Daily Kos

Hillary or Obama? The deciding issue for me

Fri Feb 01, 2008 at 08:41:23 AM PDT

I have been supporting Hillary throughout this campaign, and at times I have sharply criticized Obama out of partisanship.  But the reality is that I find many things attractive about Obama too.  I like his ability to bring out large numbers of new voters and to appeal to independents and moderate Republicans.  I think he could represent a new face of the U.S. in international diplomacy and I like many of his ideas about transparency in government.  There are times when I wonder if I have made the right choice in this election.

Of course I also admire many strengths about Hillary--her long-time commitment to children's and women's issues, her experience and knowledge in international affairs, her willingness to fight for what's right, her policy ideas about education and other issues.  And Hillary is also bringing out huge numbers of new voters, especially working class women.  How to decide?

Well, though I am attracted to Hillary for a wide range of reasons, there is one definitive issue that confirms my support for her.  More beneath the fold.

The issue for me is health care.  I recognize that many people support Obama due to his 2002 position on Iraq, but I don't see much difference between the two on how they will respond to Iraq now.  However, I do see big differences on the issue of health care.

I see this election as a almost a unique chance to achieve universal health care in the U.S.  And I'm afaid that if we don't do it now, it could be decades before we achieve it.  And I want to express my appreciation to John Edwards and his campaign for helping to move us forward on that issue.

For me, the problem with Obama is not only that his plan does not call for universal health care, but that his campaign is actually based on fighting against universal health care.

Here you can see a screenshot of a mailer that he is still sending out.  It includes a picture of a stressed working couple, worrying about their health care future (sitting in virtually same position as the infamous Harry and Louise ad; click on the link and you can compare the two ads for yourself.  The text of Obama's mailer is as follows:  

Hillary's health care plan forces everyone to buy insurance, even if you can't afford it. -- Obama campaign mailer, January/February 2008

Let's ignore for a moment the fact that the affordability subsidies in Hillary's plan are just as aggressive or more aggressive than Obama's.  Let's also ignore the fact that Obama "forces" people to buy health care for their children. And Obama also talks about requiring people who don't buy health care, but who later need it, to pay back premiums.  What makes more sense: for people to pay premiums all along or to be required to pay extensive back premiums after they suffer a catastrophic disease or accident and possibly can't even work?

Put these points aside, though.  The key point for me is that the sine qua non of universal health care is mandating everybody to be part of it, whether through a tax-funded or employer-funded or user-funded (with subsidies) system.  If people opt out, then it is no longer universal.  To try to create an opt-in universal health care system would be like trying to create an opt-in universal social security system -- it would destroy it before it ever got started.

Some people on this site have suggested that Barack's strategy is two-step, that he is trying to build a non-universal health care plan as a first step toward a universal plan later.  However, even if true (and there is no evidence of that), I think it will be impossible to achieve since he is actively trying to seek election on the basis of his opposition to "forced" inclusion in a plan.

So, in the occasional moments when I wonder if I have made the right choice for president, I ponder the two candidate's health care plans and the answer for me is clear.  In 2008, I will definitely give my support to the candidate campaigning for, not against, universal health care: Hillary Clinton.

Tags: Hillary Clinton, Barack Obama, 2008 elections, health care (all tags) :: Previous Tag Versions

Permalink | 101 comments

    •  Tipping (4+ / 0-)

      Because this is a debate we really need. I haven't understood the logic behind the mandate system, yet...

      I am an agent of change. So are you.

      by Angry Vet on Fri Feb 01, 2008 at 08:45:46 AM PDT

      [ Parent ]

      •  Mandated insurance benefits insurance companies (6+ / 0-)

        Who can offer crappy high deductible plans which devastate the working class person who has moderate health costs.

        The high overhead costs - about 30% - taken by insurance companies are not cut, so our health care remains by far the most expensive in the world, but the working person is hit with thousands of dollars of insurance costs and thousand dollar plus deductibles.

        It's a big winner for insurance companies, but it's a big loser for the working class. Many working class people will end up breaking the law, IMO. It all depends on the amount of subsidy provided as to how many people will ignore the mandates.

        "It's the planet, stupid."

        by FishOutofWater on Fri Feb 01, 2008 at 08:53:35 AM PDT

        [ Parent ]

        •  A choice between two bad plans (2+ / 0-)

          Recommended by:
          oldjohnbrown, DarkestHour

          So I'd go with the less bad which is Obama's.

          Eventually the politicians like Obama and Clinton need to wake up to HR676 which is real universal health care, not the phony health insurance stuff they are selling.

          "The United States will always do the right thing, after trying all the other options." ~ Winston Churchill

          by Gregory Wonderwheel on Fri Feb 01, 2008 at 09:00:47 AM PDT

          [ Parent ]

        •  Bingo! (0+ / 0-)

          When the gov't makes you pay money, it's a tax.

