TX Primary: Obama's poor judgement on healthcare

Why the lack of balance? (2.75 / 4)

I usually just read posts here, but this one got me out of my shell.

It's quite easy to cite experts that both agree and disagree with mandates.  Sherry Glied (a professor at Columbia) did a research study of several European mandated health care plans and that in Mass., and found that mandates don't always help increase coverage.  (And when they don't increase coverage, they certainly are hurting those who can't afford them.)  Robert Reich has fired back in equal measure against Paul Krugman's recent rants about mandates.  (Which is sad, because Krugman used to be much more measured in his arguments.)

Also, there's an inconsistency in the argument presented here, which is that the supposed 15 million who are left out of Obama's plan are also supposedly "left out" because they're young, healthy, and don't care about health insurance.  (As Clinton recently said - "they think they're invincible".)  Ok - the question is - how many of these folks are really suffering from catastrophic illnesses that are costing the taxpayers a ton because of their lack of insurance?  You can't cite statistics on cost that are averaged over the whole population and then apply them to a small subpopulation who is claimed to be left out under Obama's plan largely because they're young and healthy.

Finally, there's the final perspective, which is more of an ethical one for me - whether the government should force people to buy something from a private institution - an insurance company - if they can't afford the federal plan and don't have employer-based coverage.  Car insurance is different - driving is always considered a privilege, not a right.  But living is different.  Now, if Clinton's plan were truly universal, like Kucinich's, then I'd buy the argument, because then the government isn't mandating purchase from private companies, and is going to provide all Americans health care regardless of their "insurance" status.

(And while I understand the author is a doctor, for what it's worth, I say this after extensive discussion with my mom, who's a doctor and a sister who studied public health, both of whom are liberal Democrats and support Obama's plan.)

By the way, this bugged me:

For such a brilliant man, I am shocked that Senator Obama missed such a fundamental part of the solution to the problem of healthcare or isn't willing to take the bold changes that he advocates for. I worry that this may be indicative of his judgement regarding other issues.

This quote is simply concern trolling - there's simply no reason for someone to imply his plans are inferior, or worse, that his judgment is flawed on another issues, say on Iraq, based on a well-known and valid policy disagreement on a completely unrelated issue, health care.  If his judgment is flawed on other issues, say why.

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by: meese @ Sun Mar 02, 2008 at 03:43:44 AM CST

Don't let Big Pharma say what's best for Texans' Health (2.33 / 3)

IMHO Clinton's plan was drafted by Big Pharma, for Big Pharma.

It mandates that we have to pay whatever they dictate -- and turn down whatever procedures they can find a doctor to rubber-stamp as 'unnecessary' or 'experimental'.

Notice how Big Pharma shill Dr. Yen conflates universal coverage with universal care .   That's one of their tactics: by equating in peoples' minds universal health coverage with universal health care   they keep the debate over insurance company profits off the table.  

With universal coverage Hillary Clinton gets to reach into your paycheck with yet another automatic deduction -- and fine you the minute you can't afford it.  And most of it goes to her friends in the medical insurance industry anyway -- just like it works in Massachusetts.  

With universal care you go to the doctor or hospital and never even hear about a bill -- like it works in France, Germany, Canada, Great Britain, New Zealand, Sweden...

Obama's plan is the only one that even mentions controlling costs to move us, step by step, to universal coverage .  

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by: wagwa @ Sun Mar 02, 2008 at 08:28:31 AM CST

[ Parent ]

You're very right - care vs. coverage is important (2.00 / 1)

I hate to cite Sicko, but the movie made the valuable point that even if you ignore those who don't have health insurance, those who have insurance are still not getting health care.

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by: meese @ Sun Mar 02, 2008 at 12:44:45 PM CST

[ Parent ]

This is not correct (0.00 / 0)

I tried to make it clear in the first line that I think universal healthcare without any insurance companies e.g. single-payer is the best.

Also, please check your facts: Clinton's plan does mention cost control.

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by: sophiay @ Mon Mar 03, 2008 at 08:39:19 AM CST

[ Parent ]

You seem to be missing the point on costs (2.75 / 4)

As a doctor associated with Standford Medical Center you should have fairly decent grasp on the cost issues.  Your post suggest otherwise.

I graduated from Stanford, and as a Stanford alumni I can tell you that what I see in my financial planning and advising practice is exactly the opposite from what you state.  And, it does not matter what any expert says, what matters is what happens to people everyday.  

It is just like Obama says, people don't have health insurance because they don't want it, they don't have it because they cannot afford it.

