Wyden & Clinton: Two Universal Health Care Proposals

Hillary Clinton made headlines yesterday when she unveiled her new proposal for universal health care. However, as the Statesman-Journal reports, it's Oregon Senator Ron Wyden's health care plan that has been getting noticed on both sides of the aisle in the US Senate:

Oregon Sen. Ron Wyden, the architect of a proposed health care overhaul that's quietly been attracting bipartisan support, said there's plenty to admire in the sweeping reforms rolled out Monday by Sen. Hillary Clinton, as well as some key differences with his own plan.

Wyden's proposal has been overshadowed recently by higher-profile offerings from the presidential hopefuls, including Democrats Clinton, Barack Obama and John Edwards, and Republicans Mitt Romney and Rudy Giuliani.

But in an interview Monday with The Associated Press, Wyden said he is expecting more of his colleagues in the Senate to sign on as sponsors of his proposal in the coming weeks.

Already, three Republicans have signed on as co-sponsors, including Utah Sen. Robert Bennett, who helped lead he charge against Hillary Clinton's failed attempt to reform health care during her husband's presidency.

Wyden's and Clinton's plans both would provide universal healthcare, and have some notable similarities:

Wyden's plan and Clinton's share an important underpinning: Both rely on the "individual mandate" concept - the requirement that like auto insurance for drivers, health insurance would be a requirement, not a choice.

Both would use federal funds to pay for insurance coverage for individuals that couldn't afford it on their own, but don't qualify for Medicaid, which covers the poorest Americans.

Wyden and Clinton agree, too, that health insurers should not be able to cherry-pick their beneficiaries by rejecting those who have pre-existing medical conditions.

And both embrace the idea of "portability", allowing coverage to follow an individual, even from job to job.

There are also some major differences between the two proposals:

Wyden's plan, introduced late last year and dubbed the "Healthy Americans Act," would eliminate employer-provided health insurance. Instead, employees would get the equivalent of the cost of their health care plan in extra salary to pay for health care insurance from private insurers.

Wyden's proposal eliminates the $200 billion a year in employer tax deductions, and uses the savings to cover those who don't qualify for Medicaid, but don't earn enough to buy their own insurance - though it's not yet clear how comprehensive such coverage would be.

Clinton's plan in contrast, keeps the employer-provided system intact, a point she stressed repeatedly when unveiling the proposal Monday in Iowa.

Businesses would have to offer insurance, or contribute to a government-run pool to pay for those who lack it. And tax subsidies, far from being eliminated as under Wyden's plan, would be expanded for small businesses that offer health insurance for their employees.

Read the rest. You can also compare Wyden's and Clinton's plans.

What do you think of the two plans?

Discuss.

  • James X. (unverified)
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    I think it's more accurate to call these plans "universal health insurance." As many people have experienced, having insurance is different from getting care.

  • Robert G. Gourley (unverified)
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    Once again, the main focus is on how to pay, rather than on the care. Set the goal as perfect health for everyone, then look at how to pay for such a system. As everyone knows, folks with perfect health don't pay the same for health care as those who don't.

  • Urban Planning Overlord (unverified)
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    Good health care isn't cheap. It's easy to say doctors are making too much money, or pharmaceutical companies are ripping us off, but the truth is that when we try to "manage" costs, whether it's an insurance company under our current system or the government under a "single payer" plan, health suffers.

    Americans will just have to decide that top quality health care will cost a lot of money, most likely tax dollars, and suck it up. I don't have a problem paying more taxes to finance a top quality health program for all Americans. Do you?

  • Thomas Ware (unverified)
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    Let's see - there's some huge number of uninsured out there (47 million*) because they can't afford to purchase health care. Hillary's, and Wyden's, proposed health care plan(s) would require the uninsured to purchase health care. You know, the health care they can't afford to purchase.

    Mandatory Insurance laws have been successfully argued to be unconstitutional.

    Just another represtative of the people in name only suckling at the corporations' teat.

