Daily Kos

Senator Clinton, please listen to me

Sat Feb 02, 2008 at 05:40:42 PM PDT

UPDATE: Hypatica points out that Sen. Clinton does plan to expand Medicaid to cover poor adults without children, which allays many of the concerns I've voiced in this diary.

I grew up when your husband was President. He visited my high school one day 12 years ago when I was a freshman, and here's one of the things he said to us:

Our nation has a lot of challenges that we have to meet together if we're going to make sure the American Dream is available for all young people without regard to their background, if we're going to see that our country remains the strongest country in the world, if we're going to see this country come together instead of being divided by race, by region, by income.

Senator, you and your husband were my hero and heroine. I believed what he told us that day, and I believed him when he shook my hand and looked me in the eye and told me I was the future of this country. I believe that you believe it too.

Senator Clinton, you want to be President next year. I'm so proud, as a young woman, to see you up there as a legitimate candidate. I'm so happy to see that you survived the attacks of the '90s and come out stronger. You've made some mistakes along the way: you voted for the war in Iraq and the Patriot Act, you voted to designate part of Iran's military as a terrorist organization, you argued against Iowa students voting where they go to school, apparently unaware of the years of work your own generation of Democrats put in to make that possible. I can forgive those mistakes. You've also done a lot of good for the country - you've fought for women's choice, for example, and for pay parity and equal opportunity. I believe that the good outweighs the bad, as it does for virtually every Democrat who holds office today.

But you have made one decision that makes it extremely difficult for me to support you. It's not about the past; all of us have some things in our past we're not proud of. This is about the future, about your own American Health Choices Plan. Most of it is very good. In fact, it's much better than Senator Obama's. But there is one part that will have unintended negative consequences for millions of poor and low-income Americans:

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.

Senator, I understand that you intend, through this tax credit, to refund Americans' premium payments in part or in whole. This is a noble goal and one which I absolutely support. But the mechanism of tax credits is flawed in the context of delivery of a subsidy for a cost that must be borne monthly.

I understand that you intend to reduce the monthly costs for everyone by broadening the risk pool and banning surcharges for people who are considered high-risk due to pre-existing conditions. This will allow most middle-income Americans, who have some room in their monthly budget, to afford the up-front costs of coverage.

However, there are millions of poor Americans - students, the unemployed and the working poor - who simply do not have the ability to make that kind of change. Many of us live on less income than some people today pay in premiums: for instance, I currently subsist on the payments from the Montgomery G.I. Bill, which amount to under $10,000/year. I simply cannot pay for anything above what I have right now. If I were required to buy health insurance, I would have to stop buying groceries.

For those who are able to make the payments in order to qualify for the tax credit in the first year that your plan is in effect, the tax credit will be wonderful and it will allow them to resume living their normal lifestyle, with the addition of the peace of mind that comes with health care coverage. But most of us low-income Americans will not be able to give up paying for food, housing or heat long enough to qualify for the credit. I ask you to consider modifying your plan in such a way that it is clear you have not forgotten us and that we will be able to participate in your plan for universal health care and comply with your mandate.

One of your supporters has suggested that one way the poor could be subsidized up-front is through recognizing their eligibility for the credit and applying it to their tax withholding in their weekly or monthly checks, perhaps even paying them directly if the credit is more than the taxes withheld from them. This is a good idea but it is not sufficient.

As I mentioned, my income is the G.I. Bill, which is tax-free. Millions of other Americans have no regular interaction with the the tax system because their income comes from tax-free or informal sources such as day labor, nanny or babysitting work, community-service-based stipends, student financial aid and the like; their only interaction with the IRS, like mine, is filing taxes at the end of the year. Many self-employed people find themselves in the same situation. All of us would struggle enormously with the extra burden of a monthly premium payment, even with the promise of a refund at the end of the year.

One of your opponents, John Edwards, had a plan which included an up-front subsidy to low-income Americans so that we could enroll at little or no immediate cost. Senator Clinton, I hope that you will consider something similar. Universal healthcare is desperately needed in this country, but if it comes at the expense of asking your poorest constituents to choose between the law and the basic necessities of life, the cost is too great. If that is not what you had in mind, I hope you will clarify as soon as possible.

