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Krugman: If Obama Is President, There’s No Chance for Universal Health Care [UPDATED]

By SusanUnPC on February 4, 2008 at 12:52 AM in Barack Obama, Chicago politics, Health Care, Hillary Clinton

We Democrats have waited SINCE PRESIDENT HARRY TRUMAN (the late 1940s!) for a chance at universal health care. It’s within reach. Let’s not blow it on a candidate whose plan is weaker and who’s already making ill-considered policy shifts (see below for a sad description of Obama’s illogical backpedaling on mandates by considering the imposition of penalties on those who don’t sign up).

Here’s the “money quote” from Paul Krugman’s column in tomorrow’s New York Times (February 4, 2008):

If you combine the economic analysis with these political realities, here’s what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance – nobody knows how big – that we’ll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won’t happen.

Krugman cites essential new information — that every voter should know — from an M.I.T. study by a renowned health care analyst comparing the two candidates’ plans, important because, Krugman notes, the “principal policy division between Hillary Clinton and Barack Obama involves health care”:

[A]s I’ve tried to explain in previous columns, there really is a big difference between the candidates’ approaches. And new research, just released, confirms what I’ve been saying: the difference between the plans could well be the difference between achieving universal health coverage – a key progressive goal – and falling far short.

Specifically, new estimates say that a plan resembling Mrs. Clinton’s would cover almost twice as many of those now uninsured as a plan resembling Mr. Obama’s – at only slightly higher cost.

Twice as many people. That’s huge. Obama has attacked Hillary Clinton repeatedly for mandating coverage — but there are critical reasons that everyone be covered.

NOW Obama is suggesting (as you’ll see below) that he may “penalize” people who don’t participate. WHAT? Penalize them? Why not just include them in the first place?

Here’s more detail, what Obama said in the Thursday night debate, reported by Ezra Klein for Prospect:

Obama not only has a mandate for kids in his own health care plan — what if the parents can’t pay, one might ask? — but he said, in last night’s debate, “If people are gaming the system, there are ways we can address that. By, for example, making them pay some of the back premiums for not having gotten it in the first place.” That, of course, is exactly what a mandate does. Gaming the system, in this context, means not purchasing health care. And Obama is now threatening to force them to pay back premiums. That’s a harsher penalty than anything Clinton has proposed.

And how would that work without further encumbering impoverished families? It sounds like it’d be a terrible mess that would leave people in medical care limbo.

Here’s one key reason why mandatory universal coverage works: It forces insurance companies to cover everyone. Another reason is that even young, robustly healthy people can face enormous medical bills from accidents or from rapidly growing diseases hitting the young, including diabetes and high blood pressure (that can be discovered and treated before they become expensive). And if they sign up before they get sick, the plan’s costs would be lower. (Find out more here, including great analyses from Ezra Klein, Steve Clemons and The Urban Institute.)

Krugman continues:

[B]oth plans seek to make insurance affordable to lower-income Americans. The Clinton plan is, however, more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies. [...]

Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.

[W]e already have programs that make health insurance free or very cheap to many low-income Americans, without requiring that they sign up … many of those eligible fail, for whatever reason, to enroll.

An Obama-type plan would also face the problem of healthy people who … don’t sign up until they develop medical problems, thereby raising premiums for everyone else. Mr. Obama, contradicting his earlier assertions that affordability is the only bar to coverage, is now talking about penalizing those who delay signing up — but it’s not clear how this would work.

Krugman reports that Jonathan Gruber of M.I.T., “one of America’s leading health care economists,” explains in a new paper how Obama’s plan leaves far more people uninsured — and costs more:

Mr. Gruber finds that a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion. Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.

That doesn’t look like a trivial difference to me. One plan achieves more or less universal coverage; the other, although it costs more than 80 percent as much, covers only about half of those currently uninsured.

As with any economic analysis, Mr. Gruber’s results are only as good as his model. But they’re consistent with the results of other analyses, such as a 2003 study, commissioned by the Robert Wood Johnson Foundation, that compared health reform plans and found that mandates made a big difference both to success in covering the uninsured and to cost-effectiveness.