          When the gov't makes you pay money you can ill afford, it's a regressive tax.

          When the government makes you pay money that goes to corporations, it's corporate welfare.

          A health care insurance mandate is a regressive tax for corporate welfare.

          I know who Obama's veep will be. You can too!

          by slaney black on Fri Feb 01, 2008 at 09:52:53 AM PDT

          [ Parent ]

          •  anti-bingo (2+ / 0-)

            Recommended by:
            eleanora, anna shane

            Unlike Obama's plan, Hillary's offers a government single payer option essentially identical to Medicare.

            The mandate is that you can have a Medicare-like plan, or Blue Cross, or the federal employees benefits plan.

            No one is forcing you to subsidize insurance companies in Hillary's plan, but with Barack's plan, you are only guaranteed access to private plans.

            Like the diarist, my largest issue is healthcare. I've spent most of my career in it, and I'm ready for real reform.

        •  who provides HC for the Congressional plan? (0+ / 0-)

          Through whom is that-- a private co?  

        •  mandates (0+ / 0-)

          are the first step to single payer.  Skipping mandates plays to the self-employed who would prefer skipping and taking their chances even if it's so-called affordable. Mandating makes it cheaper for everyone. And also lets the unemployed skip and those would be the most subsidized, inner city long term unemployed men, who don't get health care.  So, it'd make younger healthier adults pay for insurance they may not need in order to cover everybody who really needs insurance.  Over time it's a win win but short term, it's about the choice of where to spend one's money and whether or not to risk a long-shot health problem just to be a good citizen.  Hillary's plan is cheaper for everyone but everyone has to buy it. Obama's costs more but doesn't force anyone who doesn't work for wages.  One is the Democratic core principle that says society must provide basic services for all citizens, and Obama's is the libertarian model where citizens don't need to be responsible for society, only for themselves.  His has appeal with younger healthier people who don't like the idea of insurance, and her appeals to everyone else.  Edwards says that this plan will lead to single payer, over time, as profits in health care become less astronomical and they find new ways to rip us all off.  

          Hillary - Alternative Energy

          by anna shane on Fri Feb 01, 2008 at 12:50:58 PM PDT

          [ Parent ]

      •  To me it's like Apollo (5+ / 0-)

        and what Hillary meant last night.

        You have to shoot for the stars if you want to hit the moon.

        If we start out with a compromise, then after all the unavoidable "nibbling away" we will have nothing that resembles Universal Health Care.

        Imagine if the Dems who pushed Social Security had backed off because they were worried that they repubs would not support it.  The repubs fought it all the way but because people were serious and shot for the stars, we got SS.

        I refuse to have a battle of wits with an unarmed person

        by NewHampster on Fri Feb 01, 2008 at 09:04:40 AM PDT

        [ Parent ]

    •  Know Who Could Really Use Health Care? (1+ / 0-)

      Recommended by:
      slinkerwink

      The soldiers she sent to Iraq.

      Both plans will bring about health care for all. It's a shame Hillary mandated that so many of our finest will need it.

      •  mandates (2+ / 0-)

        Recommended by:
        Norwegian Chef, eleanora

        are the first step to single payer.  Skipping mandates plays to the self-employed who would prefer skipping and taking their chances even if it's so-called affordable. Mandating makes it cheaper for everyone. And also lets the unemployed skip and those would be the most subsidized, inner city long term unemployed men, who don't get health care.  So, it'd make younger healthier adults pay for insurance they may not need in order to cover everybody who really needs insurance.  Over time it's a win win but short term, it's about the choice of where to spend one's money and whether or not to risk a long-shot health problem just to be a good citizen.  Hillary's plan is cheaper for everyone but everyone has to buy it. Obama's costs more but doesn't force anyone who doesn't work for wages.  One is the Democratic core principle that says society must provide basic services for all citizens, and Obama's is the libertarian model where citizens don't need to be responsible for society, only for themselves.  His has appeal with younger healthier people who don't like the idea of insurance, and her appeals to everyone else.  Edwards says that this plan will lead to single payer, over time, as profits in health care become less astronomical and they find new ways to rip us all off.  

        Hillary - Alternative Energy

        by anna shane on Fri Feb 01, 2008 at 12:52:32 PM PDT

        [ Parent ]

    •  My one question which no one answers for me (1+ / 0-)

      Recommended by:
      slinkerwink

      How do you enforce mandates and what is the penalty. Please someone answers this question. In theory it sounds great, but is it really a reality. Most of the unions are against mandates, even though they distorted their position in IA and NH.

      •  tax credits. (2+ / 0-)

        Recommended by:
        markw, eleanora

        if you don't want to participate, you can always refuse the tax credit ;-)

        Hillary 2008 - Flying Monkey Squadron 283

        by campskunk on Fri Feb 01, 2008 at 09:06:07 AM PDT

        [ Parent ]

      •  How are mandates enforced? (1+ / 0-)

        Recommended by:
        anna shane

        The same way states that mandate auto insurance enforce them .....

