This story was posted yesterday at the NYT and appears on the front page today. It is full of errors and misinformation and speculation. I expect better from the NYT. Unfortunately, comments at the NYT are closed. Here is the link to the story.:
NYT article on Obama's health plan
The story focuses on whether or not the average family will really save $2500 a year on health insurance premiums under Senator Obama's universal health plan.
More below the fold with a comparison with the McCain plan.
Why is the press arguing about a number when the question should be how do we achieve the universal coverage that Senator Obama has proposed? Or more importantly how do the Obama and McCain proposals compare? The $2500 figure is an AVERAGE based on an ESTIMATE. The NYT is missing the forest for the trees.
Senator Obama has two primary goals for his health care reform plan.
- Every American will have affordable health insurance that gives them access to comprehensive, high quality health care.
- Americans will have a choice of getting their care under a private health insurance plan OR from a new public plan like Medicare, which will give Americans who desperately want a single payer plan, the option of enrolling in one.
Obama's objective is that ALL Americans have comprehensive health insurance that gives them access to the care they need when they need it at an affordable cost.
STOP - Lets compare this to McCain's goals for health care reform.
Senator McCain's goals are :
- To give employers an incentive to drop their coverage for their workers by eliminating the special tax status given to corporations for providing health benefits.
- To throw everyone into the individual market and take "responsibility" for buying their own coverage with minimal subsidies through tax credits that don't begin to touch the costs of anything other than a high deductible health plan with "skinny" benefits.
Note: The Commonwealth Fund recently found that 25 million Americans have such limited health insurance that they spend more than 10% of their total annual household income on medical care, leaving many bankrupt or financially destitute.
- To even further deregulate the individual health insurance market, such that the insurance companies can continue to medically underwrite and reject anyone for any reason, charge whatever price they want, and exclude pre-existing conditions, by allowing insurance companies to sell across state lines, making null and void any state regulations to offer specific benefits (like covering contraceptives or cancer screening and treatment).
Both McCain and Obama want to control costs.
But McCain wants to control costs for corporations and government, and Obama wants to control the costs for the American people!
McCain's plan is "everyone for themself". Obama's plan is about security and affordability and choice for the American people.
The pundits and newsmakers want to nail down every last detail of Obama's plan. That is not going to happen. The job of Presidential candidates is to lay out their vision and put forth their goals and the broad brushstrokes for policy, but it is the Congress' job to write the legislation and work out the all the financing and details. Do not expect any more details from the Obama campaign.
But the media at least have the responsibility to get their facts straight. Senator Obama does NOT offer "tax credits". (That is McCain and Hillary) Senator Obama in fact does not involve the IRS (arguably the least compassionate of all federal agencies) in the administration of health insurance) AT ALL.
The truth is that Senator Obama's plan offers DIRECT subsidies to Americans based on their income. What this means is that if you get a subsidy based on your income of say, 60% of the premium, then you pay ONLY 40% of the premium. There is no proof of coverage to produce for the IRS. There are no IRS penalties. The premium you pay for the coverage you choose is affordable based on your income. Period. No refunds, credits or rebates. You pay what you can afford.
The NYT article is so cynical about the chances of Obama's plan moving forward..
Again, the MSM is not paying attention to what is happening behind the scenes. Senator Kennedy is already starting to draft legislation based on Senator Obama's proposal. I would imagine that Senator Kennedy would like nothing more than to successfully pass legislation that a President Obama could sign, to finally realize his goal of universal coverage for all Americans.
Senator Baucus, Chairman of the powerful Senate Appropriations Committee, is on board. Many other Democratic Senators are on board to draft a bill that reflects the goals and intent of Obama's proposal. Senator Durbin is already being talked about as the next Secretary of the Department of Health and Human Services to help Obama implement the plan.
The wheels are in motion. The Senate wants to help Obama make good on his goal of universal coverage by the end of his first term, and with a supermajority of Democrats in the next Congress, they will be in a position to do so. I predict that Legislation will be introduced in the first year of an Obama presidency, shortly after the inauguration. And a President Obama won't be beholden to the insurance companies or pharmaceutical companies as he has accepted NO PAC or federal lobbying money from these industries to help finance his campaign.
Will the die hard single payer advocates be happy?
Maybe not. But I sincerely believe that a voluntary transition to single payer, like that proposed in Obama's plan, giving the American people the choice of single payer or not, is the only way we can move towards a truly universal plan. A California health care leader asked me the other day, "Given the choice of a single payer plan, who would choose the private managed care plan?" Good question. But for those who prefer private health insurance, it will remain an option. Under Senator Obama's proposal, everyone gets what they want.