And that’s why many health care experts like Mr. Gruber strongly support mandates. …

Krugman refers to the Obama campaign’s ugly tactics against Clinton’s health plan, and why “Mr. Obama’s campaigning on the health care issue has sabotaged his own prospects“:

You see, the Obama campaign has demonized the idea of mandates — most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the “Harry and Louise” ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care.

I showed you that pamphlet the other day. It’s important to display it again. It is UGLY, Chicago-style campaigning — and, as Dr. Krugman points out, would sabotage the realization of even Obama’s own weaker plan:

In a February 1 NYT blog post, “Obama Does Harry and Louise Again…,” Krugman points out:

The Obama campaign sends out an ugly mailer. Sorry, but this is just destructive — like the Obama plan, the Clinton plan offers subsidies to lower-income families. And BO himself has conceded that he might have to penalize people who don’t buy insurance until they need care.

Read all of tomorrow’s NYT column, “Clinton, Obama, Insurance.”

THIS is the candidate who can bring us UNIVERSAL health care:

campskunk

obama is a cynic. he never had any intention of enacting universal healthcare. his plan is just an excuse for him to claim he did, and the dishonest way in which he is presenting it tells you all you need to know about his dedication to solving this problem.
AF

Great. Just great. Well health care doesn’t matter that much does it? I mean we’ll have Mr. American Idol for president and that will be fun for all of ten minutes.

She is a president people. Think!!
JoeySky18

Universal Healthcare will help lots of lower income folks. They will have access to medical treatment. The sad things that can happen to a family is when there is sickness and they could afford medical treatment. You won’t feel the pain until it hits you. A good quality healthcare is a fundamental right that everyone should have. At the moment, good quality healthcare is more of a privilege to a few.

http://noquarterusa.net/ SusanUnPC

And those poor people won’t end up at the local county hospital that is struggling to keep up — and may have to raise people’s property taxes, which has everyone furious!

Then there’s the public hospital in Seattle, which is a ZOO! It is so depressing and overcrowded there. Dirty too. But the doctors there are so damn good. It’s a Trauma 1 facility, and where people get flown by helicopter if they’re badly injured (they have the most brilliant surgeons there). I also got life-saving help at their ER last year, but hated being in the place.

ALL that would improve if ALL people had normal health care, and didn’t have to suck up the resources of ERs.

Hope

When I lived in Holland about 25 years ago everyone had health care. It was inconceivable to them, even way back then, that America didn’t have universal health care for its people.

How long is it going to take if Obama has his way?

And yes, it is worth paying for. We shouldn’t have to end up using the ER when it is already too late just because we couldn’t afford to see a doctor when prevention could have worked.
BernieO

The movie Sicko made it clear that the crisis affects a lot more than low income people. Many who are insured wind up bankrupt when their provider denies coverage. Many more cannot get insurance because of a pre-existing condition. This problem affects everyone. Actually those who are at the bottom of the income ladder are often better off because at least they qualify for Medicaid.

As for Obama I thought his mantra was “Yes we can!” I guess when it comes to the all-important issue of universal health care his message is “Don’t even try!” He has given up before the fight even begins. Why are so many Democrats are besotted with this guy?

Hope

What a fraud.
http://nv1962.net/ nv1962

What!? Doesn’t universal health care mean that supporters of the other candidate get coverage too? NEVAH!

Seriously, it’s more than mystifying, actually: saddening that a very compelling argument on a highly substantive issue, one has to compete with intangibles. A candidate championing for many years, which is leaving more than 45 million in the cold now (plus millions, perhaps dozens of millions more risking bankruptcy) and defines a country as both advanced and caring for its people, struggling to overcome the projection of its promising result, namely: hope, leapfrogging over the fundamental effort necessary to get there.

Baffling.

Well, let’s hope then that the reality-based candidate for the grown-ups carries the day.
ann

Obama repeatedly attacks Hillary, claiming she won’t answer the question about how the mandate will be enforced. I want her to say that it will be enforced the same way his is. I mean, he’s got a mandate. And, while he doesn’t have a mandate for adults, he says he’s going to charge a fine and back premiums for adults that need insurance who don’t have it??

