Yet another comparison of the Obama and Clinton health care plans shows (again) that Obama’s claims that his plan is ‘universal coverage’ are fallacious. This analysis, performed by the good folk at FactCheck.org, provides an excellent synopsis of the plans as well as their likely impact on the uninsured.
The net is this – without an individual mandate, between 15 and 26 million Americans will likely remain uninsured. Obama’s plan does not have an individual mandate. Period.
With a mandate, a few million will slip thru the cracks – like the Medicaid-eligibles who fail to enroll.
Feb
15
The attention being placed on the plans’ universality is distracting us from a real concern– the individual mandate. Simply saying the plan will be universal without effectively addressing how the mandate will be paid means that a plan called universal will not necessarily be universal. We are seeing this object lesson in Massachusetts today.
I agree Senator Obama’s plan should not be termed “universal coverage,” but because it focuses on lowering costs, the effect of a lack of a mandate may be blunted. Senator Clinton’s plan is a firm attempt towards universal coverage, but she has dodged, unsurprisingly, any discussion of the individual mandates that will be needed to enforce universality. That implies her plan is not as universal as she claims.
There also is the problem of getting either plan approved by Congress. Senator Clinton’s plan has all the hallmarks of a plan destined for denial. Senator Obama’s plan has at least a fighting chance.
So the question is whether, at least for the Democratic candidates, we embrace a notion of no compromise/no chance of passing or a notion of fair amount of compromise/fair chance of passing. What is politically possible: an ultimatum or an substantial, but incremental, change in the right direction?
Senator Obama’s plan, as suggested by Austin Goolsbee, is probably more realistic.
It’s just bizarre that Obama is advertising it as Universal. I don’t know how he could possibly justify that, unless it’s a “it depends on your definition of ‘Universal'” kind of thing.
I’m not sure which is a better plan or which is more realistic. I do know that Hilary’s plan has as much or more to do with lowering costs as Obama’s plan, so it’s not like Obama’s focusing his policy on cost, even if he is focusing his rhetoric there.
But that’s not the point. The point is that Obama’s plan is explicitly NOT Universal, and yet he continues to advertise it like it is. It’s just strange.
The ancient Chinese medical care system was based upon prevention: patients in a doctor’s practice paid only if they were healthy; the doctor took care of the sick for free, in essence providing both disease and accident health insurance and healthcare.
A practical modern equivalent might blend the ancient Chinese system with modern US Healthcare to achieve affordable prevention-based reform and universal coverage:
(1) Universal first dollar coverage for primary prevention services, paid by the government. Everyone in covered for this basic high value care without cost:
All citizens register with a national system, which gets everyone “in the system” at an affordable price. Any doctor can provide the service and bill the government; compliance is recorded in a national information system, and the clinical results are recorded in a local information system owned by the community with local Medical Society custodianship with clinical data access by the patient and those designated by the patient. Published, regionally adjusted, and adequate fees are paid to clinicians when patients use these preventive services, and the patient’s compliance is recorded and used to decrease the rate that the compliant patient pays for health sickness and accident insurance.
(2) Universal coverage for secondary prevention services provided by an individually-selected primary care MD (minus a co-pay), also paid by the government:
Patients are also encouraged to select a primary care physician; if they do, they are covered (minus a co-pay) for an additional nationally determined basic set of high-value secondary preventive services, such as management of hypertension, diabetes, smoking, obesity, inactivity, lipid disorders, pregnancy, and asthma. In addition to the fee- for- service (limited by guidelines) payments for these services, the doctors earn an annual bonus for good outcomes by the patients in their practices on basic risk status (e.g. Hbg A1c ), perhaps later also getting a bonus for excellent patient outcomes, such as low hospitalization and disability payments. Compliance with this secondary prevention earns the patient additional reductions in Accident and Sickness insurance.
(3) Universal high value Accident and Sickness Care paid by traditional pluralistic insurance funding mechanisms:
Companies and individuals can fund insurance and / or buy care and/ or fund health saving accounts with pre-tax dollars; government programs or companies can cover special populations. All insurance mechanisms must interface with the national and regional information systems. Rates are adjusted based on prevention compliance. Companies or individuals can pre-fund health care with pre-tax dollars, either as insurance or a combination of insurance and health designated savings e.g. health savings accounts. The government funded universal prevention database provides a mechanism to ensure that every legal resident has some form of pre-funding Sickness and Accident care.
(4) Universal high value Accident and Sickness policy standardization allow comparison shopping:
Coverage is for a nationally standard high valued benefits package; reimbursement is at the community average levels, which are established from insurer data made available to the community and published. Premiums are risk adjusted according to a national standard, and patients who are compliant with primary and secondary prevention get a lower rate for their accident and sickness insurance coverage. This high value limited coverage package will be more affordable that current health insurance but meet most of the important needs.
(5) True Free Market Forces determine Prices for services
One published price for all medical products and services; each supplier sets their own price. Information about products and services and outcomes are freely available, but advertising is prohibited. Many costly and perverse market distortions can be eliminated by these low cost changes.
(6) Optional Comprehensive Sickness and Accident Coverage, in addition to the universal high value Accident and Sickness plan
(7) Optional Catastrophic Limits Coverage:
(8) Aggregated (no personal identifiers) Data from all Plans available to local health planning and public health efforts: Local stakeholders participate in health planning efforts.
George Anstadt