Do you get it? People don't have health/medical insurance because it is too damned expensive.  I see it every day.  I'm a licensed insurance broker for all the major carriers in California, and am very familiar with the various plans, rates and trends.  The Clinton plan will not succeed regardless of subsidies and will only result in the same problems that exist in Massachusetts;  millions of still uninsured that are paying fines for non-compliance with the mandate.  That's what mandates do and that's why the same type of proposal failed to get off the ground in California.  

BTW, I agree with the other poster, you seem to be trolling.  Knock it off, it's bad etiquette.

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by: avomonster @ Sun Mar 02, 2008 at 05:51:05 AM CST

Let me say this as someone who's given Obama money, voted for (4.00 / 2)

him, and who will caucus for him -- I strongly agree with Paul Krugman on this issue.

I like Obama on many issues, but his health care plan is a weak one.

There are two responses to Obama when he says "people don't have health insurance not because they don't want it, they don't have it because they cannot afford it."

First, the response is "that's mostly true, but not entirely true."  Many small business owners, especially small business owners in their 20s and 30s, go naked in terms of health care coverage despite making well over the national median income.

Second, and much more important, if Social Security was only open to those who could afford it, many of the people who need it most would opt out because they couldn't afford it.  Health coverage should be mandatory notwithstanding the ability to afford it precisely because those who cannot afford it often need it most and they are equally entitled to health care.

Another problem with the "opt in or opt out" scenario with health care is that people who "opt out" nevertheless get health care, at public expense, when they have a tragic illness or a catastrophic injury.  The law requires emergency rooms to treat uninsured people when they come to the hospital in critical condition.  If an uninsured person has a catastrophic medical set back, Medicaid will kick in to cover their treatment at public expense (instead of private expense if they had insurance) when they deplete their assets to the point that they qualify for Medicaid.

The "opt out" scenario for health care is a myth.  The uninsured get coverage, it's just at public expense after they have have depleted their assets.  This is the least efficient model for delivering health care.  We need to bring everyone into the universal health care model.  Obama's health care plan is his great failure during this campaign.

Still, Hillary's health care plan, while better than Obama's, is not nearly as good as Edwards' plan or Kucinich's universal Medicare plan.

Even though Hillary's health care plan is better than Obama's, Obama is still better on the War in Iraq, still better on Kyl-Lieberman and the possible war in Iran, still better on fair trade, still better on his proposal for the creation of a Senate Office of Public Integrity which Hillary opposed, and still better in terms of his coat tails and effect down ballot in Texas.

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by: StopCornyn @ Sun Mar 02, 2008 at 08:16:47 AM CST

[ Parent ]

.. (0.00 / 0)

As a small (very small) business owner, I would jump at the chance to get group coverage for my family and employees subsidized or not.  Group plans are simply not available in the case of micro businesses and if plans are available, they are incredibly expensive while often lacking basics like preventative care.

Also, no plan that incorporates for-profit businesses is anything like Social Security.  SS and Medicare are more akin to single payer real universal coverage.  

Google Krugman wrong on mandates and see how many very credible sources have completely debunked his irrational stance on this subject.  He has an opinion, many disagree with it.

If I had my druthers we would stop fooling around with the health insurance industry and simply open Medicare to all.  

Think of all the money going to all current government health care/coverage programs (think the VA, SCHIP, Medicaid, etc.) and all the money we citizens spend (insurance premiums, deductables, co-pays, prescriptions, dental, vision, etc.).

I would wager a sound economic argument could be made that combining those resources would at least be a wash were it all focused on Medicare to all and at best give us true coverage for all with less overall stabilized cost.

But that's another subject for another diary.  This diary is wrong on facts and fairly disingenuous in theory.

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by: G Davis @ Mon Mar 03, 2008 at 00:03:25 AM CST

[ Parent ]

Mandates: examples, compliance, and enforcement (3.00 / 2)

Sophia,

As the other posters have pointed out, you have neglected many key issues in this discussion and treat it as if Obama's plan is simply wrong when in fact the "truth" is still very much subject to debate.  I would just chalk this up to initiating an interesting debate on the most substantive policy difference between two good candidates if you didn't slyly imply that this difference speaks to potential "bad judgment" by Obama in other areas.  In other words, you are guilty of being disingenuous on a topic where many disagree and are using that sleight of hand to impugn a good candidate.  There are two very relevant treatments of this topic, neither of which you even mentioned and both of which cast the discussion as a decision with a lot more uncertainty and a lot more nuance than your post indicates.

One is in Health Affairs and the other is the working paper by Gruber, which is the meat of the OpEd by Krugman you mention in your post.

If you read both of these pieces, a couple of features emerge:

1. mandates don't always work well;
   
2. the higher the cost of compliance is, the lower the compliance is;
   
3. Krugman's argument (vis-à-vis Gruber) requires 95% compliance;
   
4. we have no idea of how this would work because all examples are either not very relevant (ie Hawai'i) or not enough time has passed to know for sure (ie Massachusetts).
   

