the specifics. The majority of your diary is analysis as well as opinion, which is good to read. A number of analysts have looked at Obama's plan and have given it high marks. I also think that this is going to be an involved process, so I try not to get too fixed on the details--I suspect the final form will be different than either canidates' plans.

    I get bored with the "anger" part, or when people use terms like "betrayal" beause a candidate's plan does not meet their ideological purity test (not directed at your diary).

    I do find this statement a little problematic:

    Health care is a right, not a privilege.  The only way to secure that right is to make it truly universal.

    I know what you are saying and I don't disagree entirely with the principle, but it also sounds like "we will make you do what we think is best for you", and that helped sink the 1993 plan every bit as much as Harry and Louise.

    Deny. Distort. Divert. It's not just for Republicans anymore....

    by Azdak on Sat Feb 02, 2008 at 02:38:00 PM PST

    •  Very wise, Azdak. n/t (2+ / 0-)
      Recommended by:
      highacidity, kyril
    •  Is it that you don't think health care is (0+ / 0-)

      a right?  I'd say that "life, liberty and the pursuit of happiness" have to include health care.  How do you have life without health care?  If you die, there went your so-called life.  How much liberty or ability to pursue happiness do you have if you are medically disabled?  

      (I realize that's the Declaration, not the Constitution, but our country is founded on that ideal.)

      •  Rights, not mandates (0+ / 0-)

        you have the right to vote, is there a punishment for not voting? Rights general grant freedom, not take away freedom.

        Also, Americans have the constitutional right in most circumstances to receive an abortion, under the 14th amendment to the constitution's "due process" clause. How can we say "keep the government off my body" if we mandate that people buy health insurance?

        •  Valid points (2+ / 0-)
          Recommended by:
          splashy, Clem Yeobright

          In Australia, voting IS mandated.  I'm not sure what the punishment is for failure to vote.  (I'm sure you can leave the ballot unmarked if you like, though.)

          How can we say "keep the government off my body" if we mandate that people buy health insurance?

          Two thoughts here.  The first is that just because you have insurance doesn't mean you have to use it.  There are indeed people who don't want to use Western medicine.  They shouldn't be forced into it.

          Second thought.  If you buy it merely not to use it, what's the point?  That's wasteful.  True enough.  This is why I favor single-payer covered by the government.  In the end we will get into trouble with what's covered.  Homeopathy?  Chiropractic?  Etc.  Still, we have models to emulate - Canada, Europe.

          In one way I certainly don't want to be mandated to buy a plan.  I also prefer not to be mandated to wear a seatbelt or to limit my speed on a freeway to 70 mph.  I'd rather there be no mandate telling me that I must pay a goodly portion of my income in taxes, and tax money already goes to a host of private companies such as defense contractors.  We are forced to do that, after all.  If I want to own a home, I'm forced by the government into paying real-estate taxes.

          But a society does some things for the common good, and I accept these things.  Without having everyone in the system together, then it will have trouble staying solvent.  Krugman explains it better than I do.  He convinced me.

          •  Try being mandated to live (0+ / 0-)

            a middle-class life on poverty income.

            Hillary, who is fighting hard to ensure people making $100,000+ a year won't have to pay a 28% Alternative Minimum Tax, would effectively force a regressive tax on the working poor.

            Black is looking beautiful.

  •  MINO. (8+ / 0-)

    Without enforcement, Hillary's plan is a mandate in name only.  I've heard good arguments on both sides of the mandate debate.  I think the important thing is to get an affordable public plan passed and go from there.  The fact that Kennedy supports Obama is an indication that Obama can get it done.  JMHO.

  •  This is very well argued - thanks. I'm strongly (5+ / 0-)

    leaning Obama, but I've only just now got around to reading up on the finer points of mandates vs. no mandates.

    Hmmm - Healthy people buy insurance now, in case something happens, and you can't get insurance once something does happen.

    If healthy people who didn't have insurance suddenly found themselves SOL due to accident or illness, one of two things happen (assuming they aren't bazillionaires)

    -they don't get coverage

    -someone has to cover their costs, and they get passed on to everyone else one way or another

    either way, no good

    I had been thinking of Hillary's mandates in terms of my mistrust of her relationship with insurers. Uninsured Americans? No problem! FORCE them to pick between Aetna, Blue Cross, etc.

    My feeling had been that I am not uninsured because no one is forcing me to buy insurance. That's not my particular problem, and I felt that this was a fundamental misunderstanding of my - and many Americans' - situations.

    I still don't trust Hillary Clinton to so the right thing, but you've convinced me on the mandates. Thanks-

    •  Somehow, I don't see President Obama vetoing.... (3+ / 0-)

      a health care bill with mandates, if one eventually emerges from congress.

      Deny. Distort. Divert. It's not just for Republicans anymore....

      by Azdak on Sat Feb 02, 2008 at 02:44:11 PM PST

      [ Parent ]

      •  That's right, and I keep saying this, that (6+ / 0-)

        in the context of the kind of plans that Clinton and Obama have each put forth, it is the INSURANCE INDUSTRY that most stands to benefit from mandates and will, assuming that they believe they do not have the muscle to defeat reform altogether, ultimately push for mandates.

        I know Obama can't, for political reasons, come out and say this, but it seems breathtakingly obvious that he has figured out that putting mandates on the table upfront is a foolish way to negotiate with vested interests.  You want to concede to mandates only in exchange for MAJOR concessions on premiums and profits from the insurance industry.

        And that, I think is how a bill with mandates might well emerge from Congress, and one which is  stronger than what would emerge if mandates had been offered to the insurance industry from the inception.  

        Make the insurance industry fight for mandates.

        •  Insurance co. don't want to sell to the uninsured (2+ / 0-)
          Recommended by:
          splashy, Clem Yeobright

          The whole problem with cherry-picking is that insurance companies have tricks for identifying the low risk people and providing them with insurance.  The high risk people don't get insured and the insurance companies like it that way just fine.

        •  Obama has more leg. experience than Clinton (0+ / 0-)

          especially on this issue. He knows how to argue the fine points without giving up ground. And frankly, he isn't afraid to let the Industry into the room like Edwards was.

    •  I think that's my problem with her plan. (5+ / 0-)

      I still don't trust Hillary Clinton to so the right thing

      She touts her experience trying to get universal health care in 1993 - after months of closed-door negotiations - as formative and important for this process.  She has promised to have future negotiations for health-care behind closed doors as well, as opposed to Barack Obama, who has promised to make them open and broadcast on C-Span.

      Moreover, Hillary Clinton continues to take donations from federal lobbyists and isn't backing aggressive governmental ethics reforms like Barack Obama - meaning that insurance industry lobbyists will be able to wield influence behind the scenes, not only with Clinton herself but with the Senators and Congresspersons it's going to take to get this passed.  The lack of serious ethics reforms in her plan cast doubt on her ability to bring about any other kind of reform.

      This may seem very process-y and inside baseball, but that's how the system works.  And my greatest fear with Hillary Clinton, that wasn't present with John Edwards because of what he was saying, is that they're going to go behind closed doors, negotiate away all the affordability, keep the mandate, and walk out of the room proclaiming victory.  Meanwhile, we American taxpayers will be stuck with the bill, and forced by law to buy unaffordable health insurance.

      Put quite simply: I don't trust Hillary Clinton to stand up to the health insurance industry.  I don't trust her to pursue my interests, rather than her own political goals, at the negotiating table.  And her having a mandate as part of her plan represents a huge target on the backs of the American people for greedy for-profit health insurance companies; if they can negotiate away non-profit health insurance, they can force us to line their pockets with our money.

      That's what worries me.  With John Edwards, I trusted mandates a lot more because I knew he'd fight the insurance industry.  Given Hillary Clinton's history, and that of her husband's administration, I fear they would capitulate to the industry and screw us even further than we're already screwed.

      •  Valid concerns: (2+ / 0-)
        Recommended by:
        highacidity, kyril

        . . . Hillary Clinton continues to take donations from federal lobbyists and isn't backing aggressive governmental ethics reforms like Barack Obama - meaning that insurance industry lobbyists will be able to wield influence behind the scenes, not only with Clinton herself but with the Senators and Congresspersons it's going to take to get this passed.  The lack of serious ethics reforms in her plan cast doubt on her ability to bring about any other kind of reform.

        I just was watching Michelle Obama speak on C-Span.  She gave a TERRIFIC speech that everyone here should try to catch no matter who you support.  But she emphasized the advantage of not being too much on the inside of things, how life has gotten harder and harder for people outside the upper classes through both Republican AND Democratic administrations.  And that is true.

        Never give up! Never surrender!

        by oscarsmom on Sat Feb 02, 2008 at 03:01:04 PM PST

        [ Parent ]

      •  My feelings exactly on what her "experience" (3+ / 0-)
        Recommended by:
        slinkerwink, highacidity, kyril

        will really mean to us. She's a politically astute wheeler and dealer, and she'll be wheeling and dealing our interests away as she "gets things done" in Washington. Smoke and mirrors, lip service, and givaways to her political contributors is really all I expect from her.

        I'm feeling the mandates. I'm not feeling Clinton. If she's going to force me to pay the $400.00 a month that we went into debt covering for crap insurance that still left us with medical debt (on top of the other debt from not having enough left in our paycheck to make ends meet after health insurance was deducted) at the end of the day - then I hope to God she's not elected.

      •  Yup, behind closed doors they (3+ / 0-)
        Recommended by:
        slinkerwink, highacidity, kyril

        will negotiate away the affordability and keep the mandate.

        I feel that Obama's principle reason for keeping mandates out of his plan at this stage is two-fold:

        1.  easier to sell politicially especially in the GE
        1.  gives leverage to walk away from the table having negotiated concessions on affordability IN EXCHANGE for agreeing to mandates.

        See, I think Obama is thinking far down the road and far past this primary season and the need to throw red meat to Paul Krugman (who, by the way, has said that he thinks Obama's idea of a penalty for free-riders is just as good in his mind as mandates anyway).

    •  I'm not too worried about the "free riders" (3+ / 0-)
      Recommended by:
      highacidity, Blue Letter, kyril

      I think they will be there, but I agree with Obama, that most people given a reasonable choice WILL choose to have health insurance.  Right now it's not much of a choice for people, and the up-front cost is SO high that the risk is well worth it.

      I think it's a good trade-off for letting people feel freer, like they're making their own choices about health care systems.  Then when a gov't system has enough cred, persuade people to give up the private companies altogether (though a few will still exist for people that prefer to buy them).

      Never give up! Never surrender!

      by oscarsmom on Sat Feb 02, 2008 at 02:57:03 PM PST

      [ Parent ]

      •  One problem with the free-rider argument (3+ / 0-)
        Recommended by:
        highacidity, oscarsmom, kyril

        is that no one provides any data to support the size of the problem that they claim will exist.

        •  Pick up a standard textbook in Health Economics (2+ / 0-)
          Recommended by:
          splashy, Clem Yeobright

          and you'll find plenty of data on the size of the free rider problem and the extent of cherry picking.  All those people who show up at candidate Q&As and relay their health insurance horror stories are the victims of cherry-picking.

          •  I have never seen reliable data on the extent of (1+ / 0-)
            Recommended by:
            Blue Letter

            the free rider problem in a system with sizable subsidies, premium reductions, availability of a federal program, and extension of insurance under family plans to age 25.

            I think anyone who pretends to know the extent of free riders under that scenario is guessing.  Even Jonathan Cohn - the source of the vaunted 15 million - was totally upfront that it was a guess.

            I don't have a major issue with Obama saying, "hey, let's hold off and see what the data tells us after we take these other steps first."  The best argument against that approach is that if you could get the healthy people in right away, it'd be easier to lower premiums.

            But then there are the political issues with going with mandates up front.

            And also the fact that individual mandates are a handy negotiating tool to have with the insurance industry, which would salivate to have them under the proposed reforms.

            It is far from clear which is the better approach.

            Even Krugman has acknowledged that a ex post penalty for free riders may be just as good as mandates up front.   And I'll add that it is a much easier sell politically.

          •  here (0+ / 0-)

            National Uncompensated Care Based on Cost*: 1980-2004 (in Billions),
            Registered Community Hospitals
            Uncompensated % of Total
            Year Hospitals Care Cost Expenses

            1980 5828 $3.9 5.1%
            1981 5812 $4.7 5.2%
            1982 5796 $5.3 5.1%
            1983 5782 $6.1 5.3%
            1984 5757 $7.4 6.0%
            1985 5729 $7.6 5.8%
            1986 5676 $8.9 6.4%
            1987 5597 $9.5 6.2%
            1988 5499 $10.4 6.2%
            1989 5448 $11.1 6.0%
            1990 5370 $12.1 6.0%
            1991 5329 $13.4 6.0%
            1992 5287 $14.7 5.9%
            1993 5252 $16.0 6.0%
            1994 5206 $16.8 6.1%
            1995 5166 $17.5 6.1%
            1996 5134 $18.0 6.1%
            1997 5057 $18.5 6.0%
            1998 5015 $19.0 6.0%
            1999 4956 $20.7 6.2%
            2000 4915 $21.6 6.0%
            2001 4908 $21.5 5.6%
            2002 4927 $22.3 5.4%
            2003 4895 $24.9 5.5%
            2004 4919 $26.9 5.6%

            Data from the American Hospital Association:
            http://www.hospitalconnect.com/...

