When it Comes To Health Care Policy It Really Doesn't Matter Which Democrat Or Which Republican Wins Their Nomination

With "Super Tuesday" upon us, I am once again bringing back a post that argues there is little difference among the candidates in each of their respective parties.

My suggestion is that you not cast your caucus or primary vote for a candidate based upon their health care reform plan.

From “thirty thousand feet” the leading Republicans are offering much the same health care policy ideas—a more vibrant market serving a more responsible consumer who would control his health care choices in a system that doesn’t need to spend more money.

And, from that same "thirty thousand feet," the two remaining Democrats are all offering about the same thing--$100 billion+ in new annual spending to guarantee access for virtually all Americans to existing public and private health plan options as well as some new ones created by the government.

Republicans support an open market—no mandates and less insurance regulation—believing that the market must first get costs under control by developing new and more efficient offerings for people in the private market based on consumer-driven principles and new and more efficient and appealing options for people who have public coverage as well.

Democrats call for shared responsibility—often mandating employers and consumers to participate in their near universal system made up of Medicare, Medicaid, SCHIP, private individual coverage offered through government-run marketing structures, a Medicare-like government plan option for those under age-65, and existing employer plans.

I hate to say that it doesn’t really matter which of the Democrats, or Republicans, wins their separate primary battles. But in terms of the nits health care policy it really doesn’t.

Sure there are differences in their health care policy proposals. Among the Democrats, Obama doesn't have an individual mandate to buy coverage while Clinton does. Among the Republicans, McCain uses a tax credit to help people buy coverage while Romney talks about tax deductions.

But remember, these are political proposals--generally just a few pages long. The real health reform process will eventually have to go through the legislative "sausage factory" that is Congress and I will suggest that the starting point from one Democrat compared to another, or one Republican compared to another, is hardly material.

As you prepare to vote in your state's caucus or primary, I would recommend that you focus on the other issues that are important to you, the "electability" of each of the candidates, and perhaps most importantly on the issue of health care, which of these candidates can finally break the health care reform logjam and get something done.

Whoever the eventual nominee is in each of the parties, we will have a Democrat and a Republican offering a dramatically different approach to American health care security.

The general election is where the big decision will be made on health care--and everything else.

You can see my analysis of each of the candidates plans by using the index in the right column.

Poll Shows Democratic Presidential Candidates Attracting Independents and Moderates With Their Health Reform Plans

I was struck by this conclusion in today's Los Angeles Times regarding their recent voter survey:

"In one of the most politically significant results, the poll finds that independents and moderates were generally lining up with Democrats in the healthcare debate.

"The survey also suggested an explanation for the emerging alignment: Independents were most likely to complain about "job lock" -- the view that they are stuck in jobs they don't like solely because of health benefits.

"In all, 20% of independents said they or someone in their household were forced to stay in a job because it provided healthcare, compared with 13% of Democrats and 5% of Republicans.

"Independents are more insecure in terms of the issue of 'job lock,' which causes them to lean more toward Democrats on the healthcare issue than Republicans, said Robert Blendon, a public opinion expert at the Harvard School of Public Health."

As I have said in earlier posts regarding the Republicans' health reform proposals, their positions may look good in the primaries where they must please only conservative Republican voters, but they risk losing the middle of the country if they don't get a lot more serious about health care reform.

Democratic Presidential Candidate Bill Richardson Announces a Health Reform Plan

Democratic presidential candidate Bill Richardson recently announced his health reform plan.

Richardson's health care proposal follows the general outline offered by other Democratic candidates in that it focuses first on getting everyone insured and falls short in getting at the fundamental problem creating so many uninsured--health care costs.

Bill Richardson's health plan also builds on existing public and private health insurance programs.

Richardson would:

• Provide tax credits on a sliding scale to help residents purchase health insurance.
• Require employers to pay a share of their worker's health care costs.
• Allow people ages 55 to 64 to buy into Medicare.
• Expand Medicaid and SCHIP to cover more low-income families and children.
• Allow individuals and businesses to buy their health insurance from an expanded Federal Health Benefit Plan (the same program Congress and the President use).
• Improve health care efficiency through the increased use of health care information technology.
• Mandate that health insurers no longer can deny coverage to people with pre-existing conditions.
• Expand veterans care by giving them a "Heroes Card" enabling them to access the private system.
• Limit interest rates applied to health care bills and credit cards.
• Allow the federal government to negotiate Medicare drug prices directly with pharmaceutical companies.
• Establish incentives for preventive care programs.

Richardson claims his plan would cost an estimated $110 billion per year but that the savings from the plan would cover the cost.

Richardson was quoted as saying, "Despite Republican hand-wringing about the cost of universal care, it is clear that the cost of doing something--in lives and dollars--pales in comparison to the cost of doing nothing." He also said, "My plan does not build a new bureaucracy. The last thing we need between patients and doctors is another sticky web of red tape."

Like all of the leading Democratic candidates, Richardson is ready to move forward with a big and comprehensive reform plan. But he is not interested in a big government-run plan that would "build a new bureaucracy."