Intelligent and informed people can very much disagree with your perspective, as indicated by the 80 signatories to a dissent from Krugman's perspective, including MDs, PhDs, and MPHs.

One important quote from the piece to highlight some of this disagreement:

Some believe that an individual mandate to buy health insurance should be part of this effort; others hold that a mandate would be paternalistic or too onerous for families at the margins of affordability. Regardless of our feelings on this issue, what is clear from the evidence is that mandates alone, without strong incentives to comply and harsh punishments for violation, will have little impact on the number of uninsured Americans [ 1 ].  Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions. There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible.

Thus, mandates are not perceived as a panacea by many professionals working at the intersection of medicine, policy, and economics.  Indeed, the Gruber piece points out entirely different features which may increase compliance but don't imply the presence or absence of mandates.  For example, a system where people must opt-out.  It is also notable that these people at least profess to desire universal coverage.  Their perspective isn't simply a Republican Trojan horse.

In any event, this discussion is much better treated by a balanced and nuanced airing of the difficulties real implementation will actually face.  A very smart and motivated individual in the person of Hillary Clinton already failed to pass universal health care in the 90s.  Right now, it would be foolish to simply barge ahead without carefully weighing the options.  Obama may very well be wrong, but you are not in possession of special knowledge that qualifies you to make such an assertion in the absence rebuttals to well-grounded dissents from that perspective.

Cheers,

LwPhD

[ 1 ] S.A. Glied, J. Hartz, and G. Giorgi, "Consider It Done? The Likely Efficacy Of Mandates For Health Insurance," Health Affairs 26 (2007): 1612-1621.

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by: LwPhD @ Sun Mar 02, 2008 at 07:46:15 AM CST

Thank you for those 2 references (0.00 / 0)

Thank you for those 2 references. They were helpful. The Health Affairs piece you cite is basically a playbook on how to make the mandates work.

I agree with the 80 signatories that a mandate alone is not sufficient. And I agree that "strong incentives to comply and harsh punishments for violation" will be needed. And want to point out that Hillary Clinton's plan does not preclude any of the options to enforce that mandate. In fact, I would expect her to use the Health Affairs article perhaps as a key reference.

Also, I think a key point to both Democratic candidates plans is affordability and cutting costs.

In response to your points

>1. Mandates don't always work well.

Agreed, and that is why we can learn from the Health Affairs article and do what does work well -
"Compliance is easy.
Affordability.
Penalties are stiff but not excessive and have high probability that they will be imposed.
Enforcement is routine, appropriately timed, and frequent.
Single Annual enrollment period - Enrollment occurs nationally at one time each year.
Use multiple data sources."

BUT in the 3 places that have mandated health insurance the compliance is high. Hawaii (employer mandated) 89.9%, Switzerland 1996 Individual mandate "near-universal coverage," the Netherlands 2005 resident mandate 98.9% compliance.

>2. the higher the cost of compliance, the lower the compliance
Hmm. You just made the argument for Hillary's plan.
Her plan cost per new person: $2700
Barack's $4200.

>3. Krugman's argument requires 95% compliance
well if we take the data from Switzerland and Netherlands, then 95% might not be a bad estimate
also, I said 9 million to 15 million... (meaning I am not basing everything on Gruber but there have been other estimates as well by others.)

>4. We don't know how this would work
The paper you cited gave 3 examples. and gave the roadmap to making it work

5.
I don't think the 80 signatories are really dissenting from Krugman, rather they were saying a mandate alone is not sufficient (you need the enforcement/incentive mechanisms) and that you need  "subsidies, insurance market reform and cost containment" as well. (I agree 100%)

Krugman was not saying "an individual mandate alone would reduce the ranks of the uninsured by 15 million." Krugman was saying that key difference between Barack and Hillary's plan is the mandate. Both plans have subsidies, both have insurance reform, both push cost containment.

Gruber compares a "Barack-like plan" (one with subsidies, etc) to a "Hillary-plan" (what I call Barack plus mandate) and comes up with his number.

And again, it would not be a mandate alone - but whatever mechanisms it would take to make the mandate happen e.g. the points from the Health Affairs article.
see under point 1.

And the last point of the 80 signatories was not to call the job done just by having mandates, but one must address all those points in the Health Affairs article to make the mandate happen and to increase access for all.

and my addition, hopefully someday get to universal single payer healthcare.

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by: sophiay @ Mon Mar 03, 2008 at 08:41:33 AM CST

[ Parent ]

.. (0.00 / 0)

How is any plan that forces the purchase of a for-profit product going to 1) be passed 2) be productive if the goal is to actually provide health CARE?