            Uncompensated care also occurs when health plans deny payment for ED services or when patients do not pay assessed cost sharing fees.

            Average emergency physician uncompensated care charges were $71.04 per visit.

            ‘‘Net charges’’ was defined as total gross charges less contractual allowances. Uncompensated care was defined as net charges less collections.

            http://www.fcep.org/...

            Oregon uncompensated care:

            Uncompensated care is the total amount of health care services, based on full established charges, provided to patients who are either unable or unwilling to pay. Uncompensated care includes both charity care and bad debt, both described in more detail below.

            This a chart showing the rate starting at 5% in 1994 and declining to 3% in the late Clinton presidency and then rising to 6% during the Bush presidency.

            It has now moved recently to around 7%.

            http://www.oahhs.org/...

            The amount "based on full established charges" means about 2 to 3% of actual business turnover.

            The hospitals also lose billions in business because uninsured people with homes are afraid of getting whacked by list price charges. I've had about ten problems that would have sent insured people to the ER. I've also had insurance and avoided ERs. I just don't trust hospitals because they don't post prices.

            We measure uncompensated care as the net amount that physicians lose by lower payments from the uninsured than from the insured. Our best estimate is that physicians provide negative uncompensated care to the uninsured, earning more on uninsured patients than on insured patients with comparable treatments. Even our most conservative estimates suggest that uncompensated care amounts to only 0.8% of revenues, or at most $3.2 billion nationally.

            http://papers.ssrn.com/...

  •  Now that we are down to these two (4+ / 0-)

    Universal Health care is dead.

    I cannot afford health insurance even if it is mandated.

    So I am dead too.

    Enjoy your wrangling but they both suck on this subject.

    The biggest threat to America is not communism, it's moving America toward a fascist theocracy... -- Frank Zappa

    by NCrefugee on Sat Feb 02, 2008 at 02:39:25 PM PST

  •  I agree that the Edwards plan was best of the 3 (4+ / 0-)
    Recommended by:
    slinkerwink, oscarsmom, kyril, Valhalla

    and that HRC's plan is the closest to Edwards of the remaining 2, AND (especially) that single payer is the only way to real universal healthcare.

    All that said, Obama made a valid and, I think, winning point in the CA debate that some form of universal healthcare would be passed in an Obama administration while its less than certain a Clinton presidency is going to be able to get anything through.  It just doesn't matter how good your plan is if half the Senate is going to stonewall.  

    That's why part of the Clinton message has been that voters must pack the Congress with Democrats; it's the only way she can get anything done.  And, while its a nice talking point, it is unlikely to happen with Clinton heading the ticket.  Obama, basically, is telling voters that he can get things done, even if the Senate (for example) remains evenly split.  And, honestly, I believe he can.

    I'm sure the our side will make gains in Congress this year, but, thanks to the performance of the Harry & Nancy show to date, I'd wager those gains will be modest.  And certainly nothing approaching the majorities a Hillary Clinton presidency would require to overcome the partisan acrimony that currently exists (thanks, in no small part, to a succession of highly divisive Bush and Clinton administrations).

    •  Obama won't (2+ / 0-)
      Recommended by:
      hopefulcanadian, funluvn1

      be able to get anything done. THE Insurance industry won't even talk to him. He offers them no way to get out of the business.

      I will make them have it. I will stuff their mouths with Gold!--Aneurin Bevan (on the NHS)

      by Salo on Sat Feb 02, 2008 at 02:52:28 PM PST

      [ Parent ]

      •  That's the beauty of open-door negotiations. (4+ / 0-)
        Recommended by:
        highacidity, oscarsmom, kyril, costello7

        He doesn't have to talk to the insurance industry.  They're offered a seat at the table, but if they don't come, the negotiations go on without them - and the American people get to see who's carrying their water in the negotiating room.  Coupled with Obama's groundbreaking government transparency reforms, where we'll see exactly who's getting exactly how much money and giving exactly how much money, the people will be able to see exactly which legislators have been bought and paid for by the insurance industry.

        Health care reform can go into effect with or without the insurance industry's permission; they're the legislated, not the legislators.  We don't have to negotiate with them, merely with those who write the laws.

        •  They won't turn up. (0+ / 0-)

          Obama offers them no quid pro quo.

          I will make them have it. I will stuff their mouths with Gold!--Aneurin Bevan (on the NHS)

          by Salo on Sat Feb 02, 2008 at 03:04:59 PM PST

          [ Parent ]

          •  Who cares? Then they get no say... (5+ / 0-)

            ...in the legislation.

            They are the legislated; Congress are the legislators.  The for-profit health insurance industry gets a seat at the table, but they are no more necessary for legislation to happen than you or I are.  The only people who need to be present for legislation to happen are legislators and the President.

            The insurance industry will come to the table, or legislation will go on without them.  They get a voice, or they don't.  We don't need "incentive" to entice them to the table; if they don't show up, they get no say at all, and the people get to see who's carrying their water.

          •  And that's a bad thing?? n/t (3+ / 0-)
            Recommended by:
            highacidity, kyril, costello7

            Never give up! Never surrender!

            by oscarsmom on Sat Feb 02, 2008 at 03:13:05 PM PST

            [ Parent ]

          •  Thanks for letting us know (1+ / 0-)
            Recommended by:
            Blue Letter

            Obama offers them no quid pro quo.

            what the "mandate" actually is. A quid pro quo. Much less to do with the public's health than a way to get the classic backdoor negotiations flowing so Hillary can claim she has delivered universal healthcare to her definition of the term, even if it isn't affordable.

            It's also interesting that you use the British NHS as an example in your signature, which is in recent decades the most dysfunctional healthcare system in Europe. But I guess that's what you get when you start talking about what health care services people are obligated to receive, rather than what health people must have as a basic human right regardless of how it is delivered.

            "People are people, and lobbyists are people. But lobbyist people are more people than people people." -- beltane on Hillary. Don't tase me Kos!!

            by cville townie on Sat Feb 02, 2008 at 04:18:20 PM PST

            [ Parent ]

        •  I'm envisioning something akin to (1+ / 0-)
          Recommended by:
          kyril

          the budget negotiation scene in the movie "Dave."

          Please let it be like that.

        •  Knowing a little how ins co's work... (0+ / 0-)

          ...they'll use it as an oppty for a big PR blitz, imo.

          "The revolution's just an ethical haircut away..." Billy Bragg

          by grannyhelen on Sat Feb 02, 2008 at 05:30:16 PM PST

          [ Parent ]

      •  So I'm confused-- (4+ / 0-)
        Recommended by:
        highacidity, Blue Letter, kyril, costello7

        Are we mad at Obama because he will give insurance companies a seat at the table, or because they won't talk to him?

        Never give up! Never surrender!

        by oscarsmom on Sat Feb 02, 2008 at 03:03:52 PM PST

        [ Parent ]

      •  Well, I read elsewhere (4+ / 0-)
        Recommended by:
        highacidity, oscarsmom, Blue Letter, kyril

        that Obama poops gold, so maybe he can buy them out.

        Seriously, I don't agree with you.  

        What Obama has said is that he will help to bring the people together to demand it.  If the people join together and demand universal healthcare, it will become a reality.  The cynical view, of course, is that that can't be done.  And yet, as we speak, we are watching it being done in the nomination process.

        Otherwise, neither plan matters.  No one individual is going to break through the special interests and partisan bickering that is our government.  

        Look.  I'm old and I can be pretty cynical.  But I do marvel at the paradox of a bunch of folks who talk about "crashing the gates" when, on a very fundamental level, they don't seem to believe it can really be done.

        Well, I wanted a fighter (Edwards), but given that that choice has been taken from me, count me as one cynical old fart who believes that Obama CAN mobilize and unite the American people to demand universal healthcare.  Clinton can't.  Both plans are flawed, but only one is possible.  That's how I see it.  

        Besides, aren't you looking forward to watching the healthcare negotiations on C-SPAN?  

  •  I can't support mandates (4+ / 0-)
    Recommended by:
    sviscusi, oscarsmom, kyril, eltee

    On principle. People should have a right to choose what to do with their bodies and, for the most part, with their money (I do believe in taxes).

    Notice that only liability car insurance is required, so that if you fuck up someone else's car they aren't SOL. You are not legally required to buy insurance to protect your own car, and that's how it should be.

    I know some people for whom, because of pre-existing conditions, purchasing health insurance would be more expensive than not and saving the money and paying for their own medical care. I believe that they should have the right to do so, if it works best for their family.

    Undecided in Illinois. Help?

    by sunflwrmoonbeam on Sat Feb 02, 2008 at 02:41:11 PM PST

    •  Moreover... (6+ / 0-)

      ...if I don't want to buy car insurance, I have that freedom: I can choose not to own a car.

      If I don't want to pay for health insurance under Hillary Clinton's plan, my only option is to become noncorporeal.

      •  you can't chose (7+ / 0-)

        not to get sick, not to need an ER visit, its apples and oranges.
        You will use the healthcare system no matter what, you should be expected to pay what you can afford into a system that will lower costs for all.
        That's the way a government that truly represents the nation's greater good works.
        That's why countries in Europe and in Canada have lower infant mortality rates, and better quality healthcare, its also why they can spend more of their country's tax dollars towards prevention.
        Everyone has to pay their fair share.

        "Be the change that you want to see in the world."- Gandhi

        by hopefulcanadian on Sat Feb 02, 2008 at 03:02:16 PM PST

        [ Parent ]

        •  But paying for a non-profit system (4+ / 0-)

          Feels a whole heck of a lot better than continuing to subsidize the existence of health insurance companies.

          Never give up! Never surrender!

          by oscarsmom on Sat Feb 02, 2008 at 03:06:02 PM PST

          [ Parent ]

          •  Indeed (4+ / 0-)
            Recommended by:
            highacidity, sviscusi, oscarsmom, kyril

            I don't mind paying more taxes for a non-profit and highly regulated medical industry (no pre-existing conditions, no stupid non-approval) but I do have a serious problem being forced to make these people richer.

            Undecided in Illinois. Help?

            by sunflwrmoonbeam on Sat Feb 02, 2008 at 03:13:43 PM PST

            [ Parent ]

          •  I understand (4+ / 0-)

            but till your country is ready to go there, this is a good first step.  We pay through insurance that we purchase through employee health insurance too- to cover many things the government won't cover- dental, physio, psychotherapy etc....

            Her plan is still better than Obama's, and I think once she's elected, she can make real strides towards a truly universal healthcare (govt' funded, and govt. run) but at least she's got the right intentions and direction.

            "Be the change that you want to see in the world."- Gandhi

            by hopefulcanadian on Sat Feb 02, 2008 at 03:18:12 PM PST

            [ Parent ]

            •  My worry is that Hillary's plan (2+ / 0-)
              Recommended by:
              highacidity, kyril

              will actually make it harder for our country "to go there."  I desperately want a system like Canada has, but the hurdles are real and reaction against government involvement is a tried-and-true American value.  

              I like Obama's plan because it installs the necessary first step by creating a gov't program, but entices people to choose it rather than forcing them to accept it.

              Never give up! Never surrender!

              by oscarsmom on Sat Feb 02, 2008 at 03:50:09 PM PST

              [ Parent ]

              •  sometimes in order for (4+ / 0-)

                hopes and ideals to become reality, things must be mandated, ideals such as equality needed affirmative action, sometimes we can't just hope and wait and see if people do the right thing... Canadians don't have a choice about the system, but we love it, infact, the fact that we all HAVE to pay taxes towards universal healthcare, and the fact that we haven't ALLOWED the CHOICE of privatization, is why we love it.

                "Be the change that you want to see in the world."- Gandhi

                by hopefulcanadian on Sat Feb 02, 2008 at 04:09:44 PM PST

                [ Parent ]

                •  But Obama isn't "hoping and waiting" (0+ / 0-)

                  And neither is Hillary speeding down the track towards single-payer, in fact, as I've argued elsewhere, she's less likely to push us harder in that direction than others.  You're presenting a false scenario here.

                  Never give up! Never surrender!

                  by oscarsmom on Sat Feb 02, 2008 at 04:44:43 PM PST

                  [ Parent ]

                •  Name one government mandate (0+ / 0-)

                  that only effected an individual citizen, that was successful.

                  For instance, affirmative action mandated that an employer do something for other people, not just themselves.

                  Same with liability car insurance, public education, property taxes, etc.

                  The only parallels are things like seatbelt laws which I think are really frigging stupid.

                  In short, if I don't want to pay the insurance companies money, I shouldn't have to. I don't like the idea of being forced to pay a private company thousands of dollars when it doesn't effect another person; it's a very dangerous precedent that we really shouldn't have.