        I agree that coverage will not be 100%. But I would argue that we have universal health insurance today. People by and large are nit turned away from the emergency rooms. It is expensive. It is pure crap. But, everyone is covered .... and those who pay for health insurance and.or pay taxes pick up the tab.

        Where I think Obama is foolish on healthcare is his claim that if it were inexpensive everyone would buy it. This is pure bull shit. My company has a really good 401K plan. The majority of younger employees do not participate and the biggest majority of those that do particate do not do so to the full extent covered my the company "match". In short, they elect to leave company money on the table, they elect to not take advantage of the tax break contributing provides, and they fail to take advantage of compounding over time - which is huge for anyone planning to have a nice retirement. One cannot look at this and conclude the decision is anything but irrational.

        How that ties. If healthcare were more affordable it is almost a certainty that people in good health who see their medical future as one without hospital stays and doctor visits would elect to not be covered. The dollars spent on heathcare would instead be spent on other, more important to them, things. Younger employees at my company tend to take the bare minimum coverage offered - the lowest cost alternative fully paid for by the company. The driver for young people adding healthcare is almost always to gain coverage of a spouse or child.

        Obama needs to look at reality and adjust his healthcare plan accordingly.

        Will close by saying that my company is considering "mandating" 401K participation up to the company match. Unlike the government  they have no trouble enforcing the mandate. The company cannot however prevent people from making early, penalized withdrawals and I owuld bet anyone that there would be early withdrawals.

  •  Question? (4+ / 0-)

    How does fining people who do not have healthcare because they cannot afford it help provide those same people with healthcare?

    Seems rather circular to me.

    I am an agent of change. So are you.

    by Angry Vet on Fri Feb 01, 2008 at 08:43:24 AM PDT

    •  fining??? we were thinking internment camps ;-) (6+ / 0-)

      strawman.

      the "fine them if they don't get insurance" proposal is obama's, not hillary's. he proposes making people pay back premiums after they're "caught" without health insurance and get sick. hillary's plan uses tax credits, not fines.

      Hillary 2008 - Flying Monkey Squadron 283

      by campskunk on Fri Feb 01, 2008 at 08:48:02 AM PDT

      [ Parent ]

      •  Then... (3+ / 0-)

        Recommended by:
        tmo, slinkerwink, oldjohnbrown

        How is that a mandate? I thought the mandate thing was analogous to the "no fault" auto insurance laws in many states. Please explain it to me.

        I am an agent of change. So are you.

        by Angry Vet on Fri Feb 01, 2008 at 08:49:40 AM PDT

        [ Parent ]

        •  you get caught (0+ / 0-)

          when you're stopped and can't show proof of insurance. In this case you're caught when you see a doctor and can't show proof of insurance.  Obama's also has mandates for children and he spoke of a fine that went back to what it would have cost if you'd paid in the first place.  Like taxes, if you get caught cheating you have to pay back taxes.  It's a real mandate, it covers everybody, but unlike taxes you're paying for your own sorry self.  

          Hillary - Alternative Energy

          by anna shane on Fri Feb 01, 2008 at 01:02:18 PM PDT

          [ Parent ]

      •  ANY criticism of Hill's mandate is a "straw man". (2+ / 0-)

        Recommended by:
        tmo, oldjohnbrown

        Why?  Because she doesn't say how she'll enforce it and you can't criticize it without imagining some enforcement mechanism.  

      •  that is not a reality, tax credits (4+ / 0-)

        most that do not have it, is because they are too poor to afford and some do not pay that large amount in taxes. How do you give these people tax credits.

        •  And.... (0+ / 0-)

          Tax credits are an "incentive," not "coercion."

          Therefore, if that is the only enforcement mechanism, how would anyone be forced to get health insurance? According to this logic, they are only "encouraged." So, therefore, people still have the opportunity to opt out, thus making this plan not universal either.

          Granted, I know nothing about healthcare, since I am a foreign policy wonk, but I am looking for a substantive conversation so someone will explain it to me without the propaganda.

          I am an agent of change. So are you.

          by Angry Vet on Fri Feb 01, 2008 at 09:00:16 AM PDT

          [ Parent ]

          •  i thought you were against mandates. (0+ / 0-)

            now, you're complaining that they aren't coercive enough. are you holding out for stocks in the public square?

            Hillary 2008 - Flying Monkey Squadron 283

            by campskunk on Fri Feb 01, 2008 at 09:07:54 AM PDT

            [ Parent ]

            •  It's a matter of definition (0+ / 0-)

              If there's no penalty for non-participation, how is it a mandate?

