This is like Jason and Friday the 13th. Last time around Hillary Rodham Clinton and Ira Magaziner had secret meetings and cooked up a monstrous unwise proposal to restructure American health care on a massive scale. Well, she's back.
WASHINGTON, Sept. 15 ó Senator Hillary Rodham Clinton on Monday will lay out a plan to secure health insurance for all Americans while severely limiting the ability of insurers to deny coverage or charge higher premiums to people with chronic illnesses and other medical problems, her aides and advisers say.
If government subsidizes health insurance purchases by poor people then fewer small companies will offer medical insurance and will instead expect government will provide coverage.
A big difference from last time: She's proposing to build on the existing system of insuring Americans -- a mix of private coverage and government-subsidized care -- not remake it altogether.
Still, Mrs. Clinton's plan, described by people familiar with it, would involve sweeping change. It would create new federal subsidies to aid those who couldn't afford the required health coverage. And it would impose new mandates on large employers to provide health coverage or help pay for it.
But look at it on the bright side. Hillary's proposal might cost less than the Iraq war.
The price tag for the Clinton plan will be closer to Obama's $50 billion to $65 billion estimate than Edwards' $90 billion to $125 billion plan, sources said.It's not clear if Clinton will finance her proposal by repealing the Bush administration's tax cuts for the wealthy, as Edwards and Obama have proposed. On the campaign trail, Clinton has hinted that she would save money by fostering efficiencies and squeezing savings from .insurers and drug companies.
If insurers are prevented from denying coverage to those with existing conditions then we'll enter a new era in which insurers try to avoid getting applications for medical insurance from people who are sick. Oops, we disconnected our phone number. Oops our web site is down. Oops we moved out of areas that have lots of sick people. Ooops, we don't advertise in areas which have lots of sick people.
But maybe Red Hillary isn't as dangerous now as she used to be. We can hope that perhaps pharma companies which have been trying to buy her influence have at least partially succeeded.
One former insurance company executive recalled Clinton summoning top drug company executives to the White House for a dressing-down. "She storms into the meeting and 'The days of profiteering in the pharmaceutical industry are over!'" the lobbyist recalled. "There were no handshakes, no 'How was your flight' ... It was ugly, nasty. From that point on I knew her plan was dead."
Clinton, who says she still bears "the scars" from the experience, is a less fearsome figure these days. Since being elected to the Senate, she's enjoyed a good relationship with in-state drug companies such as Pfizer and has delivered federal funding to the hospitals she once demonized. Her rhetoric, particularly against Big Pharma, can still be fierce, but her pariahs are now patrons: The industry .contributed more than $850,000 to her re-election campaign, the second highest level of .contributions to any senator.
Has the comrade reformed? Has she embraced Perestroika? Somehow I doubt it. She still seems angry deep down. She might take out her frustrations with Bill on us. If only the woman could get laid regularly maybe she could lighten up.
"Nobody is going to be surprised when I unroll my coverage plan that I intend to dramatically rein in the influence of the insurance companies because, frankly, I think they have worked to the detriment of our economy and our health care system," Clinton told interviewer Charlie Rose during an Internet forum co-sponsored by Slate and The Huffington Post earlier this week.
Those evil insurance companies. Well okay, they are not saints. But keep in mind some of the other reasons why we have problems with health care finance:
What I worry: If the US government requires some minimal mandatory level of medical insurance then whatever they define as a minimum becomes something that everyone must have, not just the poor uninsured of today. That could result in more unnecessary and even harmful treatments. Economist Robin Hanson argues that we could cut the total amount of health care in half with little harm to health.
Regions that paid more to have patients stay in intensive care rooms for one more day during their last six months of life were estimated, at a 2% significance level, to make patients live roughly forty fewer days, even after controlling for: individual age, gender, and race; zipcode urbanity, education, poverty, income, disability, and marital and employment status; and hospital-area illness rates. This same study, using the same controls, also estimated that a region spending $1,000 more overall in the last six months of life gave local patients somewhere between a gain of five days of life and a loss of twenty days of life (95% confidence interval). (Iím using a fifty days lost per 1% added mortality rule of thumb.)
Read Hanson's full article for information about health care spending efficacy.
Real insurance would pay for treatments that are unavoidable, prohibitively expensive, or for illnesses that occur relatively rarely. Instead, insulation reimburses even relatively low-cost services, such as a test for strep throat or a new pair of eyeglasses. Insulation pays for treatment even if it is commonplace or discretionary.
The problem with insulation is that it is not a sustainable form of health care finance. Individuals, employers, and government are all under stress.
|Share |||By Randall Parker at 2007 September 16 09:53 PM Economics Health|