  • trishka (unverified)
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    i like wyden's plan better because it appears, from what i've perused, that he includes a plan on how to pay for the subsidies that will be required in order to make insurance affordable for everyone.

    clinton's looks to have some hand-waving in there, but nothing about how it's going to get paid for. that always makes me nervous.

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    Kinda like this cartoon, which has always been a favorite of mine.

  • trishka (unverified)
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    i just realised that my post above is kind of un-intelligible. what i meant to say is that wyden's plan DOES have provisions for how to pay for the subsidies, while i haven't seen anything in what i've read of Clinton's plan.

    which doesn't mean it isn't there; if somebody can find it & point it out that would be great. otherwise, i prefer wyden's.

    and stephanie, yes, bang on.

  • rscot (unverified)
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    When you read the comments on this thread it becomes abundantly clear why we still don't have a comprehensive health care solution. One should be able to expect folks who post on BO, particularly on health care issues, to be familiar with a health care proposal made by one of their own Senators - particularly a proposal that has been public for almost a year. Let's see...

    1) Universal "Insurance" vs. Universal "Health Care" The Wyden bill gives even the poorest the same insurance policy that members of congress have - a policy negotiated from a position of strength by the federal employees health benefits board and one that folks covered by it seem to be quite happy with - unlike the many clearly substandard plans highlighted in the first half of Sicko.

    Is it universal care as in, "I can go to the mayo clinic if I need it and the government will pay?" No. Than again, neither is any of the advocated single payer proposals (ie Medicare for all) Take a poll of your favorite doctors and see how many take medicare patients - you'll have a good picture of who will be available under a single payer system and who will become a "private physician" (see Great Britain). Is it universal care as in, "I can go see almost any doctor for preventive care or care when I'm sick and Insurance will pay?" Yes

    2) Focus on the sick/how to pay

    Now, to be fair, it's harder to tell how much is rhetoric, but Wyden's tag line has been health care, not sick care, and there are a number of places where the bill clearly encourages wellness: coverage for preventive care, cash discounts (market incentives) for folks who get healthy or stay healthy, and full community rating - which means that it's in your insurance company's best interests to get you healthy, because they can't dump you, can't refuse coverage, and can't raise your rates. It certainly appears to be going in the right direction.

    3) Mandatory Insurance?!? the poor can't AFFORD insurance!

    One is left speechless. The very core of the Wyden plan (did I mention it's be available for almost a year) is the provision to make certain that every single american will be able to afford the insurance (the insurance that is as good as what members of congress currently have) From the math I've been able to do (did I mention that the plan/bill has been available for almost a year) the actual out of pocket cash money cost of the insurance would never be more than 10% of income, usually much less - $0 if you are at or below the poverty line. It looks somewhat pricey compared to today's system for folks making over $150k, but we weren't talking about them. A family of four making $40k a year (let's say two parents working 20k jobs) would pay about $200 a month for good insurance for the whole family. It's affordable (as much as anything is when you're working for a living at that income in this country) and certainly a far better deal than anyone is offering them today.

    If we're going to get to work reforming the health care system in the country can we at least all agree to spend as much time learning about the issue as the insurance and drug companies spend trying to lie to us about it? Read what's out there, take any politician that glosses over the real problems to task, and let's get something done.

  • Garlynn -- undergroundscience.blogspot.com (unverified)
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    Neither plan is really very good, since they keep in place the existing broken system of private health insurers. Some of the cheapest ways to keep people healthy are to invest in preventative medicine, acupuncture, naturopathy, exercise regimens, yoga, etc.

    Rather than rewarding companies that excel at finding ways to deny benefits to their customers, why not invest in a new system that excels in finding ways to keep its customers healthy?

    I don't see this written into any of the current federal proposals.

  • Bill R. (unverified)
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    If folks think this election is going to wave a wand over this system and make it something new and wonderful, they are fooling themselves. We need to start with getting coverage for everyone. Any attempt to totally scrap the present system will go down in flames. Actually I think Wyden's plan may have the best shot. The Repubs and the U.S. business community has a strong interest in de-linking employment with health insurance. And for the sake of global competition that is a good thing for all of us. It is also a good thing if you happened not to be employed. This plan will get significant Repub support, and have an actual chance of passing. If I understand it, it does open up the federal health insurance system and provide a pathway to a public system, which could be the framework for a real single payer system down the road. That means single payer, but choice and diversity of providers.