              No laws but Liberty. No king but Conscience.

              by oldjohnbrown on Fri Feb 01, 2008 at 09:38:43 AM PDT

              [ Parent ]

              •  The enforcement comes when you get caught (2+ / 0-)

                Recommended by:
                oldjohnbrown, eleanora

                No mandate means fewer people covered.

                Mandate means more people get coverage. Similar to the IRS and cheating .... you can cheat on your taxes and maybe never get caught but their is some isk you will. Most people are pretty good about not cheating on their taxes.

                Mandates will not get 100% participation. Mandates will get a higher percentage than no mandates. Plus if you go the no mandate route then I do not see how you cannot apply that to auto insurance. Or maybe why force union dues/membership? Forcing someone to pay for something they do not want and may not be able to afford. Obama amd his supporters need to improve their position versus spin their wheels trying to defend it.

                •  All I'm saying (0+ / 0-)

                  is that if there's no penalty, there's no mandate, in response to what seemed like vague comments to the contrary.

                  There is no candidate arguing against mandates. Both candidates' health care plans feature them. The only debate is over which mandates to apply where.

                  Voluntary union membership is different because employees are under tremendous and frequently illegal pressure by their employers (and health insurance providers) to not join unions. There is no similar pressure to opt out of health insurance.

                  In response to your last sentence, Obama has basically said that he could end up with mandates as per Clinton's plan if they prove necessary. What he's trying to do is keep the plan as lean as possible while covering the greatest number of people. He's not ideologically wedded to the his current plan, and frankly Clinton's is not so much different or better. It simply tries a different, more top-down means to the same end, which is not universal health care, but more-or-less universal health insurance.

                  Universal health care is still a ways off.

                  No laws but Liberty. No king but Conscience.

                  by oldjohnbrown on Fri Feb 01, 2008 at 11:04:51 AM PDT

                  [ Parent ]

                  •  he may be (0+ / 0-)

                    against health insurance, and any mandates may be unacceptable to him.  That's a position, it's the pug one.  

                    Hillary - Alternative Energy

                    by anna shane on Fri Feb 01, 2008 at 01:07:56 PM PDT

                    [ Parent ]

                    •  What's wrong with pugs? (0+ / 0-)

                      We had a black pug for many years. He was smart enough to be able to turn the stereo down to his comfort level if it was too loud.

                      ;-)

                      I don't know where you get the idea that he's against health insurance, given that his plan depends on it. I also don't know how "any mandates" could be unacceptable to him, given that his plan has a mandate (children must be insured) and he's explicitly said that he's open to applying a general mandate if he's wrong about the intrinsic appeal of health insurance.

                      The bottom line is that both candidates want as many people covered by insurance as possible. Obama's is a more hands-off approach to start with, but he's amenable to fully mandated coverage. Hillary comes out of the gate with fully mandated coverage. There's a difference there, but it's not all that great.

                      Neither plan holds a candle to the one Kucinich offered way back in 2004, but we can't allow the perfect to be the enemy of the good.

                      No laws but Liberty. No king but Conscience.

                      by oldjohnbrown on Fri Feb 01, 2008 at 01:28:30 PM PDT

                      [ Parent ]

                      •  didn't refer to Obama (0+ / 0-)

                        but to whoever thinks mandates aren't a good idea. Obama is trying to win, something for everybody, that's his strategy, although he apparently doesn't mean me. He claims her supporters would vote for him and he's right, not because I think he's nearly as good, I don't, but because he'll be better than McCain, or any pug.  The debate was nice, but he's back to mud slinging and misrepresentation.  I don't like it, no I don't.  

                        Hillary - Alternative Energy

                        by anna shane on Fri Feb 01, 2008 at 02:26:33 PM PDT

                        [ Parent ]

        •  Tax credits (1+ / 0-)

          Recommended by:
          eleanora

          can go beyond what you pay in taxes. I've been low enough paid to get more from EITC than I paid in taxes in the first place.

    •  OK (3+ / 0-)

      Recommended by:
      Pacific John, anna shane, NewHampster

      Well, by the same logic, how does fining people who do not have health care for their children because they cannot afford it help provide those same people's children with healthcare?

      Why bite the bullet halfway?  Keeping mandates in for all will create enormous pressure to keep affordability in for all.  Once health care is voluntary, there is much less systematic pressure to make sure it's affordable.

    •  Same way imprisoning a bank robber works (0+ / 0-)

      I guess.

      What about driving without a license? It's just a piece of paper, right? Or getting a safety inspection for your vehicle? I mean, YOU are the one that might break down ot have one of those bald tires go flat. How does Obama stand on helmet laws?

      Sorry but his heathcare position is weak. Listening to all these defenses to make it seem otherwise is about like listening to Hillary explain her Iraq voting history.