Thank you,
Kyril
Student, Clark College, Vancouver, WA
Veteran, U.S. Navy, '03-'07

Tags: 2008, primaries, Hillary Clinton, health care, poverty, veterans (all tags) :: Previous Tag Versions

Permalink | 41 comments

  •  tips or flames? (30+ / 0-)

    I'll be sending this to Sen. Clinton as well, but I'd like your input.

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

    by kyril on Sat Feb 02, 2008 at 05:41:00 PM PDT

  •  kyril (7+ / 0-)

    You write so cogently and with such knowledge and conviction.  This was an excellent point:

    However, there are millions of poor Americans - students, the unemployed and the working poor - who simply do not have the ability to make that kind of change. Many of us live on less income than some people today pay in premiums: for instance, I currently subsist on the payments from the Montgomery G.I. Bill, which amount to under $10,000/year. I simply cannot pay for anything above what I have right now. If I were required to buy health insurance, I would have to stop buying groceries.

    I agree.  I am so proud to know you.

    (I support Sen. Obama, but I thought this was a superb diary.)

    1-20-09 The Darkness Ends "Where cruelty exists, law does not." ~ Alberto Mora

    by noweasels on Sat Feb 02, 2008 at 05:48:41 PM PDT

  •  This, in the end, is what it comes down to. (5+ / 0-)

    Recommended by:
    eugene, Mike Erwin, dharmafarmer, kyril, eltee

    If I were required to buy health insurance, I would have to stop buying groceries.

    What's the point of the healthcare plan if it puts people into the same economic Procrustean beds they were in when they didn't have healthcare to begin with?

    a gallon of blood for a gallon of oil!

    by haruki on Sat Feb 02, 2008 at 05:51:32 PM PDT

  •  Very well-written. I have one question though. (2+ / 0-)

    Recommended by:
    blueyedace2, kyril

    You state that you believe that her healthcare proposal is better than Sen. Obama's but you also state that her position on this particular aspect makes it difficult for you to support her.  Who would you support if her answer does not satisfy you?  I felt you were saying that you would support her opponent with the inferior plan unless her answer on this issue satisfies you.

    Recommended.

    The soul is not the ego in drag. Ken Wilber

    by macmcd on Sat Feb 02, 2008 at 05:55:35 PM PDT

    •  I don't know (2+ / 0-)

      Recommended by:
      theran, blueyedace2

      I'm completely undecided. I prefer Obama on most things, but I consider healthcare such an important issue that if it were not for this problem, the healthcare advantage alone might tip the scale in her favor.

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

      by kyril on Sat Feb 02, 2008 at 05:58:48 PM PDT

      [ Parent ]

      •  The way I see it (2+ / 0-)

        Recommended by:
        theran, kyril

        An insufficient plan is better than a dangerous plan. Obama's plan is really, really weak - but it won't leave us broke.

        As someone who currently can't afford health insurance, Hillary's plan scares me more than Obama's plan annoys me.

        I'm not part of a redneck agenda - Green Day
        Neither is California High Speed Rail

        by eugene on Sat Feb 02, 2008 at 06:09:03 PM PDT

        [ Parent ]

        •  Same here (3+ / 0-)

          Recommended by:
          eugene, theran, blueyedace2

          Well put.

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

          by kyril on Sat Feb 02, 2008 at 06:09:59 PM PDT

          [ Parent ]

        •  I think Hillary's answer on this was excellent. (0+ / 0-)

          We spend much more on health care in this country than any other country.  When we start doing it right we will be able to save enough money and provide better health care once we start to do it right.  

          I have absolute confidence that if health care can be done right in other countries and it does not bankrupt them, we can do it right in this country, save money, save lives, and give a better quality of life.  

          The soul is not the ego in drag. Ken Wilber

          by macmcd on Sun Feb 03, 2008 at 07:34:41 AM PDT

          [ Parent ]

  •  But you don't know what the percentage is (1+ / 0-)

    Recommended by:
    kyril

    I thought the other night she said the less money you make, the less even the percentage is.

    We said we want change, and they gave us a handful.

    by MouseOfSuburbia on Sat Feb 02, 2008 at 05:57:23 PM PDT

  •  Thats the problem with the mandate, essentially. (3+ / 0-)

    Recommended by:
    theran, Mike Erwin, kyril

    You pass a law that says buy healthcare. What if I don't have the money? People are out here living paycheck to paycheck. Where's that extra dough to buy healthcare going to come from?