                  And any argument for mandates because of the rising premiums for other people are the exact same arguments against welfare (WIC/foodstamps, Medicare, Medicaid, etc.) in general, and I don't see people doing that here.

                  Undecided in Illinois. Help?

                  by sunflwrmoonbeam on Sat Feb 02, 2008 at 05:24:22 PM PST

                  [ Parent ]

            •  Precisely (2+ / 0-)
              Recommended by:
              splashy, Clem Yeobright

              The US isn't going to put a Canadian system in place - sadly - yet.  But let's get ourselves on the way as soon as possible.

        •  Fair enough... (3+ / 0-)
          Recommended by:
          highacidity, oscarsmom, kyril

          ...but given Hillary Clinton's past, not only as a legislator and presidential candidate herself but in the Clinton White House, I quite simply don't trust her not to triangulate her way out of a system that will "lower costs for all" but keep the mandate part in.

          John Edwards I trusted a bit more with mandates; I knew he wouldn't do anything to screw normal people by sticking them with a bill they couldn't afford.  But Hillary Clinton's past and present show far too much willingness to capitulate to corporate interests, far too much willingness to take the money of federal lobbyists, far too little willingness to support serious and sweeping ethics and transparency reforms, for me to trust her with a mandate.

          •  what part of her past (3+ / 0-)

            is untrustworthy when it comes to healthcare???  The part where she tried to get government funded universal healthcare all those years ago?? She's got the best of intentions, this time she's just modified them so that they have the best chance of passing....  the fact is, at least she's trying, unlike Obama, who's not even expressed the INTENTION that Clinton and Edwards did..

            "Be the change that you want to see in the world."- Gandhi

            by hopefulcanadian on Sat Feb 02, 2008 at 03:15:58 PM PST

            [ Parent ]

            •  What's untrustworthy? (2+ / 0-)
              Recommended by:
              highacidity, kyril

              It's the whole idea of closed-door negotiations.  It's the whole pattern of the Clinton White House, seen time and time again in things like the Telecom Act of 1996 and welfare "reform".  It's a willingness to say all those nice progressive things and then go behind closed doors and capitulate to the Republicans.

              It's also her unwillingness to get behind serious lobbying reform, her unwillingness to get behind serious ethics reform, her unwillingness to get behind serious government transparency efforts.

              She'll get behind closed doors and the negotiations will begin - and we the people will be shut out yet again.  Then she'll do the Clinton thing and compromise with plutocrats and corporatists, drop the affordability, keep the mandate, and declare victory for "universal" health care - at which point we the people will be stuck with a bill we can't afford and a government requirement that we pay it.

              •  but this is all just (2+ / 0-)
                Recommended by:
                grannyhelen, Clem Yeobright

                wild speculation on your part.  I still don't think that there is any reason to believe she would abandon her goal of affordable, universal healthcare, she's been working towards it her whole life, if she was such a corporatist or plutocrat, why would she even have bothered all those years ago?  

                "Be the change that you want to see in the world."- Gandhi

                by hopefulcanadian on Sat Feb 02, 2008 at 03:33:49 PM PST

                [ Parent ]

                •  It isn't wild speculation... (2+ / 0-)
                  Recommended by:
                  highacidity, kyril

                  ...it's based on the pattern of behavior of the Clinton administration of the '90s and Hillary Clinton's own unwillingness to adopt the kind of serious government reforms we need to curtail corporate power at the federal level.

                  Let's also not forget Congress's role in this; she's going to need 60 votes in the Senate to get anything passed.  Even if she's serious about reform (which, given her history, I strongly doubt), she's going to have to get 60 Senators - including some red-state Democrats and at least a few Republicans - behind her on this.  With closed-door negotiations and no serious ethics or lobbying reform, every single one of those Senators, and any Congressperson on the project, can be bought, threatened, or cajoled by the insurance industry.  

                  In other words, she may not have a choice to compromise - and it's clear to me that one of the first things to go would be the government non-profit program, which many Republicans and some Democrats would see as too competitive with private industry.  With that out of the way, what for-profit insurance company wouldn't want a government requirement that every man, woman, and child in the country give them money?

                  That's the risk of a mandate, and especially with Hillary Clinton and a mandate.  If she gives one inch on affordability, we're all screwed.  With John Edwards, I had no doubt that he'd bring to the light the people who were gumming up the system and curtail the massive influence of lobbyists and corporations on Capitol Hill; with Hillary Clinton, I have very little faith that she'd do anything differently than her husband did when he was president.

                  •  Again, you're speculating (2+ / 0-)
                    Recommended by:
                    splashy, Clem Yeobright

                    wildly.  Obama has made self-described "boneheaded mistakes."  And boy were they boneheaded.  So why do you think Hillary can't learn from a mistake?

                    •  Because she clearly hasn't yet. (0+ / 0-)

                      What killed progressive reform in her husband's administration (aside from the problems resulting from his sexual indiscretions)?  Their willingness to kowtow to Republicans and corporate interests rather than hold the progressive line.  Their unwillingness to push for real campaign finance reforms, real ethics reforms, real lobbying reforms, real transparency.  Their preference for going behind closed doors and negotiating away progressive change, rather than exposing Republican hypocrisy and both parties' (and their own administration's) corporate indebtedness to the light.

                      She hasn't learned from those mistakes, and that's obvious, because she wants to repeat them.  She wants to go back to negotiating behind closed doors - if she didn't, she would have agreed with Barack that the negotiations should be open to the public.  She doesn't want to curtail lobbyist influence - if she did, she wouldn't be accepting so much money from them.  She doesn't want real transparency and ethics reforms - if she did, she'd be supporting them.

                      Those things are what is going to kill the affordability of her health care program.  The Clinton track record, and Hillary Clinton's unwillingness to make the kind of systemic changes to the way we do government that would be necessary to mitigate that track record, are evidence of this.  And if she gives in on affordability, and keeps the mandate, we're all screwed.

            •  Don't fool yourself. Her plan has ZERO (0+ / 0-)

              chance. Most Americans oppose mandates. It's socialism. Nothing less. And I don't use that word often.

        •  Paying for random ER visits and (0+ / 0-)

          paying for insurance are apples and oranges.

          And you don't have  the damn right to tell me which one I want. If I don't want to pay for insurance that's my business not yours of Hillary Clinton's.

          •  Okay (1+ / 0-)
            Recommended by:
            Clem Yeobright

            Just don't try to get the taxpayers to pay for your ER visit when you see how much it costs.

            •  Do you have a problem with WIC? (2+ / 0-)
              Recommended by:
              splashy, Clem Yeobright

              Or public education? Or roads?

              Why are you (and the many commenters on this thread) so offended about paying for others' medical care when they can't afford it, but not these other things?

              Undecided in Illinois. Help?

              by sunflwrmoonbeam on Sat Feb 02, 2008 at 05:25:56 PM PST

              [ Parent ]

              •  Well, I use public education. I use roads. (1+ / 0-)
                Recommended by:
                SingleVoter

                Beyond that, I pay big-time real-estate taxes even though I have no children, but I don't begrudge it.  I believe in public education and am happy to support its continuation.

                I am not at all against helping pay for medical care - IT'S JUST THAT I WANT UNIVERSAL HEALTH CARE AND I AM WILLING TO PAY FOR IT THROUGH TAXES.

                What I do NOT want is a continuation of our massively wasteful system.  A system that doesn't cover everyone winds up with people going into the ER when they could have been taken care of in a less expensive setting.

                I was responding to elender who wants to not have to pay for the system until he/she needs it, and then reap the benefits of the system that I have paid into for decades.

                •  Mandatory purchase from a private company (0+ / 0-)

                  is wrong. Deeply wrong.

                  Until the government runs the health system, it would be unamerican to force people to purchase health insurance.

                  We don't force people to buy anything else with one notable exception. We shouldn't start now.

                  Undecided in Illinois. Help?

                  by sunflwrmoonbeam on Sat Feb 02, 2008 at 05:48:16 PM PST

                  [ Parent ]

                  •  What exception? Car insurance? (0+ / 0-)

                    That's a little different.  I did read your comment about that.  Yes, you have to buy ONLY liability insurance, meaning that your insurance will cover the damage if you fuck up someone else's car or their physical person or their passengers.

                    The thing is, if you fuck up your own car, you can live without the car.  You cannot live without your body being in working condition.  And that means that, because you were being irresponsible and driving without medical insurance (or a health-care plan), now the taxpayers will foot your bill at the highest possible rate.

                    If mandates go hand-in-hand with fixing the overall system, and if subsidies and rebates are available for those who need it, then I support that as a way to start heading towards a European system for health-care delivery.

                    •  I don't see how mandates go hand in hand (0+ / 0-)

                      I'd like to see something about the development of Europe's (or Canada's, or Australia's) healthcare system, if they started with mandates.

                      The simple fact is that the problem is the insurance companies, not the poor people.

                      If doctors and hospitals didn't have to spend so much time and money fighting insurance companies to pay, costs would go down across the board. In fact, I suspect that it is more expensive to fund entire departments designed to get money from negligent insurance companies than it is to pay for a few peoples' emergency care. One problem is malicious, one isn't.

                      Why fight against the poor people?

                      Undecided in Illinois. Help?

                      by sunflwrmoonbeam on Sat Feb 02, 2008 at 07:42:19 PM PST

                      [ Parent ]

                      •  I have no desire to fight against (0+ / 0-)

                        poor people.  They will get far better subsidies than I will for the health insurance.  Okay by me.

                        The waste in the system is horrible right now.  The insurance companies are a huge part of it, and I'll be thrilled the day they are out of business.

                        Mandates go hand-in-hand for now.  Because if everyone isn't in the system, then the system can't remain solvent.  I've loaned my Conscience of Liberal book to someone, so I can't quote from Krugman's chapter on how the European systems work, but it was a very interesting chapter.  Basically, Krugman convinced me.

                        Eventually, instead of a mandate to purchase, we'll simply have a single-payer plan and everyone will be covered without paying premiums.  Or at least that is most certainly my fervent desire and hope.

                  •  It's not that I don't see your point (0+ / 0-)

                    I agree that it's not good to be forced to buy from private companies, but again, regulation can make the difference.  The government regulates the auto insurance industry.  It also regulates the health insurance industry but not nearly enough.  The new health plan would have to impose new rules on the insurance industry and would have to regulate it firmly.  

                    I'd rather have single-payer right effing now.  But realistically that can't happen.  So I want something else now, leading to single-payer.  The overall consensus is that Clinton's and Edwards' plans (nearly identical) have the best chance of that.  I'm paying for my plan out of my own pocket now, and I'd sure like to have a better set of options than what is currently on offer.

            •  But of course he will. (2+ / 0-)
              Recommended by:
              splashy, Montague

              As someone else has pointed out above, elender could have an incident the cost of which by the time he recovers consciousness could be one or three or five years of his income.

              What will he say then? "Oops"?

              You kids behave or I'm turning this universe around RIGHT NOW! - god

              by Clem Yeobright on Sat Feb 02, 2008 at 05:45:56 PM PST

              [ Parent ]

    •  Your position only makes sense (8+ / 0-)

      if everyone who opts out of the health insurance program is able to pay for medical care out of his/her own pocket when (as will inevitably happen) it becomes needed. Otherwise, you're simply asking everybody else, who is already paying for his/her own health insurance, to pay for the care needed by those people who opted out of the program on top of their own costs. Well, that, or you're going to say that if they get sick and don't have health insurance, they're just screwed.

      •  Education (0+ / 0-)

        Then I assume you think that parents who send their kids to private school shouldn't fund their local public school, right?

        Undecided in Illinois. Help?

        by sunflwrmoonbeam on Sat Feb 02, 2008 at 05:26:38 PM PST

        [ Parent ]

        •  Want to try that one again, in English this time? (2+ / 0-)
          Recommended by:
          splashy, Clem Yeobright

          What does school funding have to do with the question of health care? Not to mention the fact that, at least where schools are paid for out of some kind of local taxation, everyone pays for them. Nobody has to step in to subsidize them. Parents who want something else are perfectly free to pay for that if they want--but they don't get to forego their tax payments, either.

          You're the one with the philosophical objection to mandates. It should be you arguing that parents who send their kids to private school shouldn't also have to pay their local education taxes.

    •  asdf (8+ / 0-)

      You are not legally required to buy insurance to protect your own car, and that's how it should be.

      But the hospital is legally required to treat you when you do fuck up your own body. Which is expensive, and if you're uninsured and can't pay your $25,000, that cost winds up being passed through the system to those who were trying to keep themselves protected.

      That is one of the very reasons that costs are so high. It's not just about you and your health, unless you're proposing that we switch to a system in which the hospital can outright refuse treatment because you're uninsured, which I think (hope) is an unacceptable idea to us all.

      •  Hospitals are only required to do emergency care (2+ / 0-)
        Recommended by:
        Kentucky DeanDemocrat, kyril

        So say you get into a car accident and break several bones and have internal bleeding, they only have to patch you up. they don't have to worry about overall health, physical therapy, etc. etc. etc.