  •  Here's a response from a kossack against mandates (8+ / 0-)

     * [new] I live in MA and although I have insurance (5+ / 0-)

    Recommended by:
       josephk, NYFM, blue jersey mom, flautist, Great Uncle Bulgaria

    through my employer, but my seasonal temps were left to grapple with the mandatory insurance. Long story short...one of my temps is moving back to Seattle because he can no longer afford MA, in no small part due to the mandatory health plan which would add over 100 bucks a month to his incredibly tight budget.

    We either need Canada-style health insurance, or we need affordable optional health insurance. I think a mandate for purchasing insurance is doomed to fail.

    This information cannot leave this room. Ok? It would devastate my reputation as a dude. Relentless!

    by ablington on Fri Feb 01, 2008 at 07:23:06 AM PST

  •  Anyone who wants health care will be ableto getit (3+ / 0-)

    under the Obama plan. That seems universal enough to me.

  •  Besides (1+ / 0-)

    Recommended by:
    markw

    Didn't Obama say in the debate last night that we couldn't have universal healthcare cause the Republicans said so?

    If I want feel good, happy, happy I will smoke a joint. For President I want a real plan.

    by J Rae on Fri Feb 01, 2008 at 08:45:39 AM PDT

  •  Recommend for a substantive diary (5+ / 0-)

    from an Edwards, now Obama, supporter.

    We have only just begun and none too soon.

    by global citizen on Fri Feb 01, 2008 at 08:46:27 AM PDT

  •  the health care idealists graveyard (4+ / 0-)

    Lets remember right... First it was Teddy Roosevelt, then Truman... then Nixon actually and then Clinton.

    Every time it was defeated because every time Universal Healthcare caused so much opposition, it was a failure.

    There is a reason Obama is right, and that's because his plan will get passed and hers won't.  

    What irks me most is that Dems believe somehow that forcing coverage on people is a good thing... I still believe in freedom of choice, on everything.

    The only thing the government can force me to do is pay taxes and after that, as an American, I want to chose what I participate in

    •  What about all that hope? (2+ / 0-)

      Recommended by:
      oldjohnbrown, eleanora

      Your attitude is a very cynical one.  

      How do you think other countries achieve universal coverage?  They do it because everyone participates through the tax structures except those who are too poor to pay anything.  It's part of belonging to a civilized society.

      If you want to decline health care, then why should anyone feel obligated to pay for your care when you end up in the ER?  

      It's the Supreme Court, Stupid!

      by Radiowalla on Fri Feb 01, 2008 at 08:56:14 AM PDT

      [ Parent ]

  •  Just diaried a couple diaries down (3+ / 0-)

    With almost the same content, just posed differently.

    As I said down there: I think a voluntary approach to health care is the most pragmatic way to cover as many people as possible. Just look at Massachusetts' mandate system and tell me how that is working out.

    "The perfect is the enemy of the good." -Voltaire

    by PsiFighter37 on Fri Feb 01, 2008 at 08:47:04 AM PDT

    •  We have a voluntary system now, right? (2+ / 0-)

      Recommended by:
      burrow owl, markw

      I just don't agree, and I don't think economists agree either.

      •  Economists disagree with eachother (1+ / 0-)

        Recommended by:
        jorndorff

        and you are entitled to your opinion.

        Every other developed country in the world has some version of government funded health care. Insurance companies have no business deciding who lives and dies for 30 cents on the dollar.

        "It's the planet, stupid."

        by FishOutofWater on Fri Feb 01, 2008 at 08:56:49 AM PDT

        [ Parent ]

    •  Unfortunately... (2+ / 0-)

      Recommended by:
      burrow owl, eleanora

      ...a fair number of those without healthcare will find themselves applying for Medicaid, at the expense of everyone.  I'm not saying that mandatory health insurance is the way to go, but it is at least an attempt to address a growing problem.

      There are various subsidized state programs that partly address this problem.  Hardly perfect but the insured pays a scaled insurance premium.  Perhaps this is a better way for now.  

      Fear will keep the local systems in line. -Grand Moff Tarkin -SLB-

      by boran2 on Fri Feb 01, 2008 at 08:59:03 AM PDT

      [ Parent ]

  •  Nonsense, Hillary opposed single payer (4+ / 0-)

    when she had the chance and pushed for HMOs to cut doctor's fees and hospital costs.

    What happened, of course, is that HMOs grew at the expense of quality of care, primary care doctors are disappearing because it's a crappy gatekeeper job now, insurance companies made billions, and the number of uninsured grew rapidly.

    Hillary blew it on health care and she hasn't learned a damned thing.

    Edwards forced her to put a plan on the table that was a lot like his plan without the key component - a buy in to the government plan.

    It's more crappy Hillarycare which benefits insurance companies at the expense of everyone else. Her plan is similar to Mitt Romney's.

    At least Obama's plan doesn't force people to buy crappy high deductible insurance.