    John Edwards basically said, "okay, we'll send you a check to go buy it." That does solve the problem provided it covers the cost entirely, or mostly. But having to wait until the tax refund comes at the end of the year is a non-starter. And when that refund comes, chances are healthcare will be the last thing on folks mind.

    So what happens next? Penalties? Fines? What?

    With him from the beginning, with him until the end.

    by brooklynbadboy on Sat Feb 02, 2008 at 06:11:38 PM PDT

    •  People don't have to wait for tax refunds (0+ / 0-)

      It is possible to get the Earned Income Tax credit in monthly installments...many people avoid that for a number of reasons, including not knowing, being afraid of having to give part of the money back if it turns out they got too much, and because waiting until they file their taxes means they can use it as a sort of forced savings plan that allows them to accumulate a large sum that can be used for a major purchase (such as a "new" used car or home repairs).

      "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

      by Alice in Florida on Sat Feb 02, 2008 at 07:02:52 PM PDT

      [ Parent ]

  •  The way I read Hillary's plan (2+ / 0-)

    Recommended by:
    Turkana, Wufacta

    you would be enrolled in Medicaid, which you already qualify for, and which she says she would strengthen.

    Strengthen Medicaid and SCHIP: The Plan will fix the holes in the safety net to ensure that the most vulnerable populations receive affordable, quality care.

    •  No, I don't (3+ / 0-)

      Recommended by:
      theran, Mike Erwin, Wufacta

      Nor do many other poor people. There are four ways to qualify for Medicaid in Washington, and when I lived in Maryland it was the same:

      1. Be eligible for TANF (welfare), which is a family program requiring one to have children to be eligible, and the income limits are unbelievably low so even if I were supporting five kids on the GI bill I wouldn't be eligible
      1. Be pregnant
      1. Be under 19
      1. Be aged, blind or disabled.

      That's it. I don't see any promise to extend Medicaid to adults with no children.

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

      by kyril on Sat Feb 02, 2008 at 06:25:07 PM PDT

      [ Parent ]

      •  ;-) (2+ / 0-)

        Recommended by:
        owl06, kyril

        Hillary 2008 - Flying Monkey Squadron 283

        by campskunk on Sat Feb 02, 2008 at 06:27:13 PM PDT

        [ Parent ]

      •  You're SOL aren't you? (0+ / 0-)

        Well, TOUGH! You better just get ready to starve because if you don't buy healthcare you're really going to get it!

        UNIVERSAL. That means everyone, like it or not.

        With him from the beginning, with him until the end.

        by brooklynbadboy on Sat Feb 02, 2008 at 06:35:51 PM PDT

        [ Parent ]

      •  That's certainly very unfair. (1+ / 0-)

        Recommended by:
        kyril

        I will be very interested to know Hillary's reply. I have heard her talk about stengthening Medicaid, but she wasn't specific. I hope she is planning on lowering the restrictions. There is no way that universal health care is doable unless those who can't pay have the same access to health care as everyone else. She must have taken that into account.

        I know how scary it is to be uninsured, as I was there in my early 20's, so I empathize.

      •  I was just going over her plan (5+ / 0-)

        and it does take your situation into account:

        Strengthening Medicaid and the State Children’s Health Insurance Program to Serve All Low-Income Individuals: These programs serve over 55 million Americans, and have done so successfully through federal-state and private-public collaborations. The holes in this safety net (e.g., lack of coverage of poor, childless adults) will be fixed to ensure that the most vulnerable populations receive affordable, quality care. Similarly, the other part of the safety net, like public hospitals and community health centers, will continue to receive support to serve vulnerable populations.

        •  Good to know (2+ / 0-)

          Recommended by:
          blueyedace2, Hypatica

          Thanks. Much appreciated.

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

          by kyril on Sat Feb 02, 2008 at 06:47:17 PM PDT

          [ Parent ]

        •  I don't see (2+ / 0-)

          Recommended by:
          blueyedace2, kyril

          how Medicaid can be a solution to the issue -- Medicaid is a state-administered program.   While there are broad federal guidelines - each state has a fair bit of leeway in determining specific eligibility and program administration.

