Blogs: Roger Hickey

Sen. John McCain's health care plan is a dangerous fraud. It will dismantle the employer-provided system that now covers about 158 million Americans and will force millions of workers to fend for themselves in a market controlled by unregulated and predatory insurance companies. His plan would drive health care costs upward, not downward.

RELATED:
 • Bernie Horn on "How to Talk About Health Care"
 • Facts and analysis of our "Health Care for America" plan more »

Last week, the Economic Policy Institute released an important analysis of Jacob Hacker’s Health Care for America (HCFA) plan by the respected health economics team at the Lewin Group. more »

Editor’s Note: “The 2008 election campaign is almost sure to be a health care election — even before we’ve done much organizing at all,” said America’s Future co-director Roger Hickey at a conference sponsored by New Jersey Citizen Action on November 13. “So imagine what will happen once we get going.”

In this keynote speech at the “Conference on Health Care for All: Real Solutions for New Jersey and the Nation” in New Brunswick, N.J., Hickey outlines what he sees as possible. more »

One hundred and fifty-six House Members declared themselves enemies of children and families with this vote. more »

The big news from Sen. Hillary Clinton’s Monday health care speech in Iowa is that she is going to make a campaign for health care for all — not just small changes but fundamental reform — a central element of her campaign for the White House.

Before the speech Jonathan Cohn was not the only health care reporter asking the question, “Will she flinch? . . . Would she settle on something less than universal coverage, figuring the political support for it was too weak?” She didn’t. She responded to the American majority clamoring for bold leadership to achieve health care for everyone.

Clinton would achieve universal coverage by offering an array of private insurance plans that meet the standards for benefits and premium costs set by the Federal Employee Health Benefits Program — the quality plan covering members of Congress and other federal workers. And she would also offer a public health care plan similar to Medicare.

All of these plans would be portable through life changes, such as when you leave or lose a job. Employers would be required to provide their employees health insurance or pay into a fund to defray the cost of covering those employees. (Small businesses with fewer than 25 employees would be exempt, while getting tax breaks to encourage them to offer coverage.) All Americans would be able to buy into any one of the available private insurance or public plans — with a graduated system of tax credits designed to make sure that no one pays more than an (unspecified) reasonable percentage of their income on health premiums.

It is no coincidence that the basic elements are similar to those already proposed by her main presidential primary competitors. The “ideas primary” between the candidates has been shaped in part by our unique effort — chronicled in this blog all year — to engage the candidates around Yale Professor Jacob Hacker’s progressive health care plan, “Health Care for America.” more »

Americans want big changes in our heath care system. And now Michael Moore's great new film, "SiCKO," is helping to turn a desire for change into a crusade for change.

Now breaking box office records in its second week in theaters, "SiCKO" conveys powerfully emotional stories of Americans trapped in a system controlled by insurance and drug companies that deny care and destroy lives in order to maintain their profits. We walk into the movie house as individuals with our particular gripes about the health care system. And we walk out wanting to be part of a national movement for health care for all. For example, read this great account of how spontaneous organizing literally occurred in the theater lobby—at a Dallas, Texas suburban cineplex.

So, what kind of movement should we be building? more »

The following is a part of the TPMCafe Book Club group discussion of the new book "Sick: The Untold Story of America's Health Care Crisis -- and the People Who Pay the Price" by Jonathan Cohn

Several participants have rightly insisted on focusing us on a large order question: what kinds of fundamental reforms are necessary to get a health care system that will cover everyone, improve health and make the health care system much more efficient?

And the big debate is over the role of the private health insurance industry: can we regulate and “incentivise” big health insurers to get them to achieve these goals, even though their business model has produced many of the very problems the public wants solved?

A few others have plaintively insisted that all this talk about systemic change and the model of single-payer is politically unrealistic and therefore irrelevant.

Mark Schmitt  and others rightly ask if we can combine our long-term vision with a constructive participation in the messy realities of the political process.

As I noted earlier in this conversation, the public has signaled to the politicians that health care is a priority issue, and the politicians (at least on the Democratic side of the presidential race) have responded with a generalized pledge: “I will make sure that everyone is covered by the end of my (first or second) term.”