    "It's the planet, stupid."

    by FishOutofWater on Fri Feb 01, 2008 at 08:47:13 AM PDT

  •  Heh (2+ / 0-)

    Recommended by:
    slinkerwink, markhaverty

    2 virtually identical diaries posted just minutes apart.

    Where did it come from?

    Taylor Marsh? Not there...
    Hillaryis44? Not there...

    Oh, there it is. Good ol' "Fact Hub".

  •  A mandate without enforcement, (5+ / 0-)

    is a mandate in name only.  If Obama is right that his plan makes health coverage more affordable, then more people will be covered under his plan than under Hillary's.

  •  I just can't see how Obama's plan can work. (6+ / 0-)

    Universal health care means that the high risk of the already ill will be in the same pool of people with low risk for disease.  If people with low risk opt out until they get sick, the system will bankrupt itself with a pool that contains only people with high risk.  

    Guess what. Kossacks continue to be very rude. I am for Obama, but I'm not a Kossack.

    by DCDemocrat on Fri Feb 01, 2008 at 08:49:34 AM PDT

    •  most people will not opt out (1+ / 0-)

      Recommended by:
      oldjohnbrown

      IF they can afford coverage. It's when you have to choose between rent, food and insurance that insurance gets cut.

      "Everyone is entitled to their own opinion, but not their own facts." Sen Daniel Patrick Moynihan

      by atlliberal on Fri Feb 01, 2008 at 08:54:24 AM PDT

      [ Parent ]

      •  How does the cost come down (3+ / 0-)

        Recommended by:
        markw, oldjohnbrown, eleanora

        in the first place?

        The cycle is higher enrollment of healthy people --> cost reduction --> higher enrollment --> cost reduction etc.

        If they don't show up in the first place to start reducing costs so that more of them show up, then what? What's plan B?

        I think both of these proposals are flawed as hell, but I don't see how you get significant cost reductions without the mandate. Obama seems to be trying to do it through competition with a national health plan, but unless his national health plan immediately attracts a huge number of healthy young folks, how does it spread costs well enough to keep the premiums low?

        •  He's banking on the intrinsic appeal (1+ / 0-)

          Recommended by:
          Spit

          of having health insurance. If that doesn't pan out he'll switch up to some form of mandate.

          The appeal of the Obama plan to me rests in the fact that he's just trying to get something done ASAP, and he's willing to present his approach as an attempt that will need to be monitored and perhaps tweaked instead of a panacea.

          Once that's in place he'd damn well better start working on real universal health care.

          No laws but Liberty. No king but Conscience.

          by oldjohnbrown on Fri Feb 01, 2008 at 09:36:02 AM PDT

          [ Parent ]

        •  Both proposals are flawed (0+ / 0-)

          But I cringe when I hear the word Insurance Mandate. (I guess it's my libertarian streak)
          I would be all for single payer because the cost saving would come from being non profit and the efficiency of only having one place to send the bills to. Not to mention healthy and non healthy all being in the same pool. Risk is spread over a much larger area.

          But while mandated coverage sounds like it covers everyone, it really doesn't. If you can't afford insurance, it doesn't matter what the penalty is because you won't be able to pay that either.
          There are drivers out on the road right now without insurance, even though it has been mandated for years. Most policies have a rider to cover damage from an uninsured motorist.

          "Everyone is entitled to their own opinion, but not their own facts." Sen Daniel Patrick Moynihan

          by atlliberal on Fri Feb 01, 2008 at 09:47:52 AM PDT

          [ Parent ]

          •  That's what the subsidies are for (0+ / 0-)

            everybody brings up "those people who can't afford it", but if a well-structured subsidy is given and premiums are capped at a percentage of income -- included in both of these plans -- then that argument is IMO missing the point.

            The problem for me isn't those too poor to afford insurance now, because they're covered under both plans, but how you get the pool big enough to significantly reduce costs to the point that the system itself is sustainable. Obama is assuming that young, healthy people will show up and join the pool in large enough numbers to sustain the system from the getgo. I think those who are subsidized will, but that's not enough to bring the actual premiums down. I'm seriously unclear on how he gets the premiums down in the first place to get the cycle going.

            I'm dubious that significant cost reduction happens on its own without a mandate -- it might, I suppose, but I want a solid plan B, and I think he's going to have a hard time layering mandates on top of his plan when he's been campaigning hard against mandates.

            Neither of these plans are good enough, IMO, but I think if you've got the mandate that brings everybody into the pool, and you've got the subsidies to make sure those who need the help get it, and you've got the public insurance option for those who must have insurance and don't want expensive private insurance, then I think you have a better shot of moving people toward a truly public system over time, which is also something I take into account. The "which proposal positions us better for eventual single payer" question is an important one to me, and not an easy one to answer, necessarily.

