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An Amnesiac Healthcare Plan

Posted on Feb 7, 2007

By Marie Cocco

WASHINGTON—John Edwards is trying to get ahead of the political curve, but he would send us back to the future. To 1993, to be exact.

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Edwards would repeat the mistake that was at the heart of Hillary Rodham Clinton’s misadventure in trying to fix a health insurance system that was then, and is now, so out of whack that it manages to cover fewer and fewer Americans at higher and higher cost.

As Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business. He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.

The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.

So Edwards wants them to be able to buy a new public insurance plan that would be like Medicare, but not exactly. And he wants affluent people to pay more taxes to support coverage of the less fortunate, but not directly.

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Instead of simply asking for a straightforward tax to pay for covering the uninsured, Edwards falls back on that popular circumlocution, the tax credit. The credits are indirect subsidies that would be given to individuals so they could then purchase insurance. The political virtue of tax credits is that their cost is always half-hidden beneath a pile of budget documents—unlike tax hikes that show up as money withheld from paychecks but that pay directly for a government service. Because of this obfuscation, politicians in both parties love tax credits.

Edwards wants congratulations for being the first serious presidential candidate to offer a comprehensive idea for universal health insurance coverage, something every Democratic aspirant is bound to do eventually. Edwards is a smart man and a cunning politician. But his health insurance plan suffers from an odd combination of ailments.

One is political amnesia. This Clinton-like plan that would have both individuals and employers buy into closely regulated health insurance pools failed more than a decade ago—in part because it was so complicated as to be incomprehensible. Another is timidity. Edwards won’t acknowledge that the current system of private insurance is irreparably broken. 

It has failed to expand coverage to millions of workers who are employed by small business, or who work part time, or who toil at low wages—companies with high proportions of low-wage workers are far less likely to offer insurance than those whose employees earn more, according to research by the Kaiser Family Foundation. Since 2000, the portion of businesses that offer any insurance to even part of their workforces has fallen from 69 percent to 61 percent.

Over the past year, a solid majority of those who do have coverage—60 percent—experienced an increase in the amount they are responsible for paying under their plan, the Employee Benefit Research Institute says. Almost a third of covered workers reported difficulty in paying for basic necessities such as food, heat and housing because of rising healthcare costs.

This isn’t much of a foundation upon which to construct a new system. In the years since Clinton tried to build on this inhospitable terrain, the ground has eroded further. It makes no sense to try to shore it up with an awkward hybrid of public requirements and private insurance that would keep in place unnecessary complexity and bureaucratic expense.

Edwards’ advisers say the candidate didn’t push public, single-payer insurance—like Medicare—because the employer-based system is what we have today and therefore it would provide the quickest way to cover the uninsured.

But we also have Medicare today. The elderly still get care from private doctors and hospitals, and administrative costs are a fraction of what they are in the private insurance industry. And people tend to like it.

It would be just as easy—and certainly simpler—to use Medicare as the foundation for a new insurance system to eventually cover everyone. But that would require candidates to be leaders—and show more courage that those politicians who simply say they have a plan.

Marie Cocco’s e-mail address is mariecocco(at symbol)washpost.com.

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By Karl, February 14, 2007 at 6:00 am Link to this comment
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It is a “sin” that the US spends almost half a trillion dollars on the military and is the only significant country in the world that does not have a universal health care progam.  A few years ago, an international study compared the health care system of all countries in the world.  The US was about 30th in efficiency and effectiveness.  Countries like Cuba were far ahead.  Yet, the press chooses instead to focus on Pentagon propaganda…recently….looky..looky…Iran’s weapons are being used in Iraq to kill American troops.  Lies.  Instead the media, a dupe of the military-industrial complex, should be focusing on the real issues affecting Americans.  As far as the Democrats and Republicans are concerned, I say vote them all out of office.  Neither party offers real alternatives.

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By follow the money of Insurance LOBBY personnel, February 12, 2007 at 2:00 pm Link to this comment
(Unregistered commenter)

Why Health Insurance is sooooooooo HIGH!

Blue Cross / Blue Shield is the number ONE lobby boy at K - street trolling out the BUCKS to the political congress animals.

Then go down the list and YOU will notice that INSURANCE companies are the largest whores on K- Street by far.

