Think Bob Seger at a UAW picnic. Don Ho at a luau. Lawrence Welk at a retirement home. Toby Keith at Daytona.
Sen. Barack Obama’s just finished his speech at Take Back America, and it had all the excitement, electricity, and fervor, minus the ‘tiny bubbles‘. But never fear, your trusty correspondent didn’t get swept up in the hysteria, and maintained focus on the important question – does his health care reform platform make any sense?
My ongoing quest for substantive discussion of health care continues, and I was pleasantly surprised by the amount of time Obama devoted to health care in his half-hour speech.
Obama took on special interests, including pharmaceutical manufacturers, decrying their inordinate influence on government. He also noted the problems of small businesses unable to afford health care, the rising number of people without insurance. The best applause line was “we’ll bring companies and unions to the table, and while insurance companies get a seat at the table they don’t own every seat.”
Obama’s over-arching message is one of Americans taking care of Americans, and this informs and infuses his policies and platform. Beyond that, the level of detail was refreshing – he claimed by investing in technology and preventive care costs will be reduced by “up to $2500 per family per year”, talked about some form of catastrophic coverage (apparently via some form of reinsurance), and closed with the crowd-pleasing commitment to sign a bill providing universal coverage by end of the first term.
Speeches are fine and great entertainment – here’s the substance from Obama’s website.
There are core concepts that are consistent across all the Democratic candidates – availability of universal coverage with no exclusions, better health IT infrastructure, mandated coverage of preventive care, better reporting of outcome and quality data, elimination of waste, and income-graduated financial assistance.
One difference is that Obama’s plan does not “require” coverage, but rather sets up a variety of means for individuals and employers to obtain coverage. The exception is kids – his plan requires health insurance for all children.
Obama’s platform is not markedly different from his competitors, and as one a little late (and a little light) to the policy party he’s been scrambling to differentiate.
Here are the key components of ObamaCare (my appellation, not his).
1. Medicare stays as it is.
2. A “National Health Insurance Exchange” will enable individuals and small businesses to shop for health coverage from private carriers. This is a national clearinghouse wherein private insurers post their coverage areas, plans, prices, and come-ons in an effort to entice new members. (Benefit plan is likely consistent with the FEHBP).
3. A new public insurance program will be developed for individuals who don’t have access to coverage through employer-based insurance, Medicaid, or SCHIP. The benefit plan will be “based on”, you guessed it, the FEHBP. (I really have to look at that plan design one of these days…)
4. Employers will be required to contribute towards the cost of insurance.
OK, that’s the 30k foot review. My take? It’s a solid start – bringing all parties to the table is an approach that is sadly missing from other candidates’ stump speeches. His plan isn’t perfect, so here’s the critique.
Without universal coverage the rest doesn’t work. Without cost control, expanding coverage makes a big problem bigger.
And a publicly-funded reinsurance cover for catastrophic claims doesn’t make sense, as it removes the incentive for private (or public) insurers and employers and managed care firms to prevent these claims, as well as to manage them when they do happen.
The health insurance exchange, mandated coverage for kids, and investments in technology all have merit. But I still don’t see how this all adds up to a 20% reduction in health insurance premiums for the average family.
Bob Laszewski noted that Obama is one of the few pols to actually recognize the need to bring all parties to the table, including those awful insurance companies and their fellow travelers, big pharma. Bob also notes that Obama’s criticisms of the insurance industry are healthy and appropriate.
Ezra Klein has taken a close look, and thinks its pretty good. Others complain about the lack of specificity, but in fairness the more detail the easier it is for critics to shoot holes in plans (and cause collateral damage to campaigns as well).
Ok, the “Key Components”:
1. Medicare Stays at it is. Fine, after Medicare part D what more could the federal government mess up and create a bigger entitlement program that today’s children will have to figure out how to pay for.
2. A “Nat’l Health Insurance Exchange”. Let’s try to find an underwriter that will attempt to price a package for people who can’t get insurance now. That “group” of non-group individuals simply have higher utilization. Did you feel all warm and good after COBRA?, to only later find out you could not afford the coverage? Many individual (non-group) plans exist through out the country. The sad fact is that those plans serve individuals with higher utilization. Benefit plans like FEHBP sound nice, but the pricing would reach the moon.
3. Face it, that will not be “insurance”. Instead it will be prepaid health care. Those without insurance or are uninsurable (pre-existing conditions) will get something akin to Medicaid. That program will be administered by government employees which further burdens the taxpayer. That program will provide the same unique service received from the DMV or the IRS. Maybe some federal employees from FEMA will transfer over. We know how well they react.
4. Employers will be required to contribute? Nice, let’s not let the free market determine if an employer decides to offer a specific benefit or not. Which employers will be required (it will depend on the amount of $ donated to the local congressperson/Senator), for what benefit level (something like a discount card?)? We need to let the market handle this “trumped up” “problem”.
There is no health insurance crisis. Are there inequities? Yes, but let individuals and the market resolve those problems. Increasing the size of government is not the answer.
Please identify any government program that works (not including the military).
Is this a solid start? No way. Just another big program for the federal government (not private industry and market competition) to build.
Government functioned well when functional people were running it. You elect someone like Bush who thought government couldn’t do anything right and then set out to prove the theory, and use that as an argument against increased government involvement. When Democrats speak about the power of goverment, it’s implicitly assumed that they mean when it’s run by competent individuals, like themselves.
“Government functioned well when functional people were running it. ”
Well, Spike, you are taking the topic away from health insurance, but – – when was that, exactly?
More importantly, your position depends on the notion that it’s not the form of government that matters, it’s the “people running it”. Well that’s technically true of any organization – government or private – but the observation is meaningless because you do not suggest any practical alternative for choosing our government, if not the way we do it now.
“they mean when it’s run by competent individuals, like themselves.”
A government that depends on some self-anointed elite “they” is not the government described in our constitution. You actually want a system in which elites accountable to no one but themselves dictate to the knaves such as me . . . and you? Our ancestors & neighbors did not have to leave Europe or Asia or Africa to have that form of government.