The point you seem to be missing is not that everyone needs to be included to avoid the emergency room syndrome of today, but that all these plans are based on buying PRIVATE FOR-PROFIT insurance.

We are spending increasing amounts on a product that doesn't do a thing to actually provide CARE.  Why not put those dollars into a direct CARE system rather than maintaining insurance companies profit margins?

Can you provide any information showing that the Massachusetts plan, since it's the model, is working as envisioned?  Everything I've read is that costs are skyrocketing for both consumers and the government, margins of uninsured are still large.  

To keep saying mandates are necessary is not going to make it workable.  How about some practical application theory.

As an aside, is it even constitutional to force people to buy for-profit products?

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by: G Davis @ Mon Mar 03, 2008 at 09:27:15 AM CST

[ Parent ]

Have you read Hillary's plan? page 2 - choose a public plan, an option (0.00 / 0)

On page 2 of Hillary's plan, there is a nice diagram of your options

1. keep what you got
2. buy into the plan that Congress has
3. Buy a public plan similar to MediCare (non-profit, government run)

Both the plans (Hillary and Barack's) talk about prevention
Hillary's page 7

Prioritize Prevention to Reduce the Incidence of Disease that Impose Huge Human and Financial Burden.... the American Health Choices Plan (Hillary's plan) requires coverage of preventive services that experts agree are proven and effective.

The Massachusetts plan does not seem like a plan, rather just a mandate. Both plans have cost reduction/containment as a goal.

The MA plan also only took effect in 7/07 so you really can't evaluate it yet...

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by: sophiay @ Mon Mar 03, 2008 at 19:13:11 PM CST

[ Parent ]

Some scenarios (0.00 / 0)

First things first, the price you cite ($2,700) is already high enough.  This in turn makes me think that compliance will be a real issue.  So, layering mandates on top of that makes Clinton's plan very different from Obama's plan in ways that don't unambiguously argue in favor of the Clinton plan.  This speaks to the heart of the matter.  How will the mandates be enforced and who will they be applied to?  Weak enforcement makes mandates meaningless (just look at car insurance compliance) and draconian enforcement will lead to a damage to the image of universal healthcare.  If your goal is single payer, universal health care and you agree we can't arrive at that goal in one step, then do you think harsh mandates to ensure compliance is the optimal stepping stone to a single payer system from what we have right now?

Since we have your ear (or your eyeballs rather), could you provide for us a scenario of how enforcing mandates would work out:

1. poor people who are nonetheless not qualified for Medicaid;
   
2. middle class people who can ostensibly afford it, but at a cost to other goals, such as college for their kids or home ownership;
   

The reason I ask is because $220 a month is an awful lot to ask people to pay to the health industry.  They will need to be convinced, and an important distinction between the plans is how the convincing will be done.  Both Clinton's and Obama's plan are an improvement on the current situation, but as everyone points out, in risk management, removing the profit overhead is an important step.  Single payer does that.  Neither Obama's nor Clinton's plans do.  In fact, mandates could conceivably use the power of government to spur demand and inflate the overhead private companies impose by making profits.

Please, be an advocate for a healthcare plan and not for a candidate.  Everybody, Obama voters and Clinton voters both, cares deeply about this issue.  And I'll warrant that many Obama voters like myself already have at least an issue or two that they prefer Hillary on.  Please don't push us away with spin and partisan advocacy.  I already appreciate you dispensing with the "Obama's healthcare plan is a litmus test for bad judgment" argument.  Now lets get down to brass tacks and look at implementation.  You're more likely to win converts that way.

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by: LwPhD @ Tue Mar 04, 2008 at 06:44:55 AM CST

[ Parent ]

Listen to the experts? (0.00 / 0)

I am not the expert. But I have listed some in my article above. (Urban Institute, Dr. Nichols)

Some of the people I see not getting insurance - young 30 somethings, single. Then someone gets cancer, a gallbladder stone, a urinary tract infection. Then comes the crazy whopping bill of $10,000 or more. And they are bankrupt! It would have been cheaper to pay a lower amount all along.

The implementation can be worked out according to the paper that you provided. That paper is the template for how to do it. It has been done in 2 other countries.

Part of the answer to your scenarios is
answer for 1. poor people would be capped at a percentage of their income
You can't have healthcare for free.
Also, it would be similar to CA's healthy kids which covers those who barely don't qualify for MediCaid. Healthy kids is working really well in CA.

2. College for kids and homeownership.
Again, You can't have healthcare for free.
College for kids - should always be affordable (meaning the student can pay back the loans after they are working) with Government loans or state schools. (If you want private school, that's your problem)
Hillary is doing and has done a lot for College education affordability.
For homeownership, Hillary also has a plan to deal with the mortgage crisis.