Obama is wrong for America. He is like the emperor with no clothes. Everyone says how grand he sounds with his ornate speeches — no one admits that they are empty of content.

Hope

I think he is Bush’s Democratic counterpart. Wonderful huh?

different clue

I am just a semi-informed layman next to many people here, so I will limit this comment to mainly memories and impressions, as against assertions.
Ideally I would like to have tax-funded Single-Payer National health coverage such as found in certain advanced countries like Germany, France, Netherlands, and the way Canada was before Chretien and the National Liberals spent years trying to weaken it through systematic defunding (in my USAmerican opinion…and any Canadian Correction is welcome). Why has this concept been given up on without even a whimper?
Okay…several weeks ago I was listening to NPR’s Talk Of The Nation program. They had on several health system experts, including Princeton University Professor of Medical Economics Dr. Uwe Rheinhart. Doctor Rheinhart said that the proposed Clinton plan..forced purchase of private insurance by every citizen not already workplace-or-otherwise-covered..amounted to Romney’s Massachusetts plan on a national scale. Which he wasn’t criticising, because he liked that idea. To me it seems that the Clinton plan is about keeping the Private Insurance Lampreys firmly attached to the side of the Health Care Lake Trout, whereas National Health Insurance would be about stripping the Private Insurance Lampreys OFF the side of the Health Care Lake Trout, and feeding those Private Insurance Lampreys down the socio-economic garbage disposal of irrelevant redundancy.
I remember Mrs. Clinton’s last Health Plan effort. Long after the fact I remember reading an article in Harper’s Magazine about how a coalition of Insurance Executives and other Private Profiteers were concerned about the possible advent of National Healthcare and the consequent demise of their bussiness. They held a big conference at Jackson Hole and Clinton was an important co-attendee at this conference. They tasked her with the mission of preventing, aborting, and destroying the drive toward National Health Care by whatever bogus decoy plan she could come up with to keep the Private Insurance Industry squarely embedded at the center of the HealthCare system. And if she couldn’t achieve her Pro-Private-Insurance plan, she could at least prevent National Health Care from emerging, which she did.
Given that, I couldn’t understand why “the insurance lobby” was so upset with her plan. What were those Harry and Louise commercials about anyway? I raised that question in a comment on the Angry Bear econoblog. Somebody else wrote a comment back saying basically that, the Hillary Plan enshrined a tetropoly of 4 SuperMajor Insurance Corporations as the Profit-Takers at the center of the plan. All the smaller insurance companies and all the “independent agents” were to be excluded from handling the plan. When all these smaller insurance companies and independent agents realized they were to have no part and no profits in Hillary’s Big Four TetraMonopoly Insurance plan, they came together fast and hard and brought out those Harry and Louise commercials.
If HillaryCare 2.0 tries to exclude the smaller insurance companies and the independent agents yet again, I would expect Harry and Louise to reappear.
If HillaryCare 2.0 becomes the plan, and it doesn’t address the problems described in Michael Moore’s film Sicko, it will be the Private Insurance
Tetropoly Profiteers’ last hurrah. A rising tide of public hatred will eventually sweep that parasitic industry away, and we will get our National Health Insurance, like they have in the advanced civilized countries.

simon

Perhaps it’s the Zionist neofeminist shoe nazis again, you know, they want to control everything.

Wouldn’t it be prudent for the government to negotiate price controls, cap spending, first and foremost, to gain some control?

Look at the massive overhead, why do Americans pay so much more than citizens of other countries?
http://noquarterusa.net/ SusanUnPC

We can demand the ideal, and never get it. Or we can demand what’s possible, and get it.

This is a very different — and vastly larger — country than any of those in Europe.