          The problem with a Medicaid solution to the dilemma is that it relies on all 50 states playing ball with the federal government.

          I guess everyone's got their own blog now.

          by zonk on Sat Feb 02, 2008 at 06:53:49 PM PDT

          [ Parent ]

          •  Medicaid is a (3+ / 0-)

            Recommended by:
            blueyedace2, kyril, Hypatica

            state/Fed split on cost administered by the state. The states already play ball with the Feds on this.

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

            by J Rae on Sat Feb 02, 2008 at 07:02:44 PM PDT

            [ Parent ]

            •  Right (1+ / 0-)

              Recommended by:
              blueyedace2

              but my point is that the states individually administer the program.

              Each state has different eligibility and coverage requirements.  

              I'm just saying that expecting to use Medicaid as a cure-all/safety net is a risky scheme.

              I guess everyone's got their own blog now.

              by zonk on Sat Feb 02, 2008 at 07:07:58 PM PDT

              [ Parent ]

          •  and not all states have medicaid (1+ / 0-)

            Recommended by:
            kyril

            Tennessee has TennCare, which is basically a DLC wet dream plan of privatizing medicaid.

            I've been trying to get on it for years and it's a mess.

            Tennessee gov. Phil Bredeson is a DLC "new democrat" golden boy who has made reducing medicare costs for states an area of expertise.

            Here's what he has to say on the issue:

            Here are three basic ideas for Medicaid 2.0:

            No. 1: Everybody pays something. Imagine shopping at a store where nothing has a price tag and you never get a bill. You’d spend a lot more than you do now. But this is exactly how Medicaid works today. Until there’s a little economic tension … until everyone has a little skin in the game—the system will continue to be inefficient.

            No. 2: Pay for the important things first. What my mother called heartburn and took Pepto-Bismol for is now called acid reflux disease, and the little purple pill is a billion-dollar industry. Medicaid 2.0 needs to pare down what it pays for so that everyone has access to basic health care before we bring in the fancy trimmings. A Chevy for everyone before a Cadillac for anyone.

            Finally, No. 3: Pay for what works. I recently saw a report that in 2002, the FDA approved 78 new drugs. Only seven contained new active ingredients that were improvements over existing medications. Yet in many states, Medicaid has continued to pay for these new and more expensive drugs. We need to start exercising common sense in our purchasing decisions — just like the American consumer does.

            I'm less than thrilled.  

            As one of the leading DLC voices on health care policy, he will likely be appointed to any future Clinton health care task force.  

            ---
            Fight the stupid! Boycott BREAKING diaries!

            by VelvetElvis on Sat Feb 02, 2008 at 08:25:37 PM PDT

            [ Parent ]

        •  this is where shared responsibility come in (0+ / 0-)

          when JFK said ask what you can do for your country it meant a sense of shared responsibility. Obama talks about shared responsibility but his healthcare plan skips out on that, it is as if shared responsibility is a catch phrase. Universal healthcare will only be attainable with a shared responsibility. Unless everyone chips into one common pool it will never happen and the way to do it is for those who can buy healthcare at an affordable price must be mandated to do so this in turn reduces the pool of the uninsured and those who really cannot afford health insurance can then be covered by the government. If you game the system you do it at the peril of others.

  •  You tend your diary well.. (1+ / 0-)

    Recommended by:
    kyril

    on a busy night, and...

     title=

    Yes. We. Can.

    The lesson of that history is that you must not despair, that if you are right, and you persist, things will change. -Howard Zinn

    by blueyedace2 on Sat Feb 02, 2008 at 06:59:03 PM PDT

  •  A refundable tax credit is the same (3+ / 0-)

    Recommended by:
    blueyedace2, kyril, Hypatica

    as "sending people a check"...it could be done without the expenses of actually sending people the check, just paid directly into the insurance fund. Single payer would be better, and we need to keep pushing for that, but I don't see the issue you raise as an actual problem provided the system was set up properly. I have been very impressed with Clinton's command of detail and think she would be most likely to get these kinds of things right.

    "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

    by Alice in Florida on Sat Feb 02, 2008 at 07:09:21 PM PDT

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