  • backbeat12 (unverified)
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    It's really sad that it is the Independent candidate for Senate, Frohnmayer, who believes national health care (note I did NOT say insurance) is in The Constitution. C'mon Democrats, why is he more progressive, eh? (I'm still a D, but hanging on by a thread.)

    At least Wyden's plan gets it out of the employer's hands. Can you imagine how freeing it will be for workers? No longer will we convince ourselves to stick with a job just for the health insurance. Our country would become more productive and creative if workers felt free to pursue their dreams.

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    Thanks for clearing one up for me Stephanie.

    I've been using that cartoon quote for at least ten years and wrongly attributing it to Gary Larson rather than Sydney Harris.

    I just went googling around on this one and found out that I have plenty of company in getting it wrong........Small consolation there.....

    <hr/>

    Oh yeah. I'll take Wyden's plan over Clinton's by a whisker. I agree that it'll solve little and only for a short while, but like the tobacco tax thingy here in Oregon, it's marginally better than the nothing that we currently have.

  • JTT (unverified)
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    What I don't like (or understand) about Wyden's plan is it seems that by shifting the amount currently given to employees for h/c from employer-deductable to employee-income (and taxable) that you will be bumping all of those employees into higher tax brackets (thus lowering the net amount of income...and ability to pay for health care). Can someone correct/explain why this works for middle/working-class America?

  • Kevin M (unverified)
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    A question, why won't Wyden and/or Clinton introduce a senate version of HR 676 (single-payer not-for-profit health care - New and Improved MediCare for All)? How much money do they get from the health insurance industry? Clinton get a lot though I don't recall the exact amount (I've seen it published). I don't know about Wyden. Eliminate insurance companies from health care. That's at the heart of the solution in my eyes. I don't like the plans of Clinton or Wyden. Of the prez. candidates only Kucinich is offering (HR 676) a single-payer plan. Get the profit motive out of health care. It'll be good for people, all will have health care, and it'll be good for business (with the exception of the health insurance business of course). Also check out http://www.pnhp.org, Physicians for a National Health Program. Cheers.

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    Hmmm, wadda y'all think about this plan: this is blueoregon

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    Well clearly I need to pactice making links... But at least it goes to the right place!

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    Kevin, the reason no one is proposing to cut out the insurance companies is because we need some plan to pass. not a perfect plan; any plan. try to cut out a gazillion dollar industry, and guess what the result is? that's right: tens of millions spent to "convince" the public it's a terrible idea and it's 1994 all over again. i'd love to deep-six the insurance companies, not to mention most corporations. i'd also love to grow wings and fly to the moon.

  • rscot (unverified)
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    "Rather than rewarding companies that excel at finding ways to deny benefits to their customers, why not invest in a new system that excels in finding ways to keep its customers healthy?

    I don't see this written into any of the current federal proposals."

    Look a little harder. That is exactly what is written into the Wyden proposal - it removes the insurance companies ability to cherry pick customers, deny benefits, or drop sicker customers or raise their rates (wait, didn't I just say this?) Essentially the only way an insurance company can still be profitable is to spend their time, and money, looking for ways to make their customers healthier. It doesn't put the insurance companies out of business, but it certainly eliminates their current way of doing business. This is what first attracted me to the plan.

    JTT - as I understand it the new "health care standard deduction in the wyden plan was pegged several thousand dollars higher than the cost of most current benefits for exactly this reason - the additional income will be entirely offset (and then some) but the new standard deduction - keeps folks in the same bracket or lower. Either way, the actual out of pocket for working families will be substantially lower than in the current situation when you combine that deduction with the subsidies that got to families up to $84k in income.

    gotta love these single payer folks - any one who disagrees with them is a tool of the insurance companies, all evidence to the contrary. Rovian politics at its' best

  • rscot (unverified)
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    "Rather than rewarding companies that excel at finding ways to deny benefits to their customers, why not invest in a new system that excels in finding ways to keep its customers healthy?