Michael Moore makes great points, but people here think differently about government. We have to shoot for what’s possible — and that’d be vastly better than what we’ve got now.

kenoshaMarge

I too believe that we should have tax-funded Single-Payer National health coverage. But do you think for one minute that it would ever get through congress? Do you think for a single moment that the Republicans in Washington won’t convince their constituency that it is that evil socialist medicine b.s.? And the Moonstruck ninnies on our side of the fence think we can just hope our way to all good things. Hillary is a pragmatist and as such, I believe, presenting what she thinks can get done, not something she knows will not get passed.
I am not an expert and my crystal ball hasn’t told me what either of these people believe deep in their hearts. But my gut tells me that Hillary will fight like a tiger not to lose on this issue again and Barak will be so busy being conciliatory that the Republicans and the equally despicable Blue Dog Democrats will sandbag his royal Hopefulness before he knows what hit him.

And I really wish that we would stop acting like a country of necrophiliacs. All the Republicans want to resurrect Ronald Reagan’s ass and now we have zillions of Democrats thinking to do the same thing for JFK. Note to these people: Both of these men are dead and gone. This is supposedly a new generation with new ideas and looking for change. You don’t find that by digging up dead former presidents.
bob h

The question of penalties/punishments for people not cooperating could be a tricky one for Hillary. Why not offer people a dirt-cheap, bare-bones, catastrophic Medicare plan to finess the question of cooperation? Private insurers could then offer strictly regulated Medigap plans, as they do now for the elderly.

Victor

There are a couple of problems with your proposal.

1) Catastrophic coverage might lower or at least slow down the growth of health care costs, but a major expense that providers incur is unreimbursed routine medical expenses. One of the biggest problems our health care industry faces is that people who don’t have insurance use our ERs as their primary care doctors. They do this because the ER can’t turn them away for not being able to pay. Since even routine care can be expensive (even more so at emergency rates) most people can’t pay for their care. This cost then gets passed on to everyone else in the form of higher medical costs, and hence higher insurance premiums.

2) Insurers aren’t mandated to provide coverage for seniors. They can cherry pick who they provide coverage to in order to reduce their costs. If that were extended to the nation as a whole, insurers would make money at the taxpayer’s expense.

Senator Clinton’s plan really is the best for the nation.

http://www.despair.com/compromise.html Smilin’ Jim

What we have here is failure to communicate

The health care package will be a synthesis once Congress gets involved and will bear faint resemblance to what the candidates are fronting at this stage. Useful or FUBAR, it’s not in your hands.

Express your rage if you will: It’s just another replay of King Lear.

So what’s the real message?

Krugman has identified for you one group that is employing Obama as a useful idiot.
CK

Do any of these packages include provisions for increasing the supply of doctors, nurses, hospitals, home health care workers? Any incentives on the supply side such as removing the AMA monopoly on med school accreditation? Removing the cap on the number of doctors the AMA allows to be graduated?
Any incentives toward changing the patient goes to provider model? How about devloping provider comes to patient model? Mobile surgery vehicles anyone?
Oh and I did love Hillary’s “garnishing wages” response. If one can afford health insurance and makes a reasoned decision that one does not need it, then one will find his wage’s garnished to punisht him for not buying something he neither needs nor wants. At least calling it garnishment is more upfront about what it is. I wonder if they will garnish my wages if I don’t buy either a new tv or a converter box for my old tv next year. Since I neither want nor need a TV but the government has decided that new TVs are mandatory. Universal TV coverage at least as important for the OrwellState as universal health coverage.
Subsidizing illness not generating health is what this crap is all about.
Why not, we subsidize stupidity and conformity with universal mandatory public schooling, might as well subsidize illness and risky behaviour with universal mandatory health insurance.
On the bright side, it will be a boon to paper-pushers and minor functionaries countrywide.
Cee

Monday, February 04, 2008
Krugman Still Has it Wrong on Obama’s and Hillary Clinton’s Health Care Plans

I don’t command any space on the New York Times oped page, but for those of you want to know the truth about the health-care plans of Obama and Clinton — rather than the rather lopsided arguments Paul Krugman keeps making in his column on that page, as he did again today — please see my blog (below) for January 13, 2008,
“Democrats Should Stop Squabbling Over Healthcare Mandates.”
http://robertreich.blogspot.com/
Mr.Murder

Hillary Clinton has been gigged for using the word “garnish” in talking about her health care plan’s requirement for mandates to achieve universal care. I can’t find that word used.