OPEN Secrets

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By GW=MCHammered, February 11, 2007 at 7:19 am Link to this comment
(Unregistered commenter)

Physicians for a National Health Program of Single-Payer National Health Insurance… complete health care for all! http://www.pnhp.org

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By Bert, February 10, 2007 at 10:30 pm Link to this comment
(Unregistered commenter)

Where’s my in-home medical computer self-check interface, and software support? Patient, heal thyself, that’ll chop 30-40% off the total costs of healthscare, er, healthcare…they’re just trying to parley hospitals into massive jobs programs etc…all lies. See ‘patient dumping’. Dead doctors don’t lie…

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By rverne8, February 10, 2007 at 3:24 pm Link to this comment
(Unregistered commenter)

Health care is a many faceted subject; as all of us are affected, the subject of reform deserves careful consideration. For those who are seriously interested, I highly recommend Michael E. Porter and Elizabeth Teisberg’s book, ‘Redefining Health Care, Creating Value-Based Competition on Results’
One of the key points in this book is:- the high cost of health care in America mainly results from low quality care all across the health care cycle. As a worker in the health care industry, I can testify to having seen several examples of badly executed procedures that have later resulted in the patient coming back for more expensive treatment and care.  The main body of health practitioners, particularly specialists and surgeons, in this country guard the issue of quality of care with fortress like determination, resulting in a lack of shared knowledge of best practices in such areas as surgery.  Until those fortresses are lowered and reasonable assessments of patient risk are combined with public knowledge or provider’s abilities, reform will continue to careen in and out of the ditch.

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By joneden, February 10, 2007 at 9:16 am Link to this comment
(Unregistered commenter)

I am sorry to have to inform you that the system is going to have to remain broken—there is just too much money to be made by the major players. In other words it ain’t broken.

America is not for losers. If you aren’t covered at work or unable to cover yourself, you might want to consider going to Cuba or somewhere like that. In any case if you get sick here and you are not covered, do not expect the tax payers to pick up your tab. And as for putting it on your credit card, go ahead but know in advance that with the new bankruptcy laws, you may lose your house—you have no right to expect the rest of us consumers to cover for you.

Health care is not a right. If you cannot afford it, then you are just going to have to go without. This ain’t a welfare state—you want something here, you pay for it. This is capitalism and this is why we are GREAT. It is not for everyone.

Good luck!

jon
Connecting the dots: From human behaviors to Ecosystem decline
http://StudentsForTheEarth.org

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By Herman Schmidt, February 10, 2007 at 8:49 am Link to this comment
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As a nation we need to start with the proposition that everyone should be covered for a basic set of health services. The simplest way to do that is the Medicare model, where the government pays the bills. It could also be administered by individual states as long is universal coverage is the norm. A health care card for everyone with a set of fees paid by all providers. One of the barriers to getting support for this kind of system besides the insurance companies who will get none or a very small piece of the money will be those with Mercedes health care coverage, who will have to queue up with the rest of us. I want a system where my Congressman is sitting in the same waiting room as me and my family and where no one gets to the head of the line except for medical reasons. A universal single pay system will have problems, but it will be cheaper, fairer and we will be healthier. Support for such a system is far greater than we realize, and once such a system is laid out for the public to see, I think support will rise significantly.

I agree with the article. Stop pussy footing around and lay out a plan that we need.

Herman Schmidt

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By Lord Byron, February 9, 2007 at 2:47 pm Link to this comment
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Why is it that only one democratic candidate for President, Kucinich, is the only candidate who actually supports single payer health care??? 

Hillary is nowhere to be found on single payer. She’s completely ABSENT from the discussion. Obama? Haven’t heard from him yet. Gore??  Haven’t heard from him yet. Anyone else????

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By G. Anderson, February 8, 2007 at 10:07 pm Link to this comment
(Unregistered commenter)

All most all of the ideas for Health Care reform focus on increasing access to services.

These plans simply won’t work. Why, because part of the obscene profits of health care companies have come from destroying the health care infrastucture. Closing hospitals, closing clinics and forcing treatment providers out of business by paying them next to nothing, this they’ve done while at same time importing cheaper labor from the third world.

Unless we invest in new facilities, and encourage americans who want to work in the field by raising their standard of living, then these plans will fail.

There’s a reason why you can’t prounounce your doctors last name.

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By yours truly, February 8, 2007 at 4:26 pm Link to this comment
(Unregistered commenter)

So because we have this inadequate and wasteful private health insurance system we’re stuck with it?  Never mind that every day for want of health coverage some of us die, since what matters isn’t one’s life and well-being, but that health care be privatized. And this even though a Medicare for all health care system would cover everyone with nobody left out, and at half the cost of private insurance. A case of ideology uber volk. Simple as that.

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By Ed, February 8, 2007 at 10:05 am Link to this comment
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With my experiences dealing with insurance companies, hospitals and doctors, I say: tax us, build a single payer medical system and put the health insurance companies out of business. Medical services need to be more about people and less about money.

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By anonymous, February 8, 2007 at 9:31 am Link to this comment
(Unregistered commenter)

If this were an economics/efficiency/fairness argument, Medicare would have already replaced all private insurance.

Insurance companies have more money than all of us and politicians are cheap as dirt.

Any changes made will make them richer and the rest of us poorer.

You can bet your health on it.

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