Since they are all scrambling to figure out how to do that, we have an enormous opportunity before us.

I submit that one of the best things we on the “progressive” side of this debate can do this year is to engage the nation—and the politicians—in a public discussion about the private health insurance industry: about the many ways the industry deforms and cripples our health care system—and about how they actually kill people.

I reported (via the OurFuture blog and The Huffington Post ) about New York Sen. Hillary Clinton's masterful presentation at the Las Vegas presidential debate on health care.

Former Sen. John Edwards was of course, specific and eloquent, embarrassing Illinois Sen. Barack Obama for lacking details. But Clinton firmly took out after the health insurance industry. Take a look at this short excerpt and tell me it doesn’t sound like she’s getting ready to cut private health insurance completely out of her health care plan:

I am in favor of universal health care coverage. [And a system] that begins to guarantee coverage to people who already have insurance, because, let's not kid ourselves, there are a lot of people who think they have insurance except when they need it. [She tells a story about a woman excluded from insurance because of a pre-existing condition.]

Now, I don't want to wait until I'm president to begin. I'm going to introduce legislation while I'm in the Senate to end insurance discrimination. Guaranteed coverage. No more cherry picking.

You cannot eliminate people on the basis of preexisting conditions, because that's what we need insurance for. And, you know, we've now met the human gene. We're going to find out we're all susceptible to something.

So, none of us are going to be insurable if we don't change this system. And I think we need to start now in order to make sense out of it and get people the coverage they deserve to have.

Now this kind of populist rhetoric is also useful if she is planning to go for a wimpy and dangerous plan like that of Sen. Ron Wyden, D-Ore., that essentially gives all our public subsidies to the insurance companies—while pretending to regulate them. The point is that Hillary is aware of the public anger at insurance companies among the voters, and she is determined to make it work for her.

We should be doing the same thing—but with the goal of channeling that anger to some productive conclusions:

• Insurance companies distort our health care system at great cost, and therefore:

• We should demand politicians tell us how they would make insurance companies change their business model—now based on insuring the well and the wealthy. or

• We should build our health-care-for-all vision around a public system—like Jacob Hacker’s Health Care for America —not the private insurance companies.

Even if you are one of those who believe the next president will have to capitulate to the insurance industry in order to get anything passed, you’ve got to see that having the companies publicly on the defensive—explaining that they don’t want to cut off peoples’ insurance or charge outrageous premiums—has got to give us an advantage even if our goal is getting a plan for America that is marginally better than Massachusetts or California.

But millions of Americans are telling the politicians that we can do better. Edwards deserves the praise he’s been getting (including from me) for the way he’s detailed a plan that bites the bullet on paying for coverage in a progressive way and for requiring employers to “pay or play.”

But on the role of the private insurance companies, Edwards essentially splits the difference. His plan is a cross between California Gov. Arnold Schwarzenegger and Hacker (the Hackernator?).

Obama is now on the spot. He’s got to decide whether he advances a plan (or at least principles) that are more progressive than Edwards—by limiting the role of the private insurance companies. And as we all know, the grass roots and the progressive bloggers have some influence on the policy decisions of Democratic candidates trying to excite the Democratic base.

Many of the participants in this conversation are very good at explaining and detailing the many ways in which the health insurance companies have helped to create our dysfunctional health care system. We at the Campaign for America's Future are eager to work with you to turn that explanation into a grass roots campaign for change.

And then, of course, we need a positive plan to cover everyone in America. One of the things we learned last time around is that Americans want a vision for health care that they can understand—and a solution to big problems of costs and coverage that proceed from an understandable diagnosis of why we face those problems.

What we do over the next few months can help shape the proposals the 2008 Democratic presidential candidates offer to the nation on health care. And what we do over the next several years can help shape how those proposals evolve—and whether they have a chance of succeeding in our lifetimes.

This forum helped clarify the challenge we face. And, as motivation, I leave you with Matthew Holt’s description  of the outcome he fears. (It’s a pretty good description of my fears about our legacy if we don’t rise to the challenge.):

My essential fear though, is that we’ll only get to some kind of compromised quasi-universal coverage system that doesn't really cover everybody, keeps a role for a private insurance industry operating under the wrong incentives, and looks like welfare for the poor.