I find it interesting that L’il George would choose to use the word Obama uses. How often is the word “garnish” used in reference to taxes or fees used for say, Medicare or SocSec? Why would an interviewer use this word in this context?

From the ABC transcript of Sunday’s This Week interview with Hillary Clinton, here are the questions L’li George asked about Hillary’s healthcare plan (begins bottom of Pg 2 and continues to top of Pg 4):
–jawbone

STEPHANOPOULOS: Let’s look at health care, another contrast between you and Senator Obama. He’s been pressing that case this weekend.

The key difference, as you point out, is you would require everyone to have health insurance. You believe that will get to universal coverage. He would not.

Here’s what Senator Obama said about that in the debate.
(BEGIN AUDIO CLIP)
OBAMA: You can mandate it, but there’s still going to be people who can’t afford it. And if they cannot afford it, then the question is what are you going to do about it? Are you going to fine them? Are you going to garnish their wages?
(END AUDIO CLIP)
STEPHANOPOULOS: You didn’t get the chance to answer that question in the debate.

What is the answer to those two questions? Will you have fines for people who don’t buy health care, don’t apply — don’t go by the mandate? Will you garnish their wages? SNIP
STEPHANOPOULOS: Let me interrupt you there, because the other night at the debate, you said that you and Senator Edwards bit the bullet on this question…

Part 2, Steph’s questions on healthcare garnishments.

STEPHANOPOULOS: … of mandates, and Senator Edwards was quite clear in his plan. He said if people still didn’t buy the insurance, their wages would be garnished.
And I still haven’t heard, if people can afford it and they don’t buy the insurance, will their wages be garnished under your plan? Will they have to pay fines?
SNIP
STEPHANOPOULOS: But, yet, Senator Clinton, we actually have that mailing and let me show our viewers quickly what you were talking about, because you referred to it.

It says that Hillary’s plan will — excuse me, let me read this again — “forces everyone to buy insurance, even if you can’t afford it. You pay a penalty if you don’t.”

And I want to bear down on this question one more time, because they’re claiming this issue of the penalty. And a lot of independent health care experts, many who worked with you in 1994, say that without these enforcement mechanisms, you simply can’t get to universal coverage, you can’t claim to have universal coverage, so there’s no difference between your plan and Senator Obama’s.

And, I mean, you talked about automatic enrollment. Will you garnish wages of people who don’t comply, don’t buy the insurance?

–jawbone

Sounds like the straw man is being established around the issue of garnishment.

This is being attributed to Hillary, through the other campaign. In his initial attempt to give this traction, Stephanopoulos uses a disingenuous tactic of mentioning other’s opinion and trying to attribute it to her, then blocks her reply to try and insert the same direct quote as a frame of reference – garnishments.

The point being that garnishment entails past medical obligations and debts.

All the plans we’ve seen at this time talk about present/future plans.

Soros could perhaps explain the features of paying or leveraging debt in better detail, but that seems to be a way for big business to back out its obligations, cover its ass for overage billing or inflating stock, and of course for scaring John Q.Public with a word best associated with child support.

Being as the straight marriage party has a thing with candidates getting divorced…

it’s their target market.

It appears the best way the Obama camp sees to getting votes on the swing voters in the primary(mostly the male voting bloc) is to bring up a phrase best associated with payments due divorce and child support, etc.

Traditionally within the Democratic race, the swing voters from other sectors of the party register. With Sen.Clinton and Sen. Obama each capturing strong portions of the internal party voting pillars, they’ve had to target core votes as their sales pitch to turn the votes their way.

Hillary, due to the track record of negative perception sent her way during the year her husband was in office, has to find ways of reassuring the base in spite of rather mainstream and nominative positions as a Senator.

Barack, due to the shift in emphasis his campaign did leaving New Hampshire, to focus on South Carolina votes. The Pyhrric victory painted his own perception to a corner, and he was needing to play the victim card if for no other reason, to try and rob Hillary the same kind of traction.