The key here is whether one believes in a mandate or not and not on the details. The details can be worked out and have been though out (in the paper you provided...)

To mandate versus no mandate is the key question. Hillary has decided yes and Obama has decided no. With a mandate, the cost is $2700, without the mandate it is $4200.

Obama says people don't have healthcare b/c it is too expensive. His plan would be more expensive.

And again his plan would screw those of us responsible enough to get insurance (our premiums and costs would be higher b/c the cost of uninsured showing up at hospitals would be paid by those of us with insurance (hospitals have to factor in those costs to keep open). And b/c we
are democrats, when someone goes bankrupt because of uninsurance and resultant medical bills, we bail them out and take care of them(and that costs us). If we didn't bail them out and just let them suffer/die, then it wouldn't hurt the rest of us. But we are dems, and we help people.

As for spurring demand, etc. you forget that Hillary's plan has the option of a MediCaid program which has less overhead and is not for profit. If we all choose that, then we would be essentially single-payer and get rid of insurance companies!

I push for a candidate, because I care about healthcare and it one of the most important issues facing our country domestically. I only know healthcare. I am not as savvy on other issues. And on the one issue I know, Obama has chosen the wrong answer. So, I do worry how he chooses his advisors or his decision-making process.

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by: sophiay @ Fri Mar 07, 2008 at 18:35:03 PM CST

[ Parent ]

I back Obama (2.00 / 1)

but I prefer a mandate in our next step toward fair health care delivery.  That being said, it is just a step and the only system that makes sense in the long run is a single payer plan.  Obama has chosen one step along the way, Clinton has chosen another.  But Clinton showed pretty awful political instincts and judgment her first time around on health care so you should be careful using that particular argument against Obama.  Clinton's previous work in this area is to be lauded because she tried to do something about the health care problem but a prior failure is no indicator of future success, is it?

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by: morisey @ Sun Mar 02, 2008 at 08:51:04 AM CST

What Hillary's prior health care failure indicates (0.00 / 0)

is that she has been in the game and has learned from her mistakes. She has admitted mistakes in her previous approach and how legislators were generally left out of the formative process in the 90's health care debate.

A venture capitalist will generally view a potential CEO more favorably if they have "been there done that", even if prior entreprenurial attempts failed. Why wouldn't they punish failure? Because they value capability matched with experience. Not just raw capability alone.

Being in the game helps you learn from success AND failure. Sometimes you learn more when you fail because you learn different approaches to the problems at hand.

You must admit that Hillary has been in the healthcare game for decades and for such a difficult multifacted problem, my bet is on the person who has been there done that (yes even if the first attempt at universal coverage failed) and the person who has been thinking about the issues surrounding universal health coverage for two decades, not two years.  

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by: BrettC @ Sun Mar 02, 2008 at 11:12:49 AM CST

[ Parent ]

The political angle (3.00 / 1)

I agree with your assertion that, abstractly, single-payer is better than mandated insurance which is better than universally available insurance which is better than what we've got. But we live in a democracy, not in a benevolent dictatorship where Fearless Leader Knows Best.

The difference between Clinton's plan and Obama's really does tell a lot about the two of them. Clinton huddles up with the experts and proclaims a plan with a lot of coercion in it. Obama sets out a plan to takes into account the public's very strong desire to maintain control over their own health care choices.

Which plan has a better chance of becoming law? Which is more likely to earn the kind of public support that will eventually allow us to move forwards towards single-payer? Obama's plan wins those contests, hands down.

We already tried Clinton's top-down approach to health care. It failed miserably. Not because she didn't present a good plan (she did). Not because the president didn't fight hard enough for it (he did). It failed because the Clintons have a tin ear for the public's desire to choose, and because they weren't willing to consider alternatives.  Let's not make that mistake again.  

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by: LSadun @ Sun Mar 02, 2008 at 09:04:38 AM CST

Her 2008 plan is not her 1993 plan (3.00 / 1)

The approach is not at all what you portray. You are free to choose whatever healthcare plan you want in Hillary's approach. The only requirement is that you have health insurance. Not which plan.

It's not unlike car insurance. Buy whatever plan you want. But buy insurance.

She has said she has learned from her past failure about listening and working with the other side of the aisle.

What she is talking about is universal health insurance to get more people paying into the system in a systematic way to control the hidden tax on all of us who do choose to have health insurance.

For those who choose not to have health insurance (today or under Obama's plan), when they are in a car crash or get diagnosed with a dread disease, they will be treated at the hospital and all of the insured will pay for it through our higher premiums.

The idea that in this case they can buy health insurance at the hospital when they need it is laughable. That's like saying you can start your IRA or start paying into social security when you turn 65 and REALLY need it.