    I don't see this written into any of the current federal proposals."

    Look a little harder. That is exactly what is written into the Wyden proposal - it removes the insurance companies ability to cherry pick customers, deny benefits, or drop sicker customers or raise their rates (wait, didn't I just say this?) Essentially the only way an insurance company can still be profitable is to spend their time, and money, looking for ways to make their customers healthier. It doesn't put the insurance companies out of business, but it certainly eliminates their current way of doing business. This is what first attracted me to the plan.

    JTT - as I understand it the new "health care standard deduction in the wyden plan was pegged several thousand dollars higher than the cost of most current benefits for exactly this reason - the additional income will be entirely offset (and then some) but the new standard deduction - keeps folks in the same bracket or lower. Either way, the actual out of pocket for working families will be substantially lower than in the current situation when you combine that deduction with the subsidies that got to families up to $84k in income.

    gotta love these single payer folks - any one who disagrees with them is a tool of the insurance companies, all evidence to the contrary. Rovian politics at its' best

  • trishka (unverified)
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    yes, JTT, what i heard from ron wyden at the town hall meeting i attended was that the tax code would be re-structured accordingly, to avoid the scenario you described.

    speaking of which, in response to this:

    One should be able to expect folks who post on BO, particularly on health care issues, to be familiar with a health care proposal made by one of their own Senators - particularly a proposal that has been public for almost a year.

    well, at the town hall meeting that i went to where ron wyden wanted to talk about his new health care plan, and gladly welcomed questions on it, the majority of people in the audience wanted to focus the discussion on (1) the iraq war and (2) impeaching bush. so maybe that's part of the problem.

  • JTT (unverified)
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    rscot- thanks for the clarification...I knew someone could explain it. P.S. I'm not at all for single payer...more like a Switzerland model.

  • helys (unverified)
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    Both these plans would result in vast numbers of people getting sick, being taken to emergency rooms and dying because they are not getting treatment. But guess what? we could all feel good because it was their own fault. They didn't obey the law and get the mandated health care they can't afford. Oh yeah those indigent people could have got help -- so what if they would have had to sit in offices and fill out countless forms to get it. They don't want to do that. What is their problem?

    Please just give us a universal health care system -- like Obama says he will. Hillary is in the pockets of the insurance companies. And Wyden -- as good as he can be -- has been too long in Washington to say anything new.

    If every other wealthy nation can do it -- without the catastrophes the right tries to scare us with -- why can't the US of A

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    UrbanPlanningOverlord asserts that to have universal health care, we have to pay more than we currently do.

    I don't believe that's true. From what I understand, the USA pays more for health care/insurance than any other developed country, and has far lower accessibility of care.

    That results from the political dominance of insurance companies, which is unmatched in other countries; and from various partial solutions that simply don't complement one another.

    The idea that employers should cover health care as a benefit is a problem. The disconnect between Medicare and Medicaid, wherein some arbitrary classes of people receive care due to their inability to pay and others due to the severity of their illness, is also a huge problem.

    A comprehensive solution, that improves care AND lowers costs, is not impossible; it just means developing the political will to stand up to some very entrenched interests (insurance companies.)

    I'm hoping that, at some point, Gov. Kitzhaber will weigh in on the various health care proposals being tossed around by candidates and Sen. Wyden. I understand that he sees great value in his role as a facilitator, but his expertise as a former governor and a doctor and a dedicated public servant is sorely needed in this debate.

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    Please don't generalize about single-payer advocates. I'm one and I don't think people who advocate differently "are in the pockets of the insurance companies."

    Wyden's bill has a provision that expressly provides for the possibility of something like HR 676. He makes an important point that simply abolishing the health insurance industry would throw a lot of people out of work. Apart from the political pragmatics, there are important principled policy reasons to look for an evolutionary transition. Canada took about 15 years to work through its process to get to a more or less national system -- it started in the provinces & still has some degree of provincial variety.