In that case this whole cycle will start again, and in about 15-20 years when we go into a more violent collapse—then we will end up with Soviet-style rather than Danish-style socialized medicine. And we ought to be able to do much better than that.

The following is a part of this week's TPMCafe Book Club group discussion of the new book "Sick: The Untold Story of America's Health Care Crisis -- and the People Who Pay the Price" by Jonathan Cohn

Kudos to Jonathan for his important new book.

One of the reasons we are talking about what's the right approach -- or the most politically feasible approach -- to insuring all Americans is that millions of Americans are telling pollsters and politicians that the health care system is in crisis. The public has put this issue on the table for the political system -- not the policy wonks.

Individuals, like those profiled in Sick, experience the health care crisis in many ways. But is there a explanatory diagnosis for why the health care system is not serving them?

Perhaps some people think the problem is not enough careful tinkering with the system we have. But increasingly, the diagnosis that makes the most sense will focus on the structural failures of the private health insurance industry.

If insurance companies make their profits by denying care, refusing to cover people who are expensive, spending more money on advertising than they do on wellness, and just passing along increased health costs -- then the public may decide that tinkering with the private health insurance system (and subsidizing and regulating them to do what their business plan doesn't allow them to do) is not the way to go.

So I'm betting that the public, making the diagnosis that the private insurance industry is a key part of the problem, is unlikely to be impressed by tinkering.

And many experts and commentators (who do think in their heart-of-hearts that single payer is the way to go) may be surprised that the public won't see "regional buying pools" and individual mandates as giving them the kinds of guaranteed coverage the system doesn't currently offer.

This promises to be an exciting discussion. Many of us who think single-payer is the right direction have thought long and hard about step-by-step ways to get there.

Jacob Hacker's plan, recently published by EPI, is structured to allow lots of choice -- including ways to let Harry and Louise keep the private health plans they now have if they like them.

But the big question is the one Jonathan asks here: will tinkering, even at an ambitious scale, get us a health care system that covers everyone, affordably, and with the kinds of structural arrangements that can begin the reorganization of the health care system to control the spiraling health care costs our economy is now facing?

The following post is a part of this week's TPMCafe B more »

The following post is a part of this week's TPMCafe Book Club group discussion of the new book "Sick: The Untold Story of America's Health Care Crisis -- and the People Who Pay the Price" by Jonathan Cohn.

Kudos to Jonathan Cohn for his important new book. One of the reasons we are talking about what's the right approach -- or the most politically feasible approach -- to insuring all Americans is that millions of Americans are telling pollsters and politicians that the health care system is in crisis. The public has put this issue on the table for the political system -- not the policy wonks.

Individuals, like those profiled in "Sick," experience the health care crisis in many ways. But is there a explanatory diagnosis for why the health care system is not serving them?

Perhaps some people think the problem is not enough careful tinkering with the system we have. But increasingly, the diagnosis that makes the most sense will focus on the structural failures of the private health insurance industry.

If insurance companies make their profits by denying care, refusing to cover people who are expensive, spending more money on advertising than they do on wellness, and just passing along increased health costs, then the public may decide that tinkering with the private health insurance system (and subsidizing and regulating them to do what their business plan doesn't allow them to do) is not the way to go.

So I'm betting that the public, making the diagnosis that the private insurance industry is a key part of the problem, is unlikely to be impressed by tinkering.

And many experts and commentators (who do think in their heart of hearts that single payer is the way to go) may be surprised that the public won't see "regional buying pools" and individual mandates as giving them the kinds of guaranteed coverage the system doesn't currently offer.

This promises to be an exciting discussion. Many of us who think single-payer is the right direction have thought long and hard about step-by-step ways to get there.

Jacob Hacker's plan, recently published by EPI, is structured to allow lots of choice -- including ways to let Harry and Louise keep the private health plans they now have if they like them.

But the big question is the one Jonathan asks here: will tinkering, even at an ambitious scale, get us a health care system that covers everyone, affordably, and with the kinds of structural arrangements that can begin the reorganization of the health care system to control the spiraling health care costs our economy is now facing?