Universal Care: Getting The Right Mix

At Saturday’s health care forum for presidential candidates, John Edwards was bold, detailed and specific—but didn’t diagnose the problem.

Barack Obama was vague—but stressed that no president can do it without the people.

Dennis Kucinich diagnosed the problem, and pushed immediate transformation.

Hillary Clinton, surprisingly, forcefully adopted Kucinich’s diagnosis (before he spoke).

Put them all together—in the right way—and you have a winning health care plan.

I was at the forum in Las Vegas where the Center for American Progress [1] and SEIU [2] made a real contribution to the political debate by getting seven Democratic candidates together to discuss health care.

In a political system where presidential candidates, not party committees, formulate policy for the parties, forcing the candidates to refine their views early—before a crowd of party and union activists—is not a bad thing. Irresponsibly, CSPAN didn’t cover it live, but CAP streamed the event live on the web, and will soon have a transcript available.

Everyone expected former senator Edwards to stress the specifics of his plan for health care for all, and he did. The audience was not so prepared for Obama’s vagueness, but the Illinois senator stuck to principles on the grounds that he was still working on his plan.

But the real surprise was Clinton’s forceful diagnosis of the health care problem—and of her failure to win coverage for all in her husband’s administration.

The New York senator pointed to the power and greed of the insurance industry. She told the Nevada crowd that the failure of her proposal for universal coverage in 1994 made her more determined to achieve the goal now.

As reported by Robert Pear in Sunday’s New York Times, Clinton declared, “[My experience] also makes me understand what we are up against. We have to modernize and reform the way we deliver health care. But we have to change the way we finance it. That’s going to mean taking money away from people who make out really well right now.”

Pressed to explain what she meant by moderator Karen Tumulty of Time, she complained that:

…Insurance companies make money by spending a lot of money, and employing a lot of people, to avoid insuring you, and then if you’re insured, they try to avoid paying for the health care you receive.

(Monday’s front-page story in The New York Times [3] offers a particularly vivid example of that in the long-term care industry.)

With that, Clinton established a strong starting point for an explanation that most Americans can understand about why health care is in crisis. She also announced she would soon introduce legislation to “require that every insurance company had to insure everybody, with no exclusion for pre-existing conditions.”

And with that, Hillary left open the question each of the major candidates need to answer: If the insurance industry is the problem, do we want them to be the centerpiece of an expanded system of subsidies and regulations to try to “incentivize” or force them to cover everyone? And if we go down that road, will we ever get health care costs under control?

Even Edwards, with his admirably frank and detailed plan, does not really answer that question. He builds his coverage-for-all plan around both private insurers and a public, Medicare-like system, claiming that the public’s choices could eventually lead to the private companies losing the competition.

Kucinich was very clear in his response: Even if you set up a public program to compete with private insurers—and even if you regulate the private insurers (as Clinton and Schwarzenegger want to do)—the private insurance companies will find ways to “cherry pick” and cover only the youngest, healthiest and richest parts of the population. And, the representative from Ohio warned, you will end up with only the oldest, sickest and poorest people in the public system—and that is not level competition.

Kucinich’s other warning: Private insurance, with its advertising and administrative costs (necessary to do their “cherry picking” and claims-denying) can never be the basis for an efficient health care system that can get overall costs stabilized.

Kucinich’s problem is the public’s resistance to rapidly imposing his “single-payer” system on everyone—even those (represented memorably by Harry and Louise [4]) who are happy with their current health plan and don’t want to change.

But Clinton’s diagnosis of the health care problem could lead her (or Obama or Edwards) to embrace a gradual shift to a Medicare-style public plan for everyone (individuals and corporations) for whom private insurance is not working.

There was a lot of agreement on important fundamentals at the debate: Edwards, Clinton and Obama all agreed that requiring employers to either insure their workers or pay into a fund to cover them (“pay or play”) is probably the way to go.

So if you put them all together in the right way, you just might come up with a winning health care plan, a winner for the candidate and for the American people.

P.S. – I’m glad I went out to Las Vegas rather than trying to get the streaming video to work. Being there made me realize how for the Democratic Party this health care vision is very much a work in progress. People need to understand that we have the power—though our tough questions [5], through the lines we chose to applaud and through our own strong advocacy of what kind of health program the candidates should adopt. We have the power to shape the program and the message, and the winning strategy.

P.P.S – I told the taxi driver who took me to the Cox Center at the University of Nevada at Las Vegas about the debate about to take place inside. He hadn’t heard about it but thought a health care solution was really needed. Hospitalized with a serious illness—and no health insurance—he ended up with $250,000 in medical debts and had to declare bankruptcy.

After he got well, he tried to get a job (one with health insurance) at one of the big unionized hotels on the Vegas strip, but the hotel turned him down for the job because his credit records indicated he had declared bankruptcy!

This kind of Catch-22 health care system is undermining everyone’s economic security and Americans are looking to us for an alternative.