            •  Here's the link to How Obama answers your (0+ / 0-)

              Question

              http://www.barackobama.com/...

              I am surely not an expert on insurance but it made sense to me.

              "Everyone is entitled to their own opinion, but not their own facts." Sen Daniel Patrick Moynihan

              by atlliberal on Fri Feb 01, 2008 at 10:42:51 AM PDT

              [ Parent ]

              •  I've read it (0+ / 0-)

                but thanks for the link.

                I'm personally dubious that what he's setting up here will be enough to drastically reduce premiums. Certainly better managed care for all sorts of conditions is extremely helpful, as is transparency to increase real competition, but none of his points get to the fundamental problem, IMO. He's a fan of stressing preventive care, too, which is important, but I just don't think that in itself accounts for the huge amount of cost that is passed on to the consumer by the current insurance system. I don't think you can adequately get costs down for most people until you have a lot more people paying in (and the government, in this case, paying in for those who cannot).

                To be clear, again, I'm not in love with either of these plans, and wish beyond wishing that we'd just make the leap to single payer. But both of these plans start from the point of view of keeping private, for-profit insurance (though both also open up a public plan with which it must compete), and from that point of view, I don't see how a mandate, forcing everybody to pay (or be subsidized) so that all have coverage, can be avoided.

                •  I agree with you that single payer would be (0+ / 0-)

                  The Ideal option, but not very practical right now in the sense that it wouldn't pass. I think both plans get us closer to it by opening up the Govt. plan so that people will see it for what it is rather than what Republicans say it is, so it's a step in the right direction, but far from Ideal.

                  I simply disagree that mandates for private insurance gets everyone covered. It may get slightly more covered, but it won't be anymore universal than Obama's plan if it works like he thinks it will.

                  Either way, whoever wins will have to get their plan through congress and 435 other people will have their way with it before we see what the final product is.

                  "Everyone is entitled to their own opinion, but not their own facts." Sen Daniel Patrick Moynihan

                  by atlliberal on Fri Feb 01, 2008 at 11:04:54 AM PDT

                  [ Parent ]

      •  depends on the risk (0+ / 0-)

        Most people in good health, even with children, would opt out unless the penalties when they needed coverage were frightening. That is why Obama has a mandate for families with children. It's just dollars and cents, if I can save money by not paying premiums, and just pay for coverage when I need it (regardless of the cost of my care), then why pay for coverage now? One dollar now is worth more to me than one dollar at some point in the future.

    •  No "universal" health insurance plan will work (2+ / 0-)

      Recommended by:
      oldjohnbrown, jorndorff

      That is why they are both wrong.

      But until they figure out why they are wrong, and get it that the people want universal health care not universal health insurance, it is better to have Obama's bad plan than Clinton's bad plan.

      That's how I look at this debate.

      "The United States will always do the right thing, after trying all the other options." ~ Winston Churchill

      by Gregory Wonderwheel on Fri Feb 01, 2008 at 08:55:13 AM PDT

      [ Parent ]

      •  darn. (0+ / 0-)

        and hillary said health care is a core value for democrats. she should have checked with gregory first- he's againt it.

        Hillary 2008 - Flying Monkey Squadron 283

        by campskunk on Fri Feb 01, 2008 at 09:25:02 AM PDT

        [ Parent ]

        •  Health care is a core value for Democrats (0+ / 0-)

          Insurance is not.

          I'm surprised that Hillary didn't learn from getting scattered boos in Iowa every time she uttered the word "insurance." People hate insurance companies now, and they hate them for screwing them over and over again on access to health care, which is the issue.

          HR676 is more like what a universal health care plan should be.

          No laws but Liberty. No king but Conscience.

          by oldjohnbrown on Fri Feb 01, 2008 at 09:32:10 AM PDT

          [ Parent ]

  •  Hillary's plan is a failure whereever it is tried (1+ / 0-)

    Recommended by:
    KayCeSF

    First, Hillary is not for universal healh care, she is for mandatory health insurance. BIG DIFFERENCE.

    It is not "universal" either though she keeps saying it is like saying it enough times will make it so.

    Many people in Mass are fed up with their "universal" health insurance plan.

    "The United States will always do the right thing, after trying all the other options." ~ Winston Churchill

    by Gregory Wonderwheel on Fri Feb 01, 2008 at 08:49:41 AM PDT

  •  here is a link to the mailer. (4+ / 0-)

    Recommended by:
    Pacific John, markw, souvarine, rigso

    warning: big PDF

    link

    the old quote from the "daily iowan" is still in here. heh. that's the student newspaper obama used as the primary source to critique hillary's health care plan right before the iowa primary. looks like they still can't find a better source.

