The Health Care Plans

Let me begin by saying that all three major candidates have plans that are virtually identical. Almost all political pundits agree on this point. I'll explain the one thing that on the surface appears to be different in detail in just a bit, and I think you'll see that even on this issue, they're really in essence the same thing. The reality is that they're all going to have to deal with the pesky 50-49-1 nature of the Senate. And, more importantly, though they will all greatly improve care in the country, they will all fail to bring about the fundamental changes needed to bring about a true single-payer.

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All three plans have the following major principles:

1) They all propose paying for their plans by repealing the parts of the Bush tax-cut for people making over 250,000 (Edwards says $200,000), by increasing coverage and thus reducing costs, increased investment in technologies, and oversight of the industry.

2) They all require that large employers provide health care.

3) They all let you you keep your current employer-provided or individual health insurance if you wish.

4) They all allow you to forgo your own plan to buy into the Federal Employee Health Benefit Program [FEHBP] (which is the same plan offered to members of Congress) instead of keeping your privately purchased/employer provided option. In Edwards' case a similarly designed public program would be the option instead of the FEHBP. The idea behind these publicly financed programs is to force the insurance companies to keep costs low and quality high by competing with the federal government.

5) They all plan to expand Medicaid and SCHIP (the current children's health program for low-income families currently providing health care for children of families making up to twice the poverty level, meaning families making up to about $40,000). This is the same program the expansion of which Bush vetoed, a veto which Republicans in the House failed to override.

6) They all also plan to continue Medicare (federally funded Health Care for those over 65) and to allow the federal government to negotiate prices on prescription drugs (which, for some god-forsaken reason, the Republican's have been opposed to).

7) They all would make it mandatory that children be insured, either by their parents buying a program for them (with FEHBPA being among the choices), or, for the low-income families, through the federally funded SCHIP.

8)They all guarantee coverage. In other words they would require insurance companies to be willing insure even those with pre-existing conditions, and they would require that this be done at about the same cost as for the healthy. No company would be allowed to refuse health insurance (or health insurance renewal) to anyone based on medical history.

9) They all plan to subsidize the costs for insurance for those whose families make less than $100,000. The lower-income groups would have fully subsidized programs, and those with incomes nearer to $100,000 would obviously have less. It is estimated that the typical savings would be about $2500

10) They all propose forcing insurance companies to investing a majority of profits into medical care as opposed to, say, into executive salaries.


The Irrelevancy of the Mandate Question:

Now, it's well-known that Obama's proposal is the only one that doesn't force everyone, but children, to buy a plan. The fact is that Obama is right, just requiring that people buy insurance would not guarantee that they would actually do so. Afterall, some 15% of car drivers are currently uninsured even though it is required by law that they have insurance. Since his plan is virtually identical to Clinton's and Edwards', he argues if there were to be those who still could not get insurance under the plans, the majority would be those who still could not afford it. These same people would thus also not be able to get insurance under the Clinton and Edwards plans. He says that he would not be willing to put a mandate penalizing people who can't buy until he were sure that these plans were completely affordable for all Americans. Afterall, these programs are really much more health care reform, than the single-payer universal health care that is truly needed in this country. And the reason for that is that until there are 60 willing progressive Democrats in the Senate, single-payer health care will not be in reach.

Now, Hillary Clinton's campaign response to Obama regarding this issue is really laughable. She says that if in these plans health care is still too expensive for some she will just increase subsidies to reduce costs. Is that right?! Woop Dee Doo! Boy was that easy! And you don't think Obama would do the same? There's a reason all the Democratic plans look the same. It's called Congress! If increasing subsidies were so easy, then they would all be off-the-mark by not just aiming for a single-payer system (click here to read a short article on the benefits of single-payer insurance, which just a touch of a decrease in military funding would easily be affordable). But the problem is that Republicans will fight even the moderate proposals these candidates have. And remember, Obama has said that he would consider the use of mandates once he is assured the programs get costs low enough. Realize that it will take time to get the programs implemented and for the cost benefits to be instituted. After all, they all propose requiring that the insurance companies invest profits into medical care. Things like that don't happen over night. A mandate off the bat could really actually be counter-productive. I don't know about you guys, but this minor difference in his plan actually sounds practical. Get the program in place. Once it is affordable enough to cover everyone then institute a mandate. If it does not become affordable enough for universal access, use the programs effectiveness to garner support for additional subsidies to further reduce costs and add the mandate. It seems pretty practical to me.

Ultimately, the point is that all the plans are virtually the same. And unless they can bring costs low enough, a mandate may actually be counter-productive, penalizing those who still cannot afford a program, and providing republicans with primo attack fodder. If costs get low enough to the point that everyone can afford a plan, then you institute the mandate. Even Paul Krugman, who--though approving of Obama's plan--was critical of the fact that it didn't have a mandate believes that once these proposals work their way through Congress they will all be forced to make the same compromises to get passed.