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by: BrettC @ Sun Mar 02, 2008 at 11:35:04 AM CST

[ Parent ]

Do you think mandates are a politically viable (0.00 / 0)

position? In other words, will the GOP allow them to pass. My guess is no.  

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by: JayGR @ Sun Mar 02, 2008 at 10:22:33 AM CST

If manadates are not politacally viable (0.00 / 0)

then the whole goal of universal coverage is moot. Would an income in retirement be universal without mandates? Just look at the number of Americans who opt out of IRA's. Thank God we force people to pay for a retirement system even when they claim they can't afford it. We all know as a nation, or at least as democrats, we can't afford not to try and make social security work.

Why should health care be any different?

The 108th congress in 1993-1995 when Hillary tried to pass her first attempt at universal coverage had 227 R and 210 D in the house and 51 R and 48 D in the senate. So obviously this was not conducive to mandates or universal coverage. Can't imagine why her push for universal care failed.

This time around don't we all expect (hope) that the house and senate will be Dem controlled? Now is the time to think big and act audaciously (yes, I said it) and work for the most universal plan (which I think is Hillary's at this point).

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by: BrettC @ Sun Mar 02, 2008 at 11:25:07 AM CST

[ Parent ]

For a group of people (0.00 / 0)

who have been criticizing Hillary Clinton for observing that Texas hasnt been won by a Democrat since 1976, you guys sure do have a defeatist attitude.

Will the GOP "allow" them to pass?

That's why we have candidates for the Senate like Rick Noriega who, when elected, will give us a substantial majority to build a progressive America.

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by: David Mauro @ Sun Mar 02, 2008 at 11:32:10 AM CST

[ Parent ]

The pendulum (0.00 / 0)

I think that incremental steps are the surest way to build a lasting progressive America.  For example, when Republicans are forced to swallow the reality of universal insurance with substantial assistance from the government to make sure everyone has access, then other proposals become viable because the frame of the debate has changed.

David,

Once we have a progressive majority we can take the first incremental step.  Then the frame of the debate is in terms of "should we implement a plan with mandates or stay with the current (Obama-like) plan?".  This step is much more easily accomplished than when the step is much larger.  The current frame is: "should we implement a plan with mandates or stay with the current lack of a plan?".

With incremental change, you have automatically removed the current status quo (ie no plan at all) from the debate.  The new status quo, while not the best outcome possible, is certainly in the correct direction.  For true lasting change  it is necessary to pull even the dissenting voices part of the way in our direction.  This is a democracy, and it is incumbent upon us progressives to not only pass progressive legislation, but to recruit progressives into our own ranks from the other side.  Changing the frame of the debate serves as a very good first step in that direction.

To use a football analogy, it makes no sense to throw a Hail Mary on the first possession of the first quarter deep in enemy territory.  We have a good ground game and can make 5 and 6 yard plays by using the running game.  This approach gets us to our goal more slowly, but it is more sustainable.  And in the end, it may even recruit a few voters who haven't before considered themselves progressive.

I'm not naive enough to believe we'll win the Republican politicians, but we can certainly convert the less fervent members of their coalition to switch sides.  If we push too fast, this will merely be another pendulum of change, where we make great strides for a few years, and then see our gains lost in a backlash.  I'm willing to wait a few election cycles to make permanent rather than temporary gains.

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by: LwPhD @ Sun Mar 02, 2008 at 22:39:49 PM CST

[ Parent ]

cutting/pasting error (0.00 / 0)

Ooops.  Didn't scroll up high enough in the preview and pasted "David," between two paragraphs.  Sorry about that.

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by: LwPhD @ Sun Mar 02, 2008 at 22:43:03 PM CST

[ Parent ]

The bill that passes won't be either candidate's plan (0.00 / 0)

First of all, I live about 20 miles from San Francisco and Sophia - we're friends!  How cool is it to be debating politics on a Texas blog?

Second, the political reality is that neither Clinton's plan nor Obama's plan will be the one that is implemented.  The bigger question is who will be able to lead our country to implement universal healthcare?  We'll need a step one and a step two and a step three...

Clinton had her chance and failed.  Worse than that, she doesn't seem to ever admit that anything she did was a mistake nor that she'd change anything about her approach.  (If she has, I've never heard her say it or read it anywhere and I follow politics closer than anyone I know.)

After spending weeks and weeks behind close doors she had the opportuntiy to pass a compromise bill that did not include a mandate.  She fought it and it never happened.  The result?  Nothing.  Nada.  Ziltch.  (Later, SCHP was passed so at least we got something.)

Had we passed the compromise, where would we be today?  We'd likely have a lot more people insured and a lot less people under-insured.  

Leadership matters.  Engaging a working majority in the process matters.  For us to move ahead on healthcare and a whole host of issues we are going to need independants and moderate Republicans (elected and not) to feel a part of the process.