    I went to read Wyden's bill assuming it would be a lemon mandated insurance bill like Romney's Massachusetts plan, in which "affordable" insurance for lower-middle income people becomes affordable because of very high deductibles and/or large exclusions (much like current "affordable" individual insurance). The Oregon Health Policy Commission had put forward a plan of that sort & I am afraid the SB 329 will end up like that.

    Wyden's bill pleasantly surprised me. It has very strong provisions for a solid floor on benefits. Also, it looks to me as if it could generate support from small business people and people who work as independent contractors. My main immediate concern was that I am not sure he extends partial subsidies far enough up the income ladder (like the OHPC proposal, it is based on a multiple of official "poverty level," which is a very problematic statistic).

    For people who like European comparisons, Wyden's plan looks like a streamlined version of the German insurance system (though without the German method of negotiating costs). The two differences on insurance & payment are that the German system relies on mandated employer & employee joint flat rate contributions to third party funds, similar to our Social Security, and the German insurers in the mandated system are all non-profits. One way that Wyden's plan could be further developed would be to favor non-profit over for-profit insurers & eventually relegate the for-profits to a supplementary system.

    I haven't had a chance to look at Hillary Clinton's plan, so I don't know if it's a mandated lemon insurance plan or not. But in retaining the employer-based system, it probably will generate more opposition from small business people and be of less benefit to them and contract self-employed people than Wyden's plan.

    My understanding is that Obama's "universal health care" would also be some kind of privately based extension of insurance -- he is not advocating single payer.

    UrbanPlanningOverlord, you are simply wrong. Overall health outcomes in socialized systems (e.g. U.K., Denmark & some other Scandinavian countries), in single-payer state insurance systems (e.g. Canada, France) or more complex state-mandated, private non-profit social insurance systems (e.g. Germany and Japan) ALL are better than the U.S., at lower cost. Likewise, user satisfaction is higher in all of those countries than in the U.S.

    There is no perfect system. Costs are rising everywhere essentially due to the expense of new technologies, something single-payer advocates often don't really discuss. But there are lots of better systems than ours.

    If Wyden's plan could get sufficient backing, it would be a good transitional start & I think probably better than Clinton's. However, I expect Bush would veto it.

  • East Bank Thom (unverified)
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    Neither plan will work in a vacuum. Mandating insurance won't work until we have a universal living wage. Then, a sliding scale, (as i experienced in Europe) would indeed be conceivable. Then there's tort reform and the problem with expensive drugs...

    Maybe we need to more faith based reform?

  • Health Care for All (unverified)
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    Chris Lowe you need to point out what provision you believe "Wyden's bill has a provision that expressly provides for the possibility of something like HR 676." since it does no such thing in any realistic sense. You seem to have a serious misunderstanding of the fundamental philosophical differences between Wyden's bill and HR-676.

    Wyden's bill fragments the system and in practice further strengthens the power of private health insurers (it even abolishes Medicaid and SCHIP and obligates recipients to enroll in a Health American Private Insurance - HAPI - plan). HR-676 is explicitly based on the accurate premise that the fiduciary obligations and unelightened self-interest of the anti-trust exempt private health insurance industry are adversarial to the best interests of our society and the health of our people.

    You many not appreciate this, but you should know that your use of the term "single payer" also immediately flags you as someone who apparently is not directly connected with or acceptably knowledgeable about advocacy efforts for a universal national health insurance plan. Those who claim they are "single payer" advocates are generally regarded as either being new to the issue, or disingenuous, because the term doesn't actually refer to the issues of concern to national health insurance supporters. (This may go a long way to explaining why you seem to believe Wyden's bill somehow is a path to HR 676, though.)

    Wyden's plan is only transitional to something like HR-676 in ways that are irrelevant to the real social issues at the heart of the health care reform debate, at least to those seriously interested in equity. In fact, good arguments can be made it would take us further down the path of a broken health care system based on private health insurance. The real idea of private health insurance is not to actually provide health care for anyone, but in fact to impliciltly ration care in a way that those who have the least economic and political power get the least and poorest care. Wyden's plan simply provides more government subsidies for a system which, for the most part, utlimately resolves all decisions by rationing to maximize returns to the insuror rather than delivering the most health care services.