His claim that his program will cost nothing is at the outer edge of wishful thinking. Getting everyone covered will save lots of money. But it will take bundles of money up-front to get a program like this going.

Because the structure of his plan is similar to the plans already announced by rivals Barack Obama and John Edwards--and the plan coming from Hillary Clinton--his program costs will not be lower than theirs.

In many respects, this plan is comparable to the Massachusetts health plan that has found that granting access to insurance is only the beginning--being able to afford to get everyone in and then running the plan in a way that does control costs is the real challenge.

The Richardson health plan takes that first step but hardly addresses short-term affordability and long term costs.

But he is right about this, "It is clear that the cost of doing something--in lives and dollars--pales in comparison to the cost of doing nothing."

But that statement will quickly become fatally flawed short-term thinking if he doesn't more realistically deal with the long-term costs and create an affordable strategy.

Series of posts on the Massachusetts health plan

Leading Democratic Presidential Candidates Comment on Health Care This Week

Joe Paduda, over at Managed Care Matters, is attending the "Take Back America" conference in DC this week. Joe has been posting a review on his site of each of the Democratic candidates comments on health care.

Comments include a review of Clinton, Edwards, Obama, and Richardson.

The Mandate Myth--Health Reform Plans Don't Have to Mandate Coverage to Work But They Do Have Be Affordable

As the presidential candidates, Republican and Democratic, begin to come forward with their health reform plans, a side debate is heating up about whether any meaningful health care reform plan has to have a mandate, individual or employer.

The reasoning goes that for health care reform to work we need to get about everyone in the pool--both in order to solve the uninsured problem and to be able to adequately spread the cost of health insurance across as many people as possible.

We do need to spread the cost of insurance over a big pool to get the best cost structure--a pool that isn't just populated by the old and sick and therefore one that costs a lot.

However, the notion that we have to either mandate that all individuals buy coverage--or that all employers provide it--is a myth.

Today, there are a number of health insurance pools that are large enough to provide an optimal spread of risk. Each of these pools is voluntary--not mandatory:

• Most employer plans. No employer requires all employees to join their health plan. All employer health plans are voluntary. Yet employer after employer--many self-insured with just a few hundred participants--have very efficient programs.
• The Part D Medicare drug benefit. The plan is voluntary and enough people have signed up to make it workable.
• Part B of Medicare. The portion of Medicare that covers physician and other non-hospital costs is voluntary and almost all seniors sign up for it.

Each of these voluntary health insurance plans works quite well without any individual mandate.

However, each of these plans is affordable. Employers typically pay at least 75% of the costs for their employees. The government pays 75% of Medicare Part D and Part B costs.

So, it's simple.

The problem is not making people buy coverage--the problem is making health insurance coverage affordable. Massachusetts learned that this year when they first tried to mandate that all citizens buy health insurance but had to back-off because they couldn't produce a health insurance plan that everyone could afford.

If you make health care affordable enough people will come to adequately populate the insurance pool.

The challenge is not to force people to buy health insurance. The challenge is making it affordable so they can.

Many are now focusing on whether or not Barack Obama, John Edwards, Hillary Clinton, Rudy Giuliani, or any of the rest, have a mandate in their health reform plans.

Wrong.

What we need to focus on is how are they going to make health care affordable.

It's the costs, stupid!

Related posts:
Giuliani Set to Announce a Health Care Proposal--But He Has to Make it Affordable for Everyone

Deja Vu in Massachusetts--We've Been Down this Road Before--The Massachusetts Health Care Plan and Health Care Costs

It's the Cost of Health Care Stupid!!!

Democratic Presidential Candidate Bill Richardson Supports the Employer Mandate as a Way to Provide Health Insurance

Democratic Presidential Candidate Bill Richardson has weighed in on the health care debate with comments about what he would do on the issue:

"You know, every time a Democrat, it seems, we propose a new [health care] plan, it's more spending or more taxes. I'm not that way...I would have a mandate. I would say every employer...has to have a health care plan. That's how you pay for it."

Well Governor, an employer mandate is a tax and it would be used for more spending. It's just a matter of who you would tax and how much you would tax them.

There are a number of ways we can accomplish universal health care coverage. An employer mandate is one of them. An employer mandate would target the employers who do not provide coverage. The problem is that the vast majority of these employers would like to provide coverage--they just can't afford it. With the average cost of family health insurance at about $11,000 a year, an employer paying the typical 75% of that cost would have an obligation of $8,000.

Governor Richardson, you are suggesting an employer head tax of $8,000.

We do need to move toward universal coverage but we need to do it in a way that spreads these high costs as widely as possible. An employer mandate could be part of that strategy, as it is in Massachusetts, but it has to happen in a way that doesn't put small businesses--where so many new jobs are being created--out of business.

We also need to recognize how much health care does cost and understand that huge burden cannot be sustained by any one of the potential payers--individuals, their employers, or government.

And, once we figure out who is going to pay for it, we need to assure ourselves that we can contain health care costs.

The only thing worse than how much health care costs today is how much it will cost tomorrow if we don't make cost containment a big part of any solution.