        And last I checked the biggest expense in healthcare was the overhead for the insurance companies, not actually care for the uninsured. So, let's just eliminate the insurance companies :)

        Undecided in Illinois. Help?

        by sunflwrmoonbeam on Sat Feb 02, 2008 at 03:15:43 PM PST

        [ Parent ]

        •  I'd prefer that as well (6+ / 0-)

          You're correct that they don't have to care for you longer than to put you back together. But those bills can be outrageous. I saw some of them firsthand when a friend got into a motorcycle accident from which the "patching up" resulted in tens of thousands of dollars in bills, and still left her without even crutches, believe it or not. Those bills were never paid, because she couldn't pay them -- so her body was fucked up and never treated in a longer term sense (leading to many, many complications), her credit was absolutely ruined and her financial life generally even worse off than it had been, and the hospital essentially ate the cost anyway.

          There are a lot of problems in our system, but the way the uninsured filter through is a major problem. We all pay for everybody right now, except that we pay for them to get substandard band-aid care that usually costs more in the long run.

          A single payer system is what we need. I don't see us getting it at this time, and in the meantime I can't in good conscience accept the status quo. One of the things I look at in these plans is which better positions us for a transition to single payer down the road.

          •  Single payer is definitely the best (0+ / 0-)

            But I can't buy that mandates are the way to go. If you overhaul the insurance industry and put it under government regulation, with such things as making the insurance pay for what the doctor orders, as well as getting rid of the "pre-existing conditions" bullshit, and then make it affordable for everyone, people will buy it.

            I don't know a single person who had access to health insurance at a decent rate (read: not a third of their paycheck for shitty care) that didn't buy it. The only time I've been without it was when it was a third of my already small paycheck and I couldn't afford it.

            Frankly, I need to see reputable statistics that there are a large number of people that are simply choosing not to get health insurance when they have the resources to do so before I begin to consider mandates necessary.

            The problem isn't htat people don't want health insurance, it's that they can't get it or it's not affordable.

            Undecided in Illinois. Help?

            by sunflwrmoonbeam on Sat Feb 02, 2008 at 05:19:02 PM PST

            [ Parent ]

    •  You must be for SS privatization as well. (1+ / 0-)
      Recommended by:
      splashy
    •  Yes this is what many left wing Dems (3+ / 0-)

      don't understand.

      Obama didn't contradict himself, as this diarist claims.

      "If he thinks every American will voluntarily sign up, why would he raise so much vitriol about mandates?"

      He didn't say that every American will sign up.
      He said that those who want health insurance and can't afford it today will sign up once it will become affordable.

      And those who don't want health insurance obviously won't sing up. But that's their decision. This is a free country.

      The diarist doesn't seem to understand how most Americans want to make their own decisions and don't want the government to tell them what to do no matter what.

      A plan that violates this core American principle has no chance of becoming law because most Americans will oppose it.

    •  How about motorcycle helmets? (1+ / 0-)
      Recommended by:
      splashy

      I used to be against them.  I figured, if an idiot wants to bang up his brain in an accident, what do I care?  Then I found out what happens - the hardest thing to fix is a brain.  Broken bones?  Not so hard.  The motorcyclists would rack up incredibly expensive medical bills to treat their brain damage, and the public would wind up paying for it.

      This is why I don't have a problem with pushing people to pay for health care.  Because otherwise they will wind up in the ER and I'll be paying for them.

      As for pay-as-you-go medical care, that might have worked at one time, but skyrocketing costs of medical treatment have made that untenable for all but the richest people.

  •  The one question Hillary Clinton hasn't answered. (7+ / 0-)

    ...is this:

    Can she guarantee that no mandate will be put in place unless 100% of American adults - every single solitary individual man and woman in this country - have access to affordable health insurance?

    Is there even an iota of a chance that a mandate will go into place before, or without, access to affordable health insurance for every last human being in this country?

    If she can't make that guarantee, I can't support mandates... given the Clintons' history in the White House of capitulating to corporate interests and right-wingers behind closed doors, and given the influence of lobbyists on her campaign and her unwillingness to back the kind of major ethics reforms in Barack Obama's plan for government, I have absolutely no faith that the Clinton plan won't drop the affordability and keep the mandate.

    •  Exactly! (4+ / 0-)
      Recommended by:
      highacidity, bwintx, oscarsmom, kyril

      What about the people who now have to pay $10k/year to get decent health insurance for their families? Will they now be mandated to buy that insurance under Hillary Clinton's plan, or potentially an even more expensive plan? How much insurance is enough, and how can she justify making people who can't afford it anyway, who need their last dollars and cents to pay their mortgage and bills, buy expensive health insurance?

      She hasn't said a word in the debates about controlling costs like Obama has; I'm sure the insurance will get cheaper with a broader risk pool, but it might not be enough.

      "People are people, and lobbyists are people. But lobbyist people are more people than people people." -- beltane on Hillary. Don't tase me Kos!!

      by cville townie on Sat Feb 02, 2008 at 02:51:31 PM PST

      [ Parent ]

  •  I don't support mandates (6+ / 0-)

    It hasn't worked in Massachussetts.

    What's madness but nobility of the soul at odds with circumstance?

    by slinkerwink on Sat Feb 02, 2008 at 02:43:18 PM PST

    •  Why are we on the left settling for mandates? (6+ / 0-)

      I've heard over and over again that the only way to guarantee universality is to have mandates in a plan  - but that's not exactly true. The only way to guarantee true universal coverage is to enact a single payer health care system that is funded by taxes and which covers all Americans.

      From a left-wing perspective, it seems ridiculous that I have to pay private insurers or face a government-imposed fine. They're fining people in MA, and they're paying the fine because they would rather pay up than get the costly insurance.

      If we accept that these health care plans are just stepping stones towards single payer health care, then a plan with mandates is not the best way to get there - we should emphasize government subsidised health insurance that can later be refocused towards a single payer system.

  •  I have paid for health insurance for 30 years (15+ / 0-)

    and never submitted a claim. Same for car insurance, as a matter of fact.

    Do I feel abused? Hell, no! I feel damned lucky!

    I've always known I was pooling with a lot of people who were 'spending my money', and I have accepted that as a price of living in a great - if often misguided - country. I also believe strongly that one can't peel apart the economy like a bloomin onion; it's much more potato than onion, don't you agree? Why do people get paid more in Silicon Valley for doing the same work I do in Tennessee? Cut the cost of living in California and New York and watch the salaries drop!

    Good diary. Damned good diary!

    You kids behave or I'm turning this universe around RIGHT NOW! - god

    by Clem Yeobright on Sat Feb 02, 2008 at 02:46:29 PM PST

  •  To me the biggest difference between the two (5+ / 0-)

    is initial (or rhetorical) focus:

    Hillary's focus is on the "universal" part and making sure that even the "15 million" people who don't want health care get it.

    Obama's initial focus is on making health care affordable for those who want it but can't afford it.  

    Because, if you look at it honestly, those "15 million" that wouldn't buy affordable health coverage under Obama's plan would buy in under Hillary's plan either.   So then you get to the problem of enforcement, which Hillary won't talk about anyway.  

  •  Reality (4+ / 0-)

    While it's understandable that people feel strongly about policy differences between the candidates, I think what's really important are a few things:

    Consistency over time

    Judgment

    Ability to conduct bi-partisan negotiations to get things accomplished.

    By the time most legislation gets through congress, it's not going to be identical to the president's exact policy proposal.

  •  I aggree with diarist completely.... (2+ / 0-)
    Recommended by:
    slinkerwink, Partially Impartial

    Obama's proposal is fatally flawed.

    But for balance go up a few diariesand read about Hillary's proposal to freeze the interest rates of sub prime Variable mortgages.

    She must know that this is clearly unconstitutional, yet she puts it out as a solution.

    This is equal to Obamas non universal universal insurance described here.

    Which is worse?  Take your choice.  

  •  Here's my problem with Clinton's plan (3+ / 0-)

    I don't have a problem with mandates per se - in fact I support Edwards's plan as the closest we can get to single-payer while still including insurance companies. The problem with Sen. Clinton's plan is not the mandate.

    According to her website, this is Sen. Clinton's plan for ensuring affordability for working families:

    Senator Clinton’s plan will:
       * Provide Tax Relief to Ensure Affordability: Working families will receive a refundable tax credit to help them afford high-quality health coverage.

       * Limit Premium Payments to a Percentage of Income: The refundable tax credit will be designed to prevent premiums from exceeding a percentage of family income, while maintaining consumer price consciousness in choosing health plans.

    Leaving aside the problem with her specifically naming "families," which generally can be read as "adults with dependent children," and assuming that childless adults will be included with fair and adequate subsidies, there is still a fundamental problem with the tax-credit approach to subsidies for the working poor and lower middle class.

    Nearly everyone who lives below the poverty line is already stretched to the limit with basic survival expenses like food, housing, hygiene and heat. A substantial number of people below even 250% of the poverty line are in the same predicament. Any additional expenditure would require nearly all of us to cut back on one of the basic necessities of life.

    We would love to have health coverage. We are not the healthy people you discuss above who would "opt-out" if we could. The studies show that those of us with low incomes tend to be sicker, and many of us have chronic conditions that have gone untreated for years because we simply cannot afford care:

    New research indicates that it's not just the poor who are getting poorer. An analysis of poverty rates and health published in the September issue of The American Journal of Preventive Medicine found that people living in extreme poverty tend to have more chronic illnesses, more frequent and severe disease complications and make greater demands on the health care system.

    "When we talk about poverty, there is the tendency to feel it affects a small percentage of the population and the rest of us are doing better," said Steven Woolf, a professor at Virginia Commonwealth University and author of the study. But in this situation, he said, "we're all doing a little bit worse."

    link

    Under a plan which provided up-front subsidies that would prevent us from having to pay out-of-pocket, nearly all of us would run to sign up as soon as we were informed about it. But under a plan like Sen. Clinton's, we would have to pay out-of-pocket and wait up to a year to get reimbursed when we filed our taxes, if we figured out the tax forms well enough to actually get the credit, which might be a problem for many of us.

    Most of us would not be able to meet the up-front costs of insurance. Reading Sen. Clinton's plan, it appears it would be the tax credit that would reduce our total expenses to a percentage of our income, meaning we would have to pay as much as everyone else each month and then just get more back at the end of the year - but if I'm reading it wrong and in fact our monthly premium were immediately limited to a percentage of our income, we would still be hit harder than the rich and middle class. A certain percentage of the income of a rich or middle-class person goes to luxuries, whereas nearly all of the working poor's income goes to necessities. In order to meet the costs and get the tax credit, we would have to, as I said above, cut back on one of the necessities of life. Up to a year later we would be compensated, but that tax credit in February '11 won't pay for groceries in March '10.

    Sen. Clinton has the right idea. I would encourage her to look closely at the real effects of her proposed plan and consider changing this particular part to be modeled on Edwards's. This should be easy and a net positive for her now that he's left the race. If she changes this part, I will go from opposing her to supporting her on the issue of healthcare.

    During times of universal deceit, telling the truth becomes a revolutionary act. - George Orwell

    by kyril on Sat Feb 02, 2008 at 02:56:17 PM PST

  •  I NEED HEALTH INSURANCE- I NEED OBAMA (6+ / 0-)

    I'm single and 59 and need insurance. However the Clinton/Romney Plan would force me to buy insurance I can't afford. Clinton's plan would give me a tax deduction for those premiums but I don't pay enough income tax for that to matter at all. I make too much however, to get Medicaid. I would be out of luck and would have to get one of the millions and millions of exemptions from the mandatory law.

    On the other hand the Federal Employees Health Plan with costs lowered $2500/year and with subsidies offered by the Obama plan would be affordable to me and is an exceptional single-payer plan.

    The Clinton/Romney plan is smoke and mirrors- technically requiring everyone to buy insurance but  leaving most uninsured people out with necessary exemptions.

    Further, I don't trust anyone to follow up on her word to get universal affordable coverage who has taken so many millions from the health care industry's lobbyists.  

  •  Don't worry. No chance that Hillary's plan (2+ / 0-)
    Recommended by:
    badlands, oscarsmom

    becomes law.

    Most Americans HATE mandates.

    If she becomes president it will be 1994 all over again.

    I can't understand how Democrats can be that stupid.
    Doing the same thing over and over again and expecting a different result.

  •  But now follow this (2+ / 0-)
    Recommended by:
    oscarsmom, kyril

    To get Universal Health Care, you have to get it through Congress.  As we've seen, you need 60 votes in the Senate to make that happen.

    It's unlikely we'll have that next year or in 2011.  Start where you can now and make the changes towards universality incrementally.

    We can come up with the singular perfect health care plan and if 41 elected Senators resolutely oppose it, it won't pass.

    "Cultist" is an empty argument. It's the new Godwin. If you invoke it, you've already lost.

    by nightsweat on Sat Feb 02, 2008 at 03:01:19 PM PST

  •  Yeah, it pisses me off. (3+ / 0-)

    Obama is being nasty AND foolish.