And, we are going to need a president who doesn't owe the insurance lobby or the pharm lobby or any other special corporate interest who has donated to her campaign or to her husband's presidential library.  

And, we'll need a president who is willing to learn from her past mistakes.  What good is experience if you don't learn anything from it?  All she "learned" is that she has to more of what failed in the first place -- fight.  We don't need a fighter, we need a LEADER!

Healthcare isn't about a plan.  It is about politics.  It is about leadership.  Obama can lead big change.  In fact, he is right now if you look at his campaign.  Hillary has yet to prove that she can lead big change.  Her healthcare "leadership" was lacking and her campaign for president wastes money, shifts message daily, and has taken her 20 point lead and lost the last 11 elections.

Obama '08!

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by: mutzyfromcali @ Sun Mar 02, 2008 at 11:29:54 AM CST

Hillary has learned from experience, and Obama doesn't choose big change (0.00 / 0)

1. Although I couldn't find anything about her admitting mistakes(probably some PR reason that you shouldn't say mistake), I definitely found quotes that she would do things differently and that she learned from her failure and would do things differently.

The Clinton administration's failed attempt to overhaul the nation's health care system was widely derided at the time as big-government liberalism. She said that the experience [taught her] "the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done," she said. Source: NY Times, p. A22 Feb 13, 2001

"You may remember I had a few ideas about health care. I've learned a few lessons since then." Source: Address to the Democratic National Convention Aug 14, 2000

2. Funny that you mention big change,
In 2007, Obama said about healthcare, "We must act. And we must act boldly. ... Washington no longer has an excuse for caution. Leaders no longer have a reason to be timid."

But Obama chooses the smallest change of the democratic candidates.

3. Perhaps an experienced leader would know to start bargaining off with Plan A (more radical aka Hillary's plan) and know that we would end up with Plan B (less radical aka Obama's plan). Rather than start with B and end up with no change.

Again, I ideally would prefer single payer, but that is not the option our 2 candidates are offering.

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by: sophiay @ Mon Mar 03, 2008 at 18:55:46 PM CST

[ Parent ]

TX Primary: Obama's poor judgement on healthcare (3.00 / 1)

Both Clinton and Obama believe in magic and both are too cowardly to commit to universal healthcare. So called experts arguing about health insurance mandates are just speculating because we have little or no experience with such mandates.  Texas mandates universal auto insurance yet one in four Texas motorists drives uninsured.  According to Clinton and Obama, mandated health insurance will magically be different than auto insurance.  I doubt health insurance subsidies and tax credits will adequately address these compliance issues.  It is business as usual with Americans paying more to get less healthcare because both Clinton and Obama rely on inefficient corporations to provide healthcare, insurance and drugs with little or no governmental regulation.

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by: leulerus @ Sun Mar 02, 2008 at 14:55:59 PM CST

Paving the way to single payer (0.00 / 0)

LSadun said it best.

I fully support mandates for government-ensured health care, but only if they're mandating participation in a single-payer, NON-PROFIT system.

I do not support a program under which all adults are forced to participate in what is basically a government-mandated funnel into the private insurance industry's coffers.  This, like it or not, is what Hillary's plans entail.

Obama's plan is about making progress that is viable in the short term - something that he can accomplish in the first year of his administration (if the Dems can get a super majority in the Senate).

I see no such long-term planning on Hillary's part.  From her past record, I think she'd be perfectly satisfied with a system mandating participation in for-profit, privatized health care upon pain of wage garnishment.  That's not something I'm willing to accept in the long term.

This is about what is practical and what puts us on the shortest path towards single-payer.  Mandates that serve to widen the partisan divide (especially in places like Texas, where mandates will NOT be popular) and serve the interests of the private health care industry may sound good to the politically tone-deaf like Krugman, but they don't to voters.

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by: Prospero424 @ Sun Mar 02, 2008 at 19:48:32 PM CST

So, (0.00 / 0)

I assume you're supporting Ray McMurrey for U.S. Senate -- the only person in the race who supports single-payer health care.

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by: Triangulation of Death @ Sun Mar 02, 2008 at 20:45:28 PM CST

[ Parent ]

Not (0.00 / 0)

gonna get sucked into that argument in this thread.

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by: Prospero424 @ Sun Mar 02, 2008 at 22:52:05 PM CST

[ Parent ]

And now his poor judgment on disclosure... (0.00 / 0)

He isn't even the nominee yet and he already has a -gate to add to his ... resume...
From the AP:
Obama Adviser Denies Trade Remarks
By NEDRA PICKLER - 13 hours ago

SAN ANTONIO, Texas (AP) - Barack Obama's senior economic policy adviser said Sunday that Canadian government officials wrote an inaccurate portrayal of his private discussion on the campaign's trade policy in a memo obtained by The Associated Press.