Plus, his campaign shift was able to connect and energize a different donor base than the bundler/corporate sector that forms the major part of his campaign apparatus.

The negative connotation of the garnishment term aside, the fact this is bringing such a phrase up seems to indicate big business wants to make this part of the new model, as a way of covering its tail on past obligations.

Bringing the topic up as a defeat tactic of an opponent then allows you to take on the mantle of the same cause in bringing both sides together again.

Thus the reform model of most post modern New Deal programs has been established in like fashion.

Attach a stigma to the underlying demand, this denies consensus, and from that point direct the solution to the original positions you already had as part of the vested money base policy.

That was part of several modern policies, privatization in spheres of service industries, education, corrections, even the CHAMPUS/Tricare policies that steer customers to specific businesses(Wal-Mart pharmacies, for example).

Krugman himself could later focus upon the entire garnishment comparisons thrown about, and discuss a health care plan that is in effect retroactive off the pay scale side of the business model. There’s some positives to be considered in terms of how we’re able to address the payment side of provider care. It has to come after this particular debate, for reasons being it’s pretty fluid a talk, and not one given to the black/white stands we want made as a form expectation for a said candidate, party, or platform policy.

This could could increase an obligation but mitigate its overall expense in time, by allowing deferments as part of a payment plan along the lines of traditional debt relief. As these obligations are met the plan itself becomes more affordable, matched with improved cost management associated with preventive care returns on investment.

That of course would be under different nomenclature as the language of implementation is by all means necessary in the sphere of political action and policy.

Still, the idea of a Soros styled public backing of private debt made part of the plan is a way of perhaps enabling us to make good a values exchange model, not unlike what we’ve seen prior with the personnel aspects of service exchange, as in the Peace Corps.

Not just with the people, but with material finance and actual currency. As the market sector gets established to more full a measure, the actual means of exchange can be made in forms of new contracts for service(exchange students, internships, and even loan/USAID packages shaped by the use of these packaged debt obligations specifically in use from that field of practice) all can be acted in ways that benefit strategic means.

Think of it as a form of foreign aid, the countries involved both taking IOU’s on the deal, and paying selves back by meeting those terms. You cannot put a price on mind power, on service from the best and the brightest.

America gets its business in line for taking care of its own, and then models this as a way to help others. Then we’re back to a path of making the most of our moral resources, and enabling capacity abroad to do likewise.

We can’t solve all of our foreign policy problems without help, it is time we consider doing the same thing with domestic policy. Fuel imports are more what I had in mind for that being the best immediate benefit.
Thinker

Whew, Mr M there’s a lot to read there;)

But we all know the three issue with Health:

1 Most of the “sick” aren’t

2 Real affliction is indiscrinimate. Therefore an “all fair and equal” insurance system doesn’t work

3 Health is a profit driven industry supporting pill manufacturers and insurers.

What is Mrs Clinton proposing to do about that beyond pretending to subsidise the insurers?

There is a supplimentary issue. This is care. How much care is enough, Susan? Are pills more or less important than care?

Oh hell, we can always get good ol’ Rummy to come to the rescue;) Has he made his bid for the presidency yet?
Mr.Murder

Look upstairs, Krugman breaks the Obama and Hollary plans down per capita.

Hillary’s cover millions more and works out to $2,700 a year. Obama’s plan comes out to $4,400 a year for those covered.

A cheaper plan that covers more people – Hillary.

TeakWoodKite

As always, food for thought, Mr. Murder.

Think of it as a form of foreign aid, the countries involved both taking IOU’s on the deal, and paying selves back by meeting those terms.

Are there examples of foreign investment capital taking those IOU’s ? Health care requires capital investment but the subject of profits or return on investments is a political football.

Mr.Murder

Perhaps in its initial phases, that’s where working in concert with a group of nations having strong currency(NATO)can work in, or regionally, so neighbors help neighbors and divest their capital(SEATO).

John

What a pity that Obama supporters couldnt’ give a damn about the issues, except that Hillary “voted for the war” and Obama claims he would not have.
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