    How did I live without him?

    by Pumpkinlove on Sat Feb 02, 2008 at 03:01:46 PM PST

  •  Still not buying mandates (3+ / 0-)
    Recommended by:
    Chicago Lulu, oscarsmom, kyril

    Mandates are like car insurance...now I have to show proof and if I don't I get a ticket. Blech. Just make it single payer and take it out of paychecks like the way it's done with Social Security or medicare. But if you can't do THAT then you certainly shouldn't be forcing me to write yet another check to yet another insurance company.

    And can you please explain to folks like the Amish and the Christian Scientists and anyone else who doesn't believe in INSURANCE why they have to be forcibly opted into paying an insurance company for coverage they don't want. Explain to them how American THAT is, ok?

    If you handle it like social security or medicare then it's blind...we all pay the same for the same coverage. Let the government work things out with the insurance companies. But FORCING me to pay higher rates just because I'm healthy (and not even being able to say no, thanks) is wrong. I'm not saying I wouldn't VOLUNTEER to help someone pay their medical bills...I'm saying I do NOT want to be FORCED to write a check to an insurance company that's going to keep upping my premium because other people keep getting sicker. (or so they will say)

    The only way to get me to buy health insurance on my own if I'm healthy is by keeping the premium affordable and that not buying it is just silly. Or yeah, I guess the other way is to have mandates. Guess which ones the insurance companies want?

  •  Shame on OBAMA (6+ / 0-)

    Shame on Obama for calling for a new type of politics but at the same time sending negative mailings to people's home fabricating Hillary's policy on Health Care. This is the politics of Hope?

  •  Great Diary! this is (6+ / 0-)

    a big reason why i support HRC, and I don't like Obama's "Harry and Louise V2.0"

  •  Mandating... (3+ / 0-)

    ...which means compelling (it just doesn’t sound as bad) people to buy private company health insurance is not only morally wrong it is colossally stupid.

    It's like giving an armed robber a gun or a house burglar a key to your home.

    The young man who has not wept is a savage, and the old man who will not laugh is a fool. George Santayana

    by Bobjack23 on Sat Feb 02, 2008 at 03:19:32 PM PST

    •  not if you reform (4+ / 0-)

      that burglar and instead of robbing you, he'll help you. The plan includes ALOT to reform insurcance, just like Obama's. But Obama's leaves us picking up the tab for those who decide to be irresponsible and not get insurance.

    •  so why is obama doing it? (6+ / 0-)

      his plan calls for all children to be enrolled. involuntarily. they don't have a choice. they can't opt out. that's called a mandate.

      and obama said people without insurance will be assessed for "back premiums" if they access the health care system. i call that a fine.

      hillary's plan uses tax credits instead of these draconian measures obama is ramming down the throats of the unwilling american public.

      what happened to our liberty????

      Hillary 2008 - Flying Monkey Squadron 283

      by campskunk on Sat Feb 02, 2008 at 03:23:01 PM PST

      [ Parent ]

      •  gimme a link (0+ / 0-)

        Where does Hillary's plan spell out tax credits as the fining/enforcement mechanism for the mandate?

      •  Neither plan is either wise nor reasonable... (0+ / 0-)

        ...and both plans will not solve the problem of ten percent more of our money than any other modern progressive first world nation being spent every day for health care with about thirty-five percent less services delivered. In fact it will make our current travesty in healthcare even worse because when Insurance companies who daily murder patients by declining to pay for some needed treatments to increase their profits know the law forces you to buy their product then the cost will go up while past abuses of the system will remain and only increase because of monopoly practices that are as certain as sunrise to follow mandates.

        Single payer government run insurance is the only cheap sane way to provide universal health care. Any moron knows what freeing up ten percent of every dollar spent every day would do for the rest of our economy. Sadly neither of these so-called Liberal or Progressive candidates will buck the big insurance corporations but will in fact work for them against the rest of us. That is the truth whether any of us like it or not.  

        The young man who has not wept is a savage, and the old man who will not laugh is a fool. George Santayana

        by Bobjack23 on Sun Feb 03, 2008 at 03:41:53 AM PST

        [ Parent ]

  •  I like universal health care - not insurance (4+ / 0-)
    Recommended by:
    Chicago Lulu, greenearth, shigeru, eltee

    Why do we even talk about subsidizing people to purchase health insurance, which will still be inadequate if htey ever need to use it?

    We don't need to prop up health insurance cos. We need to offer an alternative. If people want to supplement with a private carrier, I guess that would be OK, but we should provide a system that would be good enough that people wouldn't see the need.

    Coming Soon -- to an Internet connection near you: Armisticeproject.org

    by FischFry on Sat Feb 02, 2008 at 03:22:42 PM PST

    •  Agreed. If every other first world (1+ / 0-)
      Recommended by:
      FischFry

      country and the upward moving second world countries can afford UHC, why can't we?

      While we are at it, why can't we provide a living wage to those who work full-time, rather than having most corporate profits go to the CEO's, exec and admin? Again most first world countries have a base salary that allows full-time workers to pay rent, eat, buy clothes, study and improve themselves. And they get basic medical care.

      Is the dirty secret that, other than a military power, we are not a first world country anymore? Is this what 30 years of rethug rule has done to us - moved us from pre-eminence to second level status?

      "Nations, like individuals, are punished for their transgressions." U.S.Grant

      by shigeru on Sat Feb 02, 2008 at 11:32:49 PM PST

      [ Parent ]

  •  I am simply amazed. (11+ / 0-)

    At a Democratic blog, I read so many comments from people saying "how dare someone force me to buy insurance when I don't want to". What happened to Democratic values? This blog would have been against Social Security too. "How dare someone tax me to provide me income in my old age? I don't need the government to tell me how to save for my future."

  •  hillary's plan is simply corporate welfare (2+ / 0-)
    Recommended by:
    Jim in Chicago, Inland

    Obama's plan is anemic, but most of those holes can be plugged.  hillary's is fundementally bad.  Edwards' plan capping profits and offering Medicare alternative, was the only real one.

    you have erected a straw man.

    The Democrats in 2008 are fighting over the soul of their Party, and so far the pro-soul side is losing.

    by Zacapoet on Sat Feb 02, 2008 at 03:27:40 PM PST

    •  But much less so than Obama's (1+ / 0-)
      Recommended by:
      splashy

      With Hillary's plan, we all get access to public insurance: expanded Medicare.

      With Obama's plan, public insurance is not guaranteed, it's a pilot program.

      So you see, Obama is friendlier to the market at the offset.

      But as with other health care market feedback mechanisms, economic forces within Hillary's framework would tend to drive patients toward the public/Medicare option. There is no was private insurers will be able to compete on a level playing field with Medicare - between profit, overhead, and claims denial games, private insurance siphons off 1/3 of resources away from patient care. Medicare only wastes about 8%.

      This situation will tilt the table so public insurance will grow, as private insurance will shrink.

      But the risk is the opposite with Obama's plan: since he does not have open enrollment, the plan cannot grow based on patient demand, and it will be hard to expand a public option once it is in place. It is likely, Obama's plan would lock in private insurers, if it even gets that far.

  •  He's trying to recapture Harry (4+ / 0-)

    and Louise, no doubt about it, table, papers, even the PLAID shirt the guy was wearing...

    But wow, 2 Hillary diaries Rec'd!!

  •  So please, answer this question. (2+ / 0-)
    Recommended by:
    slinkerwink, leonard145b

    I can't get a straight answer from a Hillary supporter.

    To co-opt your example, the 20-year-old man with no known health problems who would choose to not purchase insurance.. what does Hillary's plan do to require that he do so?

    Will it garnish his wages?

    Will it put him in jail?

    If not, what other enforcement tactic will it use to 'make' him do something he doesn't want to do?

    •  What I think will happen... (2+ / 0-)
      Recommended by:
      splashy, grannyhelen

      The person will be enrolled in a plan and charged for it.  The fee will be collected the same way we collect college loans and other governmental fees.

    •  IF you don't have insurance you (1+ / 0-)
      Recommended by:
      splashy

      cant drive your car right? What do they use for that? A fine... I don't think it would be a fine, but maybe a tax penalty.
      and if you're an Obama supporter:

      and obama said people without insurance will be assessed for "back premiums" if they access the health care system. i call that a fine.

      from a comment just a few up

      •  I believe Obama himself (2+ / 0-)
        Recommended by:
        splashy, rigso

        used the word "fine" as well.

        •  That's what I heard in the debate (1+ / 0-)
          Recommended by:
          Clem Yeobright

          A fine at the time of having to seek care for illness or injury. I imagine it could be paid over time, but also imagine the person would be required to buy into the insurance.

          "A common mistake people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools." Douglas Adams

          by splashy on Sun Feb 03, 2008 at 01:50:15 AM PST

          [ Parent ]

      •  Hideously bad example. (0+ / 0-)

        You can choose to not drive a car.  You can choose to take public transportation.  

        You can't choose to 'not be a citizen', which is the only way to avoid a mandated healthcare system.

        If a person avoids the system, and then wants in when an illness strikes, they choose to acknowledge that they must pay an increased fee and enroll.. that's their choice.  And it makes the system work out.

        But Hillary's plan takes away those choices.  It gives the Republicans a huge weapon in November.  And it would last 5 seconds under a Supreme Court review.

  •  Thank you. All those who favor universal health (4+ / 0-)

    care, whether single payer or based on the current insurance structure, must understand that mandates are essential. You lay it out very well.

  •  You can't have it both ways either. (2+ / 0-)
    Recommended by:
    MKS, eltee

    OBAMA'S CONTRADICTORY ARGUMENTS

    Obama's defense of his lack of mandates and attack on Clinton for having mandates make no sense. Let's start with his defense.

    Obama claims that he will make health coverage affordable for everyone.  He claims that no one would ever refuse to purchase health insurance if it's affordable.  Then what's his problem with having a mandate in his plan?  If he thinks every American will voluntarily sign up, why would he raise so much vitriol about mandates?

    His attack suffers from the same logical disconnect.  He claims Clinton's plan will force people to buy coverage they cannot afford.  He claims his own plan will make coverage affordable, but he never explains why Clinton's wouldn't.  He never explains this, of course, because it's simply not true.  

    There is absolutely no reason to think Obama's plan would make coverage more affordable than Clinton's plan.  In fact, the opposite is true.  Bringing healthy people into the system through mandates will make coverage more affordable for the people who are sick.

    Obama sets up a false dichotomy between affordability and mandated coverage.  In reality, these two are not mutually exclusive.  We can make coverage affordable, as Clinton's plan does, while mandating coverage at the same time.  There's no contradiction here.

    If Clinton's plan is adequately affordable and collections/garnishment isn't an issue, then the lack of a mandate is trivial as well.

    ******

    On the other hand, it doesn't exactly cut both ways from a political and from a moral perspective.  

    Obama says you deliver health reform before you impose big risks on people least able to afford them.

    Obama says you show you will keep your end of the bargain before you scare the bejeezus out of the people you say you want to help.

    Your defense of Clinton here is based on the policy wonk's perspective -- what's sensible to the bureaucrat or the economist isn't always completely in touch with everyday people.

    •  I don't get your point (1+ / 0-)
      Recommended by:
      splashy

      If Clinton's plan is adequately affordable and collections/garnishment isn't an issue, then the lack of a mandate is trivial as well.

      No, some healthier people will choose not to enroll even if it's affordable.

      •  Absolutely ... (2+ / 0-)
        Recommended by:
        splashy, Partially Impartial

        This is especially true of trust-fund kids, who would correctly be asked to pay slightly higher premiums than others their own age under any kind of progressive payment scheme.

        Obama is either being incredibly naive or incredibly disingenuous. I suspect the latter.

      •  You bet! (1+ / 0-)
        Recommended by:
        Clem Yeobright

        I would have been in that group back in my youth. I bet there are lots of people that wouldn't buy in if they weren't forced to, because they just don't think ahead much. They live for today, which is not bad in itself, but doesn't help them, or those of us that have to subsidize them, when they need health care.

        "A common mistake people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools." Douglas Adams

        by splashy on Sun Feb 03, 2008 at 01:52:54 AM PST

        [ Parent ]

  •  This is THE key issue... (8+ / 0-)

    ...and it needs to be hammered over and over and over again.

    This is probably Obama's biggest 'loser' right now. Progressives want ALL people covered, not 15 million not covered. Progressives don't want to hear about 'those who want to be covered will be covered.'

    Hillary supporters: This cannot be stressed, or repeated, enough.

    BO's stance on health care is simply not acceptable. Make sure everyone you are acquainted with knows that.

    And the 'Harry and Louise' horse manure ad is just the icing on the cake.

  •  Right now we don't have mandates, resulting in (0+ / 0-)

    some of us paying for both our own either through our employers and out of our own pocket, and many other peoples through taxes.  People should at least be in some plan where it is cheaper, instead of dumping on the rest of us and expecting us to pay for their refusal or negligence in caring for their selves.