The memo is the first documentation to emerge publicly out of the meeting between the adviser, Austan Goolsbee, and officials with the Canadian consulate in Chicago, but Goolsbee said it misinterprets what he told them. The memo was written by Joseph DeMora, who works for the consulate and attended the meeting.

Goolsbee disputed a section that read: "Noting anxiety among many U.S. domestic audiences about the U.S. economic outlook, Goolsbee candidly acknowledged the protectionist sentiment that has emerged, particularly in the Midwest, during the primary campaign. He cautioned that this messaging should not be taken out of context and should be viewed as more about political positioning than a clear articulation of policy plans."

"This thing about `it's more about political positioning than a clear articulation of policy plans,' that's this guy's language," Goolsbee said of DeMora. "He's not quoting me.

"I certainly did not use that phrase in any way," Goolsbee said.

The meeting was first reported last week by Canadian television network CTV, which cited unnamed sources as saying that Goolsbee assured the Canadians that Obama's tough talk on the North American Free Trade Agreement is just campaign rhetoric not to be taken seriously. The Obama campaign and the Canadian embassy denied there was any inconsistency between what the candidate was saying publicly and what advisers were saying privately.

NAFTA is widely opposed in economically depressed Ohio, which holds its presidential primary Tuesday and is a key battleground between Obama and Hillary Rodham Clinton. Both candidates said in a debate in Cleveland last week that they would renegotiate the trade agreement between the United States, Canada and Mexico, which is the largest trading partnership in the world, and threaten to pull out if it doesn't include more protections for workers and the environment.

"I think we should use the hammer of a potential opt-out as leverage to ensure that we actually get labor and environmental standards that are enforced," Obama said in the debate.

The memo obtained by the AP was widely distributed within the Canadian government. It is more than 1,300 words and covers many topics that DeMora said were discussed in the Feb. 8 "introductory meeting" between himself, Goolsbee and the consul general in Chicago, Georges Rioux.

Goolsbee "was frank in saying that the primary campaign has been necessarily domestically focused, particularly in the Midwest, and that much of the rhetoric that may be perceived to be protectionist is more reflective of political maneuvering than policy," the memo's introduction said. "On NAFTA, Goolsbee suggested that Obama is less about fundamentally changing the agreement and more in favour of strengthening/clarifying language on labour mobility and environment and trying to establish these as more `core' principles of the agreement."

Goolsbee said that sentence is true and consistent with Obama's position. But he said other portions of the memo were inaccurate.

He said he has been surprised that such a banal and trivial meeting with a low-level consulate official has created so much controversy and resulted in such an inaccurate depiction. He said he was invited to the consulate to meet the officials and get a tour.

He said the visit lasted about 40 minutes, and perhaps two to three minutes were spent discussing NAFTA. He said the Canadians asked about Obama's position, and he replied about his interest in improving labor and environmental standards, and they raised some concerns that Obama sounds like a protectionist.

He said he responded that Obama is not a protectionist, but that the Illinois senator tries to strike a balance between the economic struggles of working Americans and recognizing that free trade is good for the economy.

"That's a pretty ham-handed description of what I answered," Goolsbee said of memo's account. "A: In no possible way was that a reference to NAFTA. And B: In no possible way was I inferring that he was going to introduce any policies that you should ignore and he had no intention of enacting. Those are both completely crazy."

Tristan Landry, a spokesman for the Canadian embassy in Washington, said DeMora was not available for an interview Sunday. His only comment on the memo was to say that although consulate officials reach out to U.S. campaign officials to seek their views, "Canada does not in any way seek to interfere in U.S. electoral politics."

Canada supports NAFTA and does not want to see it interrupted.

The Canadian memo said that when Rioux "asked whether we could expect to hear more of this as the elections progressed, Goolsbee thought not. In fact, he mentioned that going forward the Obama camp was going to be careful to send the appropriate message without coming off too protectionist.

"As Obama continues to court the economic populist vote, particularly in upcoming contests like Ohio, we are likely to see a continuation of some of the messaging that hasn't played in Canada's favour, but this should continue to be viewed in the context in which it is delivered," DeMora wrote in the closing section.

Obama spokesman Bill Burton said Goolsbee's visit was not as an emissary from the campaign, but as a professor from the University of Chicago. He was not authorized to share any messages from the campaign, Burton said.

Burton, who was on the call while Goolsbee described his visit to the AP, said, "It all boils down to a clumsy, inaccurate portrayal of the conversation."

Asked if he agreed with Burton, Goolsbee said he did.

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by: yaelbelle @ Mon Mar 03, 2008 at 13:24:49 PM CST