...so far.
The Commonwealth Fund has done the couontry an enormous (if oddly incomplete) favor and done an independent detailed comparison of the many health "reform" proposals in congress and the Obama plan
Bottomline:
The only plan that both covers eveybody and actually controls total costs is the plan that is closest to single-payer.
Follow me for more details...
1. Comparison of the Obama, Baucus and Building Blocks Plans:
The table below compares the main features and goals three very similar plans: the latest version of the Obama plan, the proposal from Senator Baucus who as chair of the Budget committee will be playing a major role in whatever passes, and what has come to be known as the "Building Blocks" plan. The Building Blocks plan is the latest version of the mixed mandate proposal from the mainstream beltway liberal coalition, similar to the Edwards and Clinton plans from the primaries and to that of Jacob Hacker.
Indeed all three of these proposals are similar in their essence: build on the current system of mostly employer-based coverage purchased from private-for-profit insurance companies, with various mixes of tax breaks and employer and individual mandates to promote mor such purchasing from the private for-profit insurers, and some expansion of public options to make up the difference.
Since details of the Obama plan and the Baucus plan are not fleshed out, since they all derive from the same assumptions and same group of policy wonks, and are as noted so similar, they can be lumped together with the Building Blocks plan in most of the further analyses.
The table below show many of the rest of the plans in congress, from key Senators and Representatives, Republicans and Democrats:
2. Comparison of the All the Rest of the Plans:
For reasons which are not known to me, Commonwealth and Lewin chose not to analyze the Conyers' Plan, HR-676. The closest to single payer, though not quite, is the proposal by Peter Stark who, as the chair of the health subcommittee in House Ways and Means (and second in line overall after Rangel) should also play an important role. I will come back to HR-676 and how it differs from Stark's plan later, but for now, the the Stark plan stands in for the best there is (here, in this comparison) from a progressive point-of-view.
3. Summary of Coverage and Costs Of The Proposals:
So... how many of the currently uninsured will be covered?
And how much will it cost?
And an important, and often neglected, question... who pays what?
The table below provides an overall summary.
4. Number of the Uninsured Who Would Become Newly Covered:
Looking first at how many of the currently uninsured will become covered?
Out of the estimated total number of 48.9 million, only the Stark Plan, like the Conyers HR-676 plan, would automatically assure that everybody is covered.
The Wyden and Building Blocks (including Obama and Bacucus to lesser extents) come close.
The other plans, including all the ones from Republicans don't come close and don't really even try.
So, what about costs?
5. Change in Spending Just of the Federal Government:
The graph below shows just the direct costs to the Federal government, not the total cost.
In other words, not the additional costs by individual and familys such as premiums, deductibles co-pays, out-of-pocket due to resusal of insurance company to pay. It does not include additional costs by employers. It does not include additonal cost by state or local government.
Not surprisingly, the Wyden Plan, which like the McCain and Guiliani plans from the campaign, takes away the tax corporate deduction for providing insurance and does little to offer pay directly for coverage, saves the Federal Government the most. While the proposals from Stark, Enzi, Burr and the Building Blocks plan cost the Federal Government the most.
When the Congressional Budget Office comes out with favorable analyses of the Wyden plan, this is what they mean. But as we shall see, this is a very incomplete and essentially dishonest view.
6. Total Change in National Expenditures on Health Care:
This table show the change in total costs, the total national expdentiture on health care. This is the one that corresponds with Percent of GNP spent on health care, that infamous statistic that shows that U.S. spends twice as much as other developed industrialized nations, but is the only one not covering everybody and the only one bankrupting families if they get sick... and the only one depdendent on for-profit private insurance companies.
Notice the complete turn-around compared to the JUST federal government view in the prior table. While the Wyden plan saves the Federal Government money, it actually increases total costs and dumps those cost onto others.
Indeed most of the other plans... Enzi, Baldwin, Burr and alas even Building Blocks (including Obama and Baucus) amount to huge give aways and supports for the private for-profit insurance companies.
Only the Stark Plan (like Conyers HR-676) actually saves money for the overall system, the country as a whole. Only Single-Payer like plans can actually control overall total costs.
7. Who Pays by Stakeholder Under the Different Plans:
This is the real story, typically ignored by proponents of the other plans including the Wyden plans and the various variations of mandate plans (Obama, Baucus, Clinton, Edwards, Building Blocks, etc.)
The Building Blocks plan, like the Obama and Baucus plan, would increase costs overall, and to the federal government and for employers. The Wyden plan dumps even heavier on employers. Regardless of what the CBO or GAO or beltway mainstream may say, being "revenue neutral" and saving the Federal government money is not the most important goal of health care reform. We do need to control costs, but it is overall total costs that are what really count. We also need to provide coverage that is truly Univeral for all people, Comprehensive in covering all health needs, and does not bankrupt you if you get sick.
The Stark proposal, like the Conyers' HR-676, takes on access to health care coverage as a national responsibility, paid for by federal taxes, but reducing direct and total costs to states, local governments and for individuals and families. And as noted they are the only plans that makes a significant overall cost reduction and control. And they are the only plans that actually result in coverage for everybody!
Of course worst of all, essentially fraudulent nonsense, are the Republican plans (Enzi and Burr) that provided minimal addition coverage, while lining the pockets of the for-profit private insurance companies even more than now.
Okay. That is a lot to digest for now (there is always more here and here)
I will back on Tuesday with part two, including more on the Stark versus Conyers conundrum.