    Right now, it is too expensive for someone who doesn't have it to get it, but when Health Care is revised and reformed there will be help, lower costs, and all kinds of other alternatives that in the end people will be able to afford.  There will be no excuse not be covered when it is afordably available regardless of your particular financial situation.

    Those who choose to opt our are only dumping their own garbage on other people.  It's something a republican might find acceptable to do to others, but hopefully not us.

    •  Let's be practical, please! (0+ / 0-)

      Eventually we will need either mandates or single-payer.  The diarist writes:

      Obama...claims that no one would ever refuse to purchase health insurance if it's affordable.  Then what's his problem with having a mandate in his plan?

      Because mandates are political poison.  Those who want No Reform Whatsoever will use them to block us.  It will be too hard to get them passed...at first.

      Obama gets us from 45 million uninsured down to 15 million.  Once we are there, we can take the next step which will be mandates or single-payer.  I believe that Obama correctly recognizes that this will be a long fight that we must win in stages.

      BTW, Hillary understands a similar truth...in the last debate she implied that her plan was a comprmise between status quo and Single Payer.  

      At the end of the day we know Single Payer is the goal.  Both candidates know this too.  They are taking different paths to get there.  Our choice is not which current Healthcare proposal is best, but which candidate can best lead and educate the electorate toward Single Payer.  

  •  Edwards, uh I mean Clinton's plan (3+ / 0-)

    The plan HRC is advocating is far superior.  But I prefer to call it by its correct name: The Edwards Health Care Plan.

    •  I don't want to get into this too much (5+ / 0-)

      But they both adopted the consensus best plan that's been developed over the past 15 years by health policy experts.

      Edwards adopted it before Clinton, but neither of them came up with it.

      •  LOL (1+ / 0-)
        Recommended by:
        formernadervoter

        Clinton never would have adopted it if Edwards had not gotten there first.  She wanted to wait until after being elected to create a plan.  Look, I gave HRC credit for following Edwards lead.  I'm just bitter that he never got the credit he deserved in the MSM.  But the only reason I'm leaning towards Obama (and not fully on board) is because I hate his health care plan.  If I vote for JRE instead of Obama on Tuesday, it will be because of Obama's stupid health care plan.  Even Mittens Romney could do better than this.

      •  The person responsible for UHC? (3+ / 0-)

        Bill Bradley.  In 2000, he proposed using means-tested refundable tax credits for people to purchase private insurance.  Although the Bradley proposal did not have a mandate, he was the first to propose allowing everyone to buy into FEHBP.

        Al Gore that year proposed only universal health care for children and nothing for people from ages 18-64.  Gore also said that allowing everyone to buy into the federal employee plan would screw FEHBP.  I'm glad to know that Gore has changed his tune since then.

        Anyhow, from that perspective, even the Obama plan -- while I prefer Hillary's plan -- seems much better than any Republican plan.

        Partially Impartial, this truly is a wonderful diary, and as an actuary (a life insurance actuary), I really appreciate your arguments about anti-selection and the free rider problem.

        The doctor said I wouldn't have so many nose bleeds if I kept my finger outta there. - Ralph Wiggum

        by jim bow on Sat Feb 02, 2008 at 04:47:29 PM PST

        [ Parent ]

    •  Now if Clinton would just buy into (2+ / 0-)
      Recommended by:
      formernadervoter, Valhalla

      Edwards' proviso that if the health insurance industry could not offer the same quality of coverage for the same amount of money as the competing public plan that his administration would look seriously at single payer.

      Democracy is not something you believe in or a place to hang your hat, but it's something you do. You participate. If you stop doing it, democracy crumbles.

      by wave of change on Sat Feb 02, 2008 at 04:08:10 PM PST

      [ Parent ]

    •  But Hillary already solved health care in '94! (0+ / 0-)

      I'm personally enjoying my health care that she won for us back then.

      Yep, heckuva job, Hilly!

      •  What's the point? (1+ / 0-)
        Recommended by:
        grannyhelen

        You kids behave or I'm turning this universe around RIGHT NOW! - god

        by Clem Yeobright on Sat Feb 02, 2008 at 05:54:28 PM PST

        [ Parent ]

        •  Hillary=Bad (2+ / 0-)
          Recommended by:
          splashy, Clem Yeobright

          if I had to guess...

          ...sigh.

          "The revolution's just an ethical haircut away..." Billy Bragg

          by grannyhelen on Sat Feb 02, 2008 at 06:23:45 PM PST

          [ Parent ]

        •  Point: if you can't pass it who cares re details? (1+ / 0-)
          Recommended by:
          Clem Yeobright

          While I do admire the analysis that went into this (even if I think some is not correct), for me the big, glaring 800-ton elephant in the room is the fact that HRC already had the chance to get meaningful health care reform, and blew it.  

          So for me, the small differences between the plans are a lot less relevant than whether or not we can get a plan at all.  And based on HRC's track record, I really question whether she can do it.

          Kudos to her for trying to push this again, but I've gotta say, when it comes to her 35 years of experience, I less than impressed by her "experience" on the two most important issues of the campaign -- Iraq and health care.

  •  Obama wants this unity: (2+ / 0-)
    Recommended by:
    slinkerwink, rigso

    http://www.salon.com/...

    While Clinton wants Dem unity to get this done.

    Your call.

    "It takes a Clinton to clean up after a Bush"

    by gotalife on Sat Feb 02, 2008 at 03:45:37 PM PST

  •  If you are going to quote RAND (1+ / 0-)
    Recommended by:
    MKS

    you should also quote the Randstudy showing that only about 15 million people would opt out of Obama's insurance plan. Even Hillary Clinton cited that study and conceded this point.

  •  We can discuss the different parts of (2+ / 0-)
    Recommended by:
    ManhattanMan, huckleberry

    both plans until we are blue in the face and never touch on, what to me is the most important point.

    Who has the best chance of getting their plan implemented? Or more importantly to this race, whose style of governance has the better chance of moving the discussion past the "socialist medicine" repub talking point to the "which way to reform health care" discussion.

    While I see the positive points in mandates, I don't see Hillary as having the ability to build the political base to move health care reform forward. So to me, I'll take moving forward 75% of the way instead of rehashing the losing battles of 16 years ago.

  •  As an Edwards supporter (10+ / 0-)

    this is the thing that really turns me off from Obama.  I haven't decided yet who I will support, but this wrong-headed thinking that appears to buy into a right-wing meme makes it difficult for me to go in his direction.

    Democracy is not something you believe in or a place to hang your hat, but it's something you do. You participate. If you stop doing it, democracy crumbles.

    by wave of change on Sat Feb 02, 2008 at 03:51:15 PM PST

  •  congratulations, PI! (4+ / 0-)

    partially

    Hillary 2008 - Flying Monkey Squadron 283

    by campskunk on Sat Feb 02, 2008 at 03:51:23 PM PST

  •  About Clinton's health plan (0+ / 0-)

    If you listened to the California debate, then you would know that she and Obama both allow people to stay with the health care insurer that they already have. Please do not claim that the risk pools are going to be completely different depending on who you vote for, the truth is that while Clinton is "mandating" health care, she is also allowing people not to go with her plan. This is going to allow the same people out of the plan as in Obama's plan.

    She talked about doing it herself in the debate the other night in California:

    And the reason why I have designed a plan that, number one, tells people, "If you have health insurance and you're happy with it, nothing changes," is because we want to maximize choice for people.

    So if you are satisfied, you're not one of the people who will necessarily at this time take advantage of what I'm offering. But if you are uninsured or underinsured, we will open the congressional health plan to you. (Applause.)

    "Since, then, we both wear masks, either let us both retain them or put them aside together." -The Man in the Iron Mask

    by L etudiante on Sat Feb 02, 2008 at 03:55:55 PM PST

  •  I agree with Robert Reich on this (7+ / 0-)

    As a practical matter, the difference between Sen. Clinton's and Sen. Obama's approaches come down to timing and sequencing. Mrs. Clinton wants a mandate first, believing that enrolling the younger and healthier will help reduce costs for everyone else. Mr. Obama thinks forcing people to buy health insurance before it's affordable isn't realistic. He wants to lower health costs first, and is willing to consider a mandate only if necessary.

    This fight is little more than a distraction, given that a mandate would matter only to a tiny portion of Americans. All major Democratic candidates and virtually all experts agree that the combination of purchasing pools, subsidies, easy enrollment and mandatory coverage of children will cover a large majority of those who currently lack insurance -- even without a mandate that adults purchase it. A big chunk of the remainder are undocumented immigrants, who aren't covered by any of the plans.

    Who's left? Only around 3% of the population. So the question they're really battling over is whether it's better to require this 3% to buy insurance, or lure them into buying it with low rates and subsidies.

    The answer depends on who's in this 3%. Mrs. Clinton thinks they're mostly younger and healthier than the general population so they should be required to buy health insurance. That way, they'll bring costs down for everyone else because their payments will subsidize the others.

    Mr. Obama thinks a lot of them are people who won't be able to afford even the subsidized premiums, so they'd either ignore a mandate or wouldn't be able to pay for it. He says if his plan gets 97% coverage without a mandate and he finds that the remaining 3% are mostly young and healthy, he'll go along with a mandate.

    Who's correct? It's hard to know. So far, the Massachusetts experiment suggests Mr. Obama. Massachusetts is the only state to require that every resident purchase health insurance. The penalty for failing to do so could reach $4,000 next year, but the state has already exempted almost 20% of its current uninsured from the requirement. Massachusetts is concerned they can't afford a policy, even with subsidies similar to those in all the Democratic plans. So far, about 50% of Massachusetts's uninsured have complied with the mandate.


    "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

    by Zackpunk on Sat Feb 02, 2008 at 03:57:07 PM PST

    •  Robert Reich's numbers don't add up. (2+ / 0-)
      Recommended by:
      formernadervoter, Lysis

      Nor do Obama's. Why does Reich even bother to compare Hillary's plan to Romney's? The Romney plan doesn't contain a single-payer option, which is where the savings really accrue, but only if everyone, the healthy and the sick, participates.

      Have you read the following critiqueof Reich's critique of Hillary's plan? I find it quite persuasive.

      •  I disagree with that critique (0+ / 0-)

        The car insurance analogy is just ridiculous. You are required to get insurance in order to receive a title for your vehicle, and not everybody needs a vehicle. But everybody needs to live.

        Forcing people to buy junk insurance that they may not be able to afford is not universal health care. Believe me, I'm from Massachusetts -- I know what a joke that is.


        "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

        by Zackpunk on Sat Feb 02, 2008 at 05:02:30 PM PST

        [ Parent ]

        •  Huh?? (1+ / 0-)
          Recommended by:
          Lysis

          The car insurance analogy is just ridiculous. You are required to get insurance in order to receive a title for your vehicle, and not everybody needs a vehicle. But everybody needs to live.

          So how does that argue against requiring people to get health care coverage? If everyone needs to live, than doesn't that argue for everyone being covered?

          Forcing people to buy junk insurance that they may not be able to afford is not universal health care. Believe me, I'm from Massachusetts -- I know what a joke that is.

          As I just explained, Romney's plan is not comparable to Hillary's plan, because it does not allow people to buy into Medicare, i.e., federally administered single-payer coverage. There are very few people who would call Medicare "junk insurance." Even people who presently have private insurance but are unhappy with their coverage would be afforded this option under Hillary's plan. What do you have against that?

          •  The car insurance analogy (0+ / 0-)

            The critique of Hillary compared the viability of her plan to the already existing model of car insurance. I'm saying that it is a horrible analogy because not everyone is required to own a car.

            There are certainly differences between Hillary's plan and Romney's plan, but there are also similarities -- namely that both mandate that every single person buy health insurance. I think that's a mistake.

            Obama's plan is basically the same as Hillary's but to do it in steps. First, make it as easy as possible for everyone to obtain health insurance -- then take a look at those who still don't have it and figure out the best way to get them insured. It just makes more sense to do it that way.

            And I might add that it also is a better position going into the general election. I don't want to have to sit through a bunch of ads talking about how Hillary is going to force you to buy health insurance. That could cost the Democrats the election.


            "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

            by Zackpunk on Sat Feb 02, 2008 at 05:39:59 PM PST

            [ Parent ]

            •  People without cars don't buy windshields. (1+ / 0-)
              Recommended by:
              grannyhelen

              There is nobody who doesn't use the health care system or doesn't expect it to be there when they have an emergency.

              Obama's plan would prove unworkable and extremely expensive - especially his 'buy a lottery ticket the day after the lottery' plank - and would set back UHC another 30 years.

              Does that help?

              You kids behave or I'm turning this universe around RIGHT NOW! - god

              by Clem Yeobright on Sat Feb 02, 2008 at 05:51:41 PM PST

              [ Parent ]

              •  and having adjusted auto claims... (1+ / 0-)
                Recommended by:
                Clem Yeobright

                ...I can tell you that auto insurance and health insurance are very different animals entirely.

                It's bad to try and make analogies between the two.