    You might also read Section 303 of HR-676 before repeating Wyden's propagandistic argument about displaced workers. He's been called on this disingenuous argument many times, and he continues to repeat it for reasons only known to him.

    If you want to see a plan which is potentially transitional to a national health insurance plan, it's Edwards' plan. He simply offers a national health insurance option as an alternative to the entire system of anti-trust exempt private/non-profit/not-for-profit insurers. Clinton claims to do something similar, but her plan seems to be a PR stunt in response to bad poll results and recent reporting that Americans rank health care and the war as the top two issues this election. If you don't think her plan is a PR stunt, or that maybe she is just plain unclear on the concept of universal health care and thinks we are all idiots out here, this quote attributed to her says it all:

    http://news.yahoo.com/s/ap/20070918/ap_on_el_pr/clinton_ap_interview_6 "She said she could envision a day when 'you have to show proof to your employer that you're insured as a part of the job interview'".

  • andy (unverified)
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    Nobody ever seems to talk much about the actual coverage provided by these various plans. The media just tosses around the phrase "universal coverage" but they don't provide any actual substance. For instance what exactly is covered in there? Breast implants for teenagers? Hip replacements for senior citizens? Free contraceptives? Lung transplants for smokers? Knee replacements for obese people? Cancer drugs that cost $250,000 per year?

    The devil is in the details. There isn't enough money to give everyone everything so the real screaming will only start once people realize that they won't be getting covered for every little thing.

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    Health Care for All,

    My understanding of the philosophical difference between Wyden's plan and publicly funded universal health insurance is fine, thanks. That said, it is likely that there are things I can learn, and I invite you to help me.

    However, I'd appreciate it if you would stop questioning my motives or seriousness. That is not actually a good way to get people on your side, or even to listen to you.

    Thank you for the reference about how HR 676 addresses the employment issue. I will follow it up.

    Personally I dislike the term single payer because it is an opaque jargon. However, I get most of my information on current efforts focused on HR 676 from Healthcare-Now!, an organization with which I suppose you are familiar. The top of their webpage reads:

    "HealthCare NOW! MEDICARE for ALL - Organizing for a Quality National Single Payer Healthcare System for All, HR 676."

    I can quote you other uses of the term "single payer" from them in e-mails they send, if you like. I am reasonably sure I have heard David Himmelfarb and Steffy Woolhandler of Physicians for a National Health System use the term in radio interviews.

    Do they have it wrong? Is there a different group you would recommend working with? I am not asking this as a debating point, but completely seriously.

    It is true that in a sharp critique of Clinton's plan by Rose Ann Demoro, executive director of the California Nurses Association/National Nurses Organizing Committee, Demoro does not use the term. That critique is well worth reading regarding the Clinton plan, and much of it would also apply to Wyden's and Obama's and I suppose Edwards'. Since Demoro I think represents the most aggressive cutting edge of the public provision movement, perhaps you are right that movement rhetoric is changing, which would be all to the good.

    You are right about Edwards' plan providing an apparently immediate introduction of a publicly funded option into competition with private insurers, if he can get it through, whereas Wyden's bill only mentions such a possibility obliquely. You are right that it is not clearly stated.

    Please explain how Wyden's plan would increase fragmentation? On the face of it, eliminating Medicaid as a separate program would both be a consolidation and remove the stigma associated with a means-tested program that contributes to underfunding.

    Likewise detaching insurance from employment and from specific employers would reduce fragmentaion, wouldn't it?

    My sense that Wyden's bill could lay groundwork for a later transition to a fundamentally different system is partly based on this perception that it reduces fragmentation. If that perception is wrong, please help me see why.

    Eliminating Medicaid might be objectionable as a privatization measure, in moving some people from a current though problematic form of public provision. But I believe people currently eligible for Medicaid would be fully subsidized under Wyden's plan.