Will it be hard to bring costs under control? You bet! Is there a magic bullet? No.
And in fact, health insurance reform is unlikely to address some of the systemic problems that are behind the US high costs for health care. The US has way too many specialists (who charge more and are paid more than primary care doctors) and way too few primary care physicians. Other countries with lower costs have 2/3rds primary care and 1/3rd specialists. In the US, this is flipped. We have 1/3rd primary care physicians and 2/3rd specialists.
In the private health insurance industry, we spend about 30 cents of every dollar on administrative costs. Under Medicare (80% of the elderly get their insurance under the single payer system under Medicare), we spend about 3 cents of every dollar on administrative costs. Under Obama's plan, the more people who choose the single payer plan, the more savings there will be in reduced administrative costs.
In addition, the health care industry is one of the last to embrace Information Technology to reduce paper work, streamline processes, reduce errors, and save money. Obama will invest in IT to realize these savings. They will not accrue overnight. But that is not a reason to begin.
Finally, the US does a relatively poor job of making sure that all Americans get the preventive care they need and receive the services they need to manage their chronic conditions and prevent expensive and devastating complications from poorly managed disease.
Obama embraces all of these paths to controlling costs.
What is McCain's plan to control costs for the American people?
I don't know. As far as I know, he doesn't have one.
Let's get a few things straight.
No one knows how effective these ideas will be at controlling costs.
No one knows how to control health care costs, short of a budget or limit on spending.
No one knows how much the plan will cost.
What I do know is that there is more than enough money going into the US health care system for everyone to get the care they need. If all parties continue to pay about what they are paying now (or less if they have relatively low incomes or are a small business) and those who pay nothing now, pay what they can afford and is fair, we can cover all Americans with a comprehensive plan and fairly pay providers for the care and services they provide, we can cover everyone.
However, if we don't pay our doctors and hospitals a payment that is considered fair, any reform will fail. And if we don't pay primary care physicians more than specialists, the imbalance in the provider supply will not be addressed and our costs will continue to rocket out of control relative to other countries.
How can we control costs?
I would argue that we need to establish a budget based on an amount per person per year (pmpy), say, $6700 (about 6% less than what are now spending) and establish that as the budget for health care for the US for 2010 (adjusting for inflation moving forward). If the US finally did the right thing, and established health care as a right, such that every American has the right to the best health care available when they need it at an affordable cost, with a goal of promoting and improving the health of the American people, the total cost for 301 million Americans would be approximately $2 trillion - which is actually less than what the US will spend this year.
The problem with health care reform is not ideas or facts or knowledge.
It is political will. And rarely does a leader make such an important proposal to ensure that all Americans have access to the health care they need. Many others have backed down in the face of special interest opposition. For years, it was the physicians who opposed universal coverage. But the AMA does not have the political clout it had in days past. Now it is the pharmaceutical and health insurance industries who pull the strings. They don't care about the welfare of the American people. The pharmaceutical industry has more than enough lobbyists for every single member of the Congress. The insurance industry is one of the major contributors to national and state election campaign financing and so many of our Senators and Congressmen owe their seat to the financial support of the insurance industry.
But I believe Obama does have the political will.
I believe that Obama does share this value with the majority of the American people.
I believe Obama has the ability to lead us to national health insurance that covers every single American.
I believe that Obama will stand up to the pharmaceutical companies and the health insurance companies and tell them that the rules are about to change. Obama will negotiate with tthem over price and value, and we will make the private health insurance companies compete with a single payer plan.
And oh yeah, one more thing.
Obama's plans for the individual market are the OPPOSITE of McCain's.
McCain appears to want to make health insurance in the US the exclusive provence of the private sector, sold to individuals and families with no regulation. Whereas Obama's proposal is to regulate these plans to stop them from cherry picking healthy people and leaving those who need coverage out of luck with no options. I believe that Obama understands that the practices of the private insurance companies in the individual market are immoral and if they want to offer health insurance, they have to take anyone who wants to buy (no discrimination based on health status, age, ethnicity, religion, race, gender, income, wealth, geography, risk factors, genetics, or any other individual characteristic) and offer them a fair price within a risk pool.
Obama's plan will make it illegal for health insurance companies to exclude pre-existing conditions or charge higher premiums because of your health, or tell you they will not sell you insurance.
But what everyone should understand after all is said and done, and all of the cynics have had their say, and all of the opponents have shot their arrows is that at least Barack Obama has a plan and a proposal that provides health care to the American people in a way that is just, with the welfare of the American people at heart.