                "The revolution's just an ethical haircut away..." Billy Bragg

                by grannyhelen on Sat Feb 02, 2008 at 06:25:43 PM PST

                [ Parent ]

                •  So you agree with me... (0+ / 0-)

                  That's what I'm saying.


                  "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

                  by Zackpunk on Sat Feb 02, 2008 at 06:39:52 PM PST

                  [ Parent ]

                  •  Inasmuch as auto and health are completely (1+ / 0-)
                    Recommended by:
                    Clem Yeobright

                    different forms of insurance, yes. But there are standard rules of underwriting in terms of adverse selection that come into play especially when you're talking about health ins, which make it counter-intuitive to believe that you can decrease rates without mandating (or having some other mechanism to deal with adverse selection), or that it's "cheaper" to have people who have not paid into the system pay penalties when they go to access benefits.

                    "The revolution's just an ethical haircut away..." Billy Bragg

                    by grannyhelen on Sat Feb 02, 2008 at 07:04:56 PM PST

                    [ Parent ]

              •  No, it doesn't help at all (0+ / 0-)

                Simply saying "Obama's plan wouldn't work" is not a very helpful rebuttal at all.

                Obama's plan is Hillary's plan, only he wants to roll it out incrementally so they can adjust it properly as it goes along.

                Does that help?


                "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

                by Zackpunk on Sat Feb 02, 2008 at 06:43:41 PM PST

                [ Parent ]

                •  Nope. Think about pools. (1+ / 0-)
                  Recommended by:
                  grannyhelen

                  There are 'winners' and 'losers' in every pool.

                  'Losers' are always suspicious that they are being exploited. As 'losers' drop out of the pool, the fees for those remaining increase, thus creating a higher threshold for the evaluation of 'winning' and 'losing'. The system feeds on itself and ultimately is left with only high-risk members, many of whom may start with an assured cost of $10k/yr or more.

                  That system cannot survive. It falls of its own weight, and health financing reform goes back on the shelf for 15 or 20 years, with the burden of the memory that 'it didn't work the last time'.

                  Add mandates to the initial configuration and the story changes, doesn't it?

                  Hint: Re-read the diary.

                  You kids behave or I'm turning this universe around RIGHT NOW! - god

                  by Clem Yeobright on Sat Feb 02, 2008 at 06:58:10 PM PST

                  [ Parent ]

                  •  Hint (1+ / 0-)
                    Recommended by:
                    Clem Yeobright

                    Re-read Reich's response.

                    We're talking about a very small fraction of people.

                    Here's a question that Hillary has yet to answer: What do you with the people who refuse to pay, simply as a matter of principle? How do you enforce these mandates?

                    Obama has stated that he is open to imposing mandates if people start gaming the system. It's just a more sensible approach -- roll it out incrementally and make the appropriate adjustments as needed, as opposed to cramming it through first.


                    "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

                    by Zackpunk on Sat Feb 02, 2008 at 07:05:39 PM PST

                    [ Parent ]

                    •  Oh fuck. A stealth candidate. (0+ / 0-)

                      Implementing a policy he explicitly campaigned against. Where is the mandate for that?

                      You kids behave or I'm turning this universe around RIGHT NOW! - god

                      by Clem Yeobright on Sat Feb 02, 2008 at 07:28:10 PM PST

                      [ Parent ]

                      •  What on earth are you talking about? (0+ / 0-)


                        "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

                        by Zackpunk on Sat Feb 02, 2008 at 07:42:27 PM PST

                        [ Parent ]

                        •  How the hell does he distribute this mailer today (0+ / 0-)

                          and come back in a year and say "I was just kidding"?

                          You kids behave or I'm turning this universe around RIGHT NOW! - god

                          by Clem Yeobright on Sat Feb 02, 2008 at 08:37:54 PM PST

                          [ Parent ]

                          •  Oh... (0+ / 0-)

                            I agree that it's stupid for both candidates to contrast themselves on this point. I was watching Hillary on CNN today going on about how she was the candidate offering universal health care, not Obama etc... That's a gross distortion of the truth. I'm not sure why this somewhat wonky detail has become such a huge campaign issue for both of them.


                            "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

                            by Zackpunk on Sat Feb 02, 2008 at 09:50:44 PM PST

                            [ Parent ]

                    •  But Reich is fudging the numbers ... (1+ / 0-)
                      Recommended by:
                      Clem Yeobright

                      You clearly didn't read the Gene Sperling article that I gave you the link to earlier. Here's what Sperlling has to say on Reich's "very small faction of people."

                      Reich's assertion that Senator Clinton "has no grounds for alleging that [Senator Obama's plan] would leave out 15 million people" is simply wrong.

                      For Bob to suggest that it is a cheap shot to make this highly supported point is puzzling. A recent study in the Journal of Inquiry found that in a voluntary system like the one Senator Obama advocates, "Even if the . . . subsidies were designed to be as effective as possible at covering the uninsured, at most half of the uninsured would gain coverage." Assuming that Senator Obama's child mandate would cover all children, his plan would still leave half of the adult uninsured population without healthcare. That's well over 15 million. Indeed, a number of independent analysts have confirmed that Senator Obama's plan would leave at least 15 million uninsured, including the Washington Post [6/9/07, "[T]he Obama plan could leave a third of those currently uninsured lacking coverage."], the Wall Street Journal [12/04/07, "Mrs. Clinton charges that Mr. Obama's plan would leave 15 million people without insurance. Outside experts agree that number is in the ballpark."], Jonathan Gruber of MIT [12/05/07, "The 15 million estimate that [Senator Clinton] used was validated by myself and other experts."] Jonathan Holohan of the Urban Institute [New Republic, 12/03/07, "Obama would still leave about 22 million, 23 million, but he has a mandate for children, about 9 million uninsured kids, so assuming you get most of them, you get pretty close to 15 million."], Len Nichols of the New America Foundation [New Republic, 12/03/07, "Every reasonable model out there . . . will show you that the kind of subsidies that we could do, 50 percent or so, are going to get you half [the uninsured] . . . The way you go from half to 15 [million] is the kid mandate."], and George Miller and Charles Roehrig of the Altarum research institute [New Republic, 12/03/07, "We've done some very crude hand calculations that suggest that the estimate of 15 million uninsured under an Obama-like plan (no individual mandate, coverage of all children, incentives) is in the right ball park."].

                      Bob is certainly free to disagree with these experts, but where is the validity in launching the steep charge that "HRC has no grounds for alleging that O's would leave out 15 million people"? (emphasis added).

                      Link

            •  So you'd rather surrender ... (1+ / 0-)
              Recommended by:
              Clem Yeobright

              And I might add that it also is a better position going into the general election. I don't want to have to sit through a bunch of ads talking about how Hillary is going to force you to buy health insurance. That could cost the Democrats the election.

              Believe me--most Americans will prefer Hillary's plan to McCain's (assuming he has one) when it's properly explained to them. But out of sheer cowardice, you'd rather concede universal health care in the US for another 30 years (as per Clem's comment) than go with a plan that might be the subject of negative ads.

              Talk about spineless Democrats ...

              •  I don't believe you (1+ / 0-)
                Recommended by:
                mrchumchum

                But nice use of Republican buzz words.


                "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

                by Zackpunk on Sat Feb 02, 2008 at 06:40:33 PM PST

                [ Parent ]

                •  And I can't believe ... (1+ / 0-)
                  Recommended by:
                  Clem Yeobright

                  that an Obama supporter would be bothered by Republican buzz words.

                  •  Of course we would (1+ / 0-)
                    Recommended by:
                    mrchumchum

                    The tone, style, and substance of a debate is important. Calling someone a coward simply because he disagrees with a political strategy -- it's exactly the kind of divisive and insulting rhetoric that we're trying to move past.

                    Fortunately, I'm smart enough to know you don't represent the typical Hillary supporter.


                    "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

                    by Zackpunk on Sat Feb 02, 2008 at 07:02:16 PM PST

                    [ Parent ]

                    •  I'm not a Hillary supporter ... (1+ / 0-)
                      Recommended by:
                      Clem Yeobright

                      yet. I'm still a recovering Edwards supporter. But Obama's position on health care may be driving me inexorably into Clinton's camp.

                      I still have two days to decide. Maybe Barack will come around.

                      Btw, you're not disagreeing with a strategy when you oppose universal health care coverage--you're disagreeing with a fundamental plank of the Democratic platform for most of the past 60 years.

                      •  Oh please (1+ / 0-)
                        Recommended by:
                        NeuvoLiberal

                        Of course Obama supports universal health care. It's just a question of how to get there. Look, Clinton is the one who said she expects to deliver universal health care "by the end of her second term." Remember that one?

                        If Obama's health care plan was sooooo insane, why was he endorsed by the United Healthcare Workers Union?


                        "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

                        by Zackpunk on Sat Feb 02, 2008 at 07:35:49 PM PST

                        [ Parent ]

                        •  At least Hillary (1+ / 0-)
                          Recommended by:
                          Clem Yeobright

                          had the smarts to steal Edwards' plan.

                          If Obama's health care plan was sooooo insane, why was he endorsed by the United Healthcare Workers Union?

                          If you are talking about the SEIU, as you probably know, the union split its endorsements. My guess is that the California Union endorsed Obama because of its visceral hatred for Gov. Schwarzenegger, whose plan is superficially similar to Hillary's plan in that it also includes mandates. They wanted Schwarzenegger's plan to fail, which in part to their efforts it now has. But Hillary's plan is different for reasons I have already explained--when people understand these differences they will warm up to the plan. After all, people like to have choices, which is exactly what Hillary's plan gives them--now they can actually choose between their private insurance and government-administered single-payer. I know what I would choose.

                          I shouldn't be upset with the California Nurses Shum and others who have misrepresented Hillary's plan. After all, even you were equating Hillary's plan with Romney's earlier this evening.

                          •  Here we ago again... (0+ / 0-)

                            ...believing that once the American people are informed of how reasonable our policies are, they will surely vote for us.

                            Have we learned nothing from Gore and Kerry?

                            You do know that Obama's plan also gives everyone the same choices as Hillary's, but that's besides the point. I have nothing against Hillary's plan, because it's nearly identical to Obama's. The only difference is that Obama wants to roll his out incrementally so he can make the necessary adjustments along the way. That's it. That's the only difference.

                            And this is going to keep you from voting for Obama? This is madness.


                            "Never let your sense of morals prevent you from doing what is right." - Salvor Hardin

                            by Zackpunk on Sat Feb 02, 2008 at 09:45:23 PM PST

                            [ Parent ]

                          •  But Obama's plan would be the death knell ... (1+ / 0-)
                            Recommended by:
                            Clem Yeobright

                            for any transition to single-payer coverage. Without mandates, it's estimated (by all reasonable economists) that half of all presently uninsured adults would opt out of coverage in the belief that they can save money by gambling on their good health. This would leave the only sickest of the remaining uninsured adults opting for single-payer coverage. This would render the single-payer option unaffordable for those uninsured without heavy subsidies from the federal government. As a result, even though the single-payer option spends only 2-3% of its expenses on administrative overhead as opposed to a rate of 20-30% in the private insurance sector, it would still be either (A) unaffordable to those in need, or (B) deemed a failure by the American public because of its costs.

                            And yes, I have read all of Obama's proposals for lowering cost care costs (some of which are the same proposals that Newt Gingrich made over 13 years ago), and yes, I have studied the theories of the "behavioral economists" (i.e., repackaged neoliberal economists) who crafted Obama's health care plan. I simply do not share their faith that by "liberating" market forces, health care costs will go down.

                            And listen to how you sound.

                            Here we ago again... (0 / 0)

                            ...believing that once the American people are informed of how reasonable our policies are, they will surely vote for us.

                            So what do you suggest? That we sound and act like Republicans? That we accede to their framing of the issues? Do you honestly believe that Republican ideas still hold sway with the American public? That McCain is such an awesome opponent? If Hillary succeeds in defeating Obama, I have no doubt that she will succeed in defeating McCain. She will fight with any means she can find, and I'm positive that she won't merely appeal to reason.

                            And this is going to keep you from voting for Obama? This is madness.

                            From what I can see, this is the biggest point of departure in the policies of the two candidates. And yes, it's a goddam huge issue for me. If Hillary can actually deliver universal health care, then she will go down in history as a great president. I'm not saying it's guaranteed, but at least with her plan we have a shot at it. With Obama's plan I am convinced that we don't.

      •  The Romney plan has two problems (1+ / 0-)
        Recommended by:
        Clem Yeobright
        1.  The subsidies are too small so poor people can't afford even the weakest plan.
        1.  There is no public option putting competitive pressure on private suppliers.
    •  This is an important point (2+ / 0-)
      Recommended by:
      lrhoke, Chichibabin

      How do we know the subsidies are enough to make the coverage affordable if there is a mandate right away? Waiting on the mandate helps set the right price levels first. Then if healthy, well-off people are gaming the system -- something that will be easy to tell by who is signing up and who isn't -- mandates can and should be imposed.