    It is also my impression from reading the bill that Wyden's plan, by setting out what appear to by strong minimum coverage requirements for plans in his proposed system & some other features, would place a significant constraint on insurers' ability to ration access or care for the sake of profit. These look to me similar to the constraints in the German system which provide a strong floor. If that's wrong, please educate me. General arguments about the problems of profit motivation in healthcare provision, with which I agree, won't address the question, which is how much Wyden's plan would regulate such problems by defining the requirements of market entry in certain restrictive ways. Is the appearance of such regulation illusory? Why?

    The aspects of Wyden's plan of greatest concern and least clarity within its own terms is the question of high deductibles. Any plan which bases "affordability" for working class families on high deductibles will not solve the problems of delayed necessary care and consequent later costs, as Demoro points out in the piece linked above.

    The subject line of this discussion was a comparison of Clinton's plan to Wyden's. Having looked at Hillary's since last night, it is a disastrous hodgepodge. All I was saying about Wyden's plan is that it seems significantly different from a number of other individual mandate plans in ways that make it better.

    At the end of the day I suppose I am demoralized about the prospects for public provision, partly because I don't see very effective organizing. That draws me into willingness to participate in the relative merits of the several non-public plans that appear to have greater immediate prospects. Perhaps that counts as a form of lack of seriousness, I don't know. But it's not because I don't understand the difference.

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    Health Care for All,

    Now I've looked at Section 303 of HR 676. About displaced workers it says, in full:

    "(e) First Priority in Retraining and Job Placement- The Program shall provide that clerical and administrative workers in insurance companies, doctors offices, hospitals, nursing facilities and other facilities whose jobs are eliminated due to reduced administration, should have first priority in retraining and job placement in the new system."

    This does not really seem to answer the point. Since a central argument about national health insurance is that it would reduce costs greatly by reducing the enormous private bureaucracy and paperwork of the current system, most of which presumably goes to wages and salaries, the logical inference would be that many, many fewer jobs would exist in the new system. Giving current health sector administrative workers first shot at that much reduced number doesn't say anything about those who don't get them.

    At minimum, there should be a companion bill providing detailed and funded education and retraining benefits for workers displaced by this transition.

    You mentioned that Wyden had been "called on this disingenuous argument many times." Can you give references that might explain in greater detail why this shouldn't be a worry? Do we, for instance, have evidence from Canada's transition?

    This isn't a sufficient reason not to switch to a public system, not by a long shot. But as far as I can see, it is a real issue that pro-worker progressives should face directly and not sweep under the rug. If I'm wrong, help me see why it isn't a real issue.

  • Tom Civiletti (unverified)
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    t.a. wrote:

    "... the reason no one is proposing to cut out the insurance companies is because we need some plan to pass. not a perfect plan; any plan."

    The insurance companies are the biggest problem with the current system. They siphon off the money needed to make health care for all affordable. So, we either remove the insurance companies from the system, or we pass a plan which does little or nothing to address the problem. Sometimes the only worthwhile change is radical change.

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    So, Tom, how do we pass that radical change?

    Setting aside the policy debate for a moment, what's the political plan for making it happen?

  • Tom Civiletti (unverified)
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    This is how we pass it, Kari:

    We stop running away from the term "socialized" and explain how it means health care for all, emergency rooms used for emergencies instead of basic health care for the poor, families saved from health problem caused bankruptcy, longer lifespans for Americans, and an overall healthier population with the economic advantages that confers.

    If the insurance and pharma companies attempt to demonize single-payer, we demonize them for the killers they are.

  • Gayle Alexia (unverified)
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    I think it should be mandatory that every member of the house and senate watch the documentary "Sicko" before putting these plans on the table. What is it these politicians don't understand about unemployed? Not every one in America is working. There are laid off, displaced, disabled ,homeless,full time students, etc., how are they supposed to purchase these plans that are offered by employers? MOdel it after France, since they are NUMBER ONE in the world. What is so hard about giving credit to another country for doing it right? It makes me sick. These plans still put the decisions in the hands of the insurance companies. I was sent home early after surgery because my insurance company wanted me to leave against my doctor's recommendations. Unacceptable.

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