    Hillary 2008 - Flying Monkey Squadron 283

    by campskunk on Fri Feb 01, 2008 at 08:55:41 AM PDT

  •  obama's still attacking healthcare from the right (4+ / 0-)

    Recommended by:
    burrow owl, markw, eleanora, souvarine

    ...and hillary shot this down pretty effectively during the debate. for one thing, premium cost is capped as a fixed percentage of income. the less money you make, the lower your premium is, until it becomes free when you fall into medicaid eligibility territory (which will be expanded upward).  she's already proposed expanding SCHIP eligibility up to 400% of poverty ($82,000 for a family of four).  

    Hillary 2008 - Flying Monkey Squadron 283

    by campskunk on Fri Feb 01, 2008 at 09:04:54 AM PDT

  •  National Healthcare (2+ / 0-)

    Recommended by:
    oldjohnbrown, Catte Nappe

    I have not felt that the differences in the plans constitute a major consideration in choosing which candidate to support.  The reality is, that in order to get any national healthcare program through Congress, there will have to be a great deal of negotiation, horse-trading, and compromise.  Thus, the healthcare program that we ultimately get, will inevitably be quite a bit different from the plans put forward by any of the candidates.  I do think that Obama has put his finger on an aspect of the Clinton program that is going to be a bulls-eye when the opponents start taking pot-shots against it, namely the universal mandate.  A lot of Americans will not like the sound of that.  On the other hand, you are correct that I am not sure that Obama has fully addressed the actuarial problem of how you can have universal coverage without universal participation.

  •  I remain (3+ / 0-)

    Recommended by:
    tmo, slinkerwink, oldjohnbrown

    Unconvinced, with even more questions about Hillary's proposed solution than I had before.  Here are my questions:

    1. How are these mandates enforced: Fines or Tax Credits?
    1. If either, how much?
    1. If the idea is to increase the number that are in the premium-paying pool, how does that lower premiums to other people? Doesn't that, instead, raise demand for premiums, thus raising their prices?
    1. In essence, doesn't this plan confuse the situation more?
    1. If people are required to buy health insurance, wouldn't the allocation of risk then drop to the worker, instead of the employer?
    1. What incentive do companies have to continue providing health care to their workers?

    Very substantive debate. I look forward to the answers to these questions, as long as they stay away from the propaganda. You have a chance at convincing an Obama supporter on this one, HRC fans.

    I am an agent of change. So are you.

    by Angry Vet on Fri Feb 01, 2008 at 09:08:35 AM PDT

    •  Too bad (0+ / 0-)

      I laid these questions out above, as well. No answers......

      I am an agent of change. So are you.

      by Angry Vet on Fri Feb 01, 2008 at 09:13:13 AM PDT

      [ Parent ]

    •  here. (3+ / 0-)

      Recommended by:
      markw, oldjohnbrown, Angry Vet
      1. neither- we will flog you in the public square if you don't buy insurance.
      1. LOTS of flogging.
      1. not with the other provisions in hillary's plan. your argument that "demand" will increase premiums is appropriate for free-market systems, but not mandatory systems.
      1. no, it simplifies it. confusion is in the mind of the beholder.
      1. "drop to the worker"??? the risk is assumed by the insurance entity, whether its' a for-profit or a non-profit. the worker and the employer ate the ones BUYING the insurance. they pay for the insurer t assume the risk.
      1. the same as they have now- people like to work for companies with good benefits packages. if they have to pay for it out of their own pocket, it's a disincentive to quit their job.

      Hillary 2008 - Flying Monkey Squadron 283

      by campskunk on Fri Feb 01, 2008 at 09:18:58 AM PDT

      [ Parent ]

      •  Thanks (2+ / 0-)

        Recommended by:
        oldjohnbrown

        For the answers, but I return to one simple rejoinder on them:

        "How?"

        I am an agent of change. So are you.

        by Angry Vet on Fri Feb 01, 2008 at 09:23:17 AM PDT

        [ Parent ]

        •  my, you are full of questions today, aren't you? (0+ / 0-)

          here. this will provide specifics for all your inquiries.

          Hillary 2008 - Flying Monkey Squadron 283

          by campskunk on Fri Feb 01, 2008 at 09:28:48 AM PDT

          [ Parent ]

          •  It does not address the affordability question (0+ / 0-)

            How can anyone tell anyone else what's "affordable"? It's a freaking insult to my intelligence. I'm paying half my income towards rent now, and not by choice. There's nothing left after rent, utilities, and food. NOTHING. And yet my income level will almost certainly exclude me from the public offering and from any subsidies. How would I pay for something that I can't possibly afford?

            A word after a word after a word is power. -- Margaret Atwood

            by tmo on Fri Feb 01, 2008 at 11:35:54 AM PDT

            [ Parent ]

  •  Universal health insurance is not ... (1+ / 0-)

    Recommended by:
    tmo

    Universal health care.

    I don't understand why this isn't clear to people, especially on DailyKos.  

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