      Waiting on mandates (for adults) also takes the biggest weapon in the other side's arsenal -- distrust of Big Brother style government -- out of the equation and makes passage of the basic plan to make health care affordable (to which mandates could be added later) much easier. This is why Ted Kennedy is supporting Obama's position.

      I'm not saying Obama is right. But I think he COULD be and that there are FAR more important issues than this difference in their health plans on which to vote such as:

      --who will reduce the power of corporate lobbyists in Washington

      --who will bring more (young and independent) voters to our side to win the general election

      --who will not try to take the Party back from the grassroots

      --who will provide a clear distinction from the Republicans on Iraq without having to "explain" her vote and why she still stands by it

      --who will inspire the nation to lobby Congress to adopt his agenda

      --who will promise to bring the troops home by a date certain rather than hedging on that, on permanent bases, etc.

      etc. etc. etc.

      Hey Hillary: How did you go from "It takes a (whole) village" to "It takes a (solitary) President"?

      by Jim in Chicago on Sat Feb 02, 2008 at 04:28:01 PM PST

      [ Parent ]

  •  Recommended (3+ / 0-)

    Rec'd because this diary is a solid explanation of why and how single payer is necessary. Very concise and compelling.

    Every day's another chance to stick it to The Man. - dls.

    by The Raven on Sat Feb 02, 2008 at 03:57:19 PM PST

  •  A mandate is a losing position (2+ / 0-)
    Recommended by:
    MKS, leonard145b

    in the general election.

    America is fiercely independent and won't go for a vast expansion of government power in the form of a health care mandate.

    I don't support it and neither will the majority of Americans.

    •  In which case... (0+ / 0-)

      Congress will not go with a mandate and phase it in later as people acclimate to the overall program and they can address some of the missing pieces.

      The whole point in discussing plans you know will never happen is in differentiating the two candidates. The very preliminary high level plans they propose will be given to Congress as a starting point for health care reform.

      Obama has designed an incomplete plan. That's one conclusion. More importantly, the areas that are incomplete he tries to justify as necessary  fundamentally. He takes a positional argument when it isn't necessary. That's an important distinction for me.

      Clinton has also designed an incomplete plan, but it is less incomplete, more complete, and more importantly, she never fails to say up front that single-payer is the best option and that the only obstacle nowadays is the insurance companies greedy backlash. That's an important distinction for me too.

      So regarding health care plans that will never happen I rank Clinton's as better and Obama's as worse.

      HR 676 or California's SB-840 - the only health reform proposals worth my vote.

      by kck on Sat Feb 02, 2008 at 04:39:17 PM PST

      [ Parent ]

      •  Right. (0+ / 0-)

        The whole point in discussing plans you know will never happen is in differentiating the two candidates.

        Mrs. Clinton's plan will never happen because she'll never make it to the White House, but OK.

    •  Let's make that (0+ / 0-)

      Right wingers and libertarians are  fiercely selfish.. rather than Americans are independent

      It's like saying " I don't need cops...I got my gun,'

      Sheesh...no wonder Obama is getting the middle....it's consists the "me, me, me" mentality.

  •  I hate her plan. (5+ / 0-)

    I hate Obama's plan.
    I hated John's plan.
    They are not the answer.
    Like the CEO's salary from Cigna of 37 million or something wasn't enough?
    This is all you need to know.
    The reason pharma and insurance companies support Hilliary is why?
    Christ.
    I think all of us...JE's, BO's...and HRC"s supporters should get really honest here and admit none of these will address the problems.
    This is a huge nightmare right now.
    And you guys are just grasping thinking any of our guys gave us the solutions that are needed.
    And I say that as someone who has great insurance from a great company and if that should fall through..which it will not, I have my S.O to fall back on.
    In all honesty though - the solution that is called for would cause them to lose the election - so it's just a never ending pile of crap.

    Clinton's proposal relies heavily on private insurance companies to provide coverage for people who aren't already insured.

    "If the insurance industry calculates this carefully, they'll make money off it," said Uwe Reinhardt, a professor of economics at Princeton University.

    "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Beloved Mom, December 25 2007, once again on notice.

    by Christin on Sat Feb 02, 2008 at 04:03:11 PM PST

    •  exactly-get the insurance companies out (6+ / 0-)

      Pay for universal health care via the same taxes we pay for military sercurity, social security, roads, debt interest, fire, police...

      Click on my signature line to learn more.

      •  Yup - did no one here see Sicko? (3+ / 0-)

        My god....her plan totally relies on the private sector.
        As does BO's.
        As did JE's.
        It seems Partially and her supporters...along with a host of others - don't understand what those private insurers will do to people.
        If they have to take this many on, at a reduced rate, holy shit.
        Say hello to "denied. denied. denied. "
        The claims will go into the shredder by the millions.

        Meanwhile, like someone else said upthread.
        Americans are a sorry lot.
        The majority are NOT uninsured.
        And all they're going to see is YOU"RE FORCING me or others to get something?!!?!??
        And they're NO toddlerism kicks in.

        They all have Nancy Reagan syndrome.
        THey will only be for something if it happens to them.
        So since the majority are not sick, they'll say hell no to forced mandates.
        Then when they get sick, it's hell yes.

        It's the American public people.
        Kinda "moranish".

        I'm just puzzled that we as Democrats are not grasping that her plan will go down in flames because no one tells Americans what to do.
        Ever.
        Even if it's for their own good.

        "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Beloved Mom, December 25 2007, once again on notice.

        by Christin on Sat Feb 02, 2008 at 04:31:15 PM PST

        [ Parent ]

        •  actually not many did (1+ / 0-)
          Recommended by:
          cosbo

          His previous flick took in 110 million with Sicko a flop at 24 million

          Obama used to be for single payer before he came out against it.

          by formernadervoter on Sat Feb 02, 2008 at 04:44:04 PM PST

          [ Parent ]

          •  Yup . And that should tell us something. (1+ / 0-)
            Recommended by:
            cosbo

            I think the health care crises country is huge.
            We all do, right?
            So do most Americans.
            But they didn't want to see it.
            The movie got RAVE reviews from the critics.
            And?
            Crickets.
            Because bottom line is -
            the majority of Americans do have some form of health insurance.
            the majority of Americans are not ill.
            And the majority of Americans are selfish, sad to say.
            And as long as they are okay, well, fuck off peoples.

            What's sad to me is that more progressives did not bother  to watch this move.
            That more Kossaks did not.
            Then maybe they would understand that us arguing about which candidate's health plan is better is such a waste of time.

            And again....for all the reasons stated above , it's why you can never tell the American public they HAVE to buy something they say they don't want or can't afford.
            She is going to get crucified on that "can't afford" shit.

            And I'm for mandates, so you don't need to preach to me.
            But I'm also for a single payee system, so all this is crap to me actually.

            "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Beloved Mom, December 25 2007, once again on notice.

            by Christin on Sat Feb 02, 2008 at 04:51:49 PM PST

            [ Parent ]

            •  I agree. I guess the problem in this instance... (3+ / 0-)

              is that Obama's arguments against Hillary's plans are undermining the cause of UHC itself. We could argue until the cows come home who's plan is better (JRE's of course) but when it hits congress, it will be a different matter. Fine. But not if you've undermined yourself with your own argument against your own plan as Obama is doing.

              He can't be arguing against mandates when he has mandates in is own plan. The hypocrisy in that will come back to bite him on the ass the Ins Co's starting running his own ads against him.

              He's undermining UHC. That's heart of the problem. IMO.

              Spears/Hilton '08

              by cosbo on Sat Feb 02, 2008 at 05:01:58 PM PST

              [ Parent ]

              •  me and the so just discussed this too... (1+ / 0-)
                Recommended by:
                cosbo

                i laughed when i read your post cosbo.
                This is me: "hey john...who's health care plan is the best?"
                The SO: "Edwards, no doubt."

                But then he said the same thing I did.
                That they're all lacking because they all rely on the insurance companies.
                Who answer to wall street and who's goal is to make a profit out of denying coverage.

                I see what you're saying.
                But do you think Americans will go for a mandate?
                I don't.
                Just like I don't think they'll go for the single payee system either.
                I think this whole thing is hopeless to tell you the truth.
                And the only way Americans will go for anything is if we (they) are all dumped by our employers health plans.
                Then, the change will come.

                "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Beloved Mom, December 25 2007, once again on notice.

                by Christin on Sat Feb 02, 2008 at 05:10:48 PM PST

                [ Parent ]

                •  Believe it or not, I think they'll for the.... (1+ / 0-)
                  Recommended by:
                  Christin

                  mandates. Why? Because people are getting desperate. The problem is not just the uncovered millions, the problem is also that the covered people aren't really covered either. Think Nataline Sarkysian. Insurance companies like nyceve are getting away with murder everyday. Literally. Lots of people are waking up to that fact. So some dramatic change is necessary and I do think that they will accept the mandates if it puts the squeeze in big insurance lowers the premiums.

                  Listen, Hillary copied Edwards plan, and there were a couple times well he said she had a good plan. Your gonna laugh, but I really trust him on this.

                  Now, can she get it passed the way it is? That's a completely different story. Email in two years and we'll probably have a giggle.

                  Spears/Hilton '08

                  by cosbo on Sat Feb 02, 2008 at 05:17:20 PM PST

                  [ Parent ]

                  •  Well..... (1+ / 0-)
                    Recommended by:
                    cosbo

                    The problem is not just the uncovered millions, the problem is also that the covered people aren't really covered either. Think Nataline Sarkysian.

                    But the plan the Hillary is offering does NOT address that issue.
                    Those are two separate issues entirely Cosbo.
                    Nataline had health insurance.
                    Her problem was not that she did not have any.
                    Hillary's plan only offers limited insurance.
                    It does NOT address being denied by those mofo's, period.

                    So the biggest problem of them all does not go away.
                    Only a single payee system with address that, period.
                    Only taking out private insurers will address Nataline's problems.
                    That's why I push people to see Sicko.
                    A movie, not about people who do not have insurance but those of us who do.
                    HRC and BO's plan do nothing for this. Nothing.

                    And you know...I'd rather have have the insurance plan my company offers.
                    I'm covered through Aetna's Open choice plan, so I don't have to deal with HMO's.
                    I would never want Hillary's plan over mine.
                    I think most of us with good health insurance through our companies feel that way.
                    Why would you think we would opt out and go for her bare bone plan with a mandate?

                    And again..the majority of Americans are covered. That's the problem.
                    Saying that they'll embrace mandates...
                    just not getting that.

                    Insurance companies like nyceve are getting away with murder everyday.

                    nyceve has her own damn company?
                    Then what is she always bitching about. :-)

                    But yes they do get away with murder.
                    And neitiher Hillary or Obama or even John would stop them from their acts of murder.

                    "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Beloved Mom, December 25 2007, once again on notice.

                    by Christin on Sat Feb 02, 2008 at 05:39:35 PM PST

                    [ Parent ]

                    •  nyceve writes....YOU. (2+ / 0-)
                      Recommended by:
                      Christin, Kentucky DeanDemocrat

                      I understand what you're saying. What will take away the power is making the gov't plan more attractive and cheaper than the private insurers. That was genius of Edwards plan. If people couldn't afford the private, then they always had access to the gov't plan, and possibly a cheaper one at that. If it's a good plan and cheaper, I'm going on theory people will go towards that aggressively. Heck I would've. Then I could quit my job and freelance for more money.

                      Clinton said that she's putting the congressional plan on the table as the alternative...let's see if that comes to pass, and is cheaper and draw people towards it voluntarily.  I just don't think the insurance private co's will like that at all.

                      I'm watching how it all plays out. I have hope. But since it's Clinton, I have huge reservations...you know?

                      Spears/Hilton '08

                      by cosbo on Sat Feb 02, 2008 at 05:58:44 PM PST

                      [ Parent ]

                      •  oh hold up!! i just saw your sig line. (1+ / 0-)
                        Recommended by:
                        cosbo

                        when did that start??
                        i am so weeing my pants.

                        "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Beloved Mom, December 25 2007, once again on notice.

                        by Christin on Sat Feb 02, 2008 at 06:33:58 PM PST

                        [ Parent ]

                        •  about 3 days ago. lol. (1+ / 0-)
                          Recommended by:
                          Christin

                          since the presidency is all about the media sale...why not go for the ultimate.

                          LOL.

                          Spears/Hilton '08

                          by cosbo on Sat Feb 02, 2008 at 06:59:12 PM PST

                          [ Parent ]

                          •  damn.....and you know where I'm going (1+ / 0-)
                            Recommended by:
                            cosbo

                            right now?
                            i can't take my craving for frito lays cheese puffs any longer.
                            i do not know what the hell is wrong with me.
                            I read dlisted dot com to offset the horrific political news and miserable state of the world.
                            And all those britney posts about her cheeze doodle addiction?
                            reminds me how i used to like them.
                            So for the 2nd time in one week I am making the SO take me to seven eleven to buy a bag of cheeze puffs and a big gulp.
                            i tried to fight it all day.
                            and i'm caving.
                            it's ten in the pee emm on the east coast. and