John Edwards releases his health care plan

Today, John Edwards released his plan to provide universal health care to all Americans. If you're too busy to read the 7 page summary you can check below for my summary and comments.

The full plan is available here.

Edwards divides the funding of his plan into four components based on the responsibility of four main actors: Businesses, Government, Insurance Companies, and Individuals.  

1. Businesses. Businesses will either be required to either provide a comprehensive health plan for their employees or they will have to contribute to the cost of covering them through Health Markets (explained below). Edwards claims his plan will reduce business costs and actually make it easier for them to offer insurance because all Americans will be covered (increasing the pool size) and because if the cost of administering their own plan is too high, they can choose to put money into the Health Markets which takes the burden of administration off of them.

2. Government.
a. Medicaid and the state CHIP programs will be expanded to cover all adults under the poverty line and all children and parents under 250% of the poverty line.
b. Tax credits will be offered to subsidize individuals who are not eligible for employer-based health insurance or Medicaid/Medicare. These tax credits will be used for the purchase of insurance through Health Markets. The credit is on a sliding scale and can be used even if the family has no tax liability.
c. Mandate that insurers insure everyone regardless of preexisting conditions, age, etc. In addition insurance policies must offer preventive and chronic care treatment.
d. Continued support for public health infrastructure (An aside...Isn't Spitzer talking about cutting funding to public hospitals to balance the budget?)

3. Insurance Companies. Finally we get to Health Markets. Edwards describes these as "regional...non-profit purchasing pools that offer a choice of competing insurance plans." Now I was skeptical of this whole health care plan and this point in particular UNTIL, I read this sentence,
"At least one plan would be a public program based upon Medicare." And then this explanation,


"Health Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan." (emphasis mine)

This is key and quite ingenious I think. It allows for some market competition to try to lower prices as insurance companies compete against each other and the federal government. If the government program proves to be the best option (which if we have a Democratic government, it surely will be) then it will be a no-brainer to choose the federal plan and over time we should have a gradual transition to a single-payer system. The framing on this is excellent. We can talk about competition and it will be hard for the republicans to beat this back. If the private market wins, so be it. If it doesn't, then don't Americans deserve the best plan available, even if it happens to be the federal plan?

The final point about Health Markets is that administrative costs
will be borne by the Health Markets themselves (not sure how this works unfortunately). Therefore, businesses that opt in, will not have to worry about the costs of running a plan. They will only pay the taxes similar to paying the current payroll taxes. This is a good incentive. And while it may lead to more business dropping health coverage of their employees, at least they will have to put in money into these plans.

4. Individuals. Individuals will be required to obtain health insurance through one of the three options: Employer-based plans, Public Programs, or Health Markets. The Amish are exempt.

The entire program is expected to cost between 90 and 120 billion a year and would be at least partially paid for by increasing taxes on those making over 200,000 a year but also by collecting taxes that are not currently brought in by the IRS.

In addition there is much in this plan to reduce or contain costs in the health care system.
Briefly,

1. Help doctors deliver the best care.
a. Promote evidence-based medicine:
 - Establish a public organization to dissemination information (without the taint of pharma companies).
 - Support new technologies to disseminate information
b. Reward providers that give the best care with the best results (similar to rewarding good drivers) by providing higher reimbursements to them.
c. Prevent medical errors

2. Invest in preventative care.
a. Make preventative care cost little or nothing for patients.
b. Improve treatment of chronic diseases (i.e. pay for diet and nutrition counseling)

3. Allow patients to review a hospital or doctors performance.  

4. Work for environmental and health justice by reducing pollution, especially in low-income/minority neighborhoods and support translation services.

5. Improve Productivity with Information Technology.
a. Electronic Medical Records
b. Support local infrastructure to make health care delivery more efficient.

6. Protect patients against dangerous medicines.
a. restrict direct-to-consumer advertising for new drugs.
b. strengthen the FDA's ability to monitor new drugs after they reach the market.
c. Ensure that researchers evaluating medical devices and drugs are truly independent.

That's it.

I think it's excellent. Ideally I'd just want to expand Medicare to all people, but I think this is very politically astute. It allows for a mechanism to transition to such a system in a way that is politically feasible. In addition, it does NOT set up a universal health care system that offers NO future mechanism for a single-payer system (like the MA plan or Wyden's plan).

I give it an A (A+ reserved for Medicare for all).


Poll
What grade do you give Edwards's plan?
A+
A
A-
B+
B
B-
C+
C
C-
Horrible

Votes: 41
Results : Vote Link : Polls

Display:


The marker (3.00 / 1)

It'll be interesting to compare HRC, Richardson's, Clark's and Obama's plans. Edwards has laid down a pretty strong marker.


by adamterando on Mon Feb 05, 2007 at 03:23:03 PM EST

I'll bet Hillary's anonymous source (none / 0)

e.g. anonymous campaign member of team hillary releases the first fault with the plan..


McCain - a serial Opportunist, from marriage to policy positions
by TarHeel on Mon Feb 05, 2007 at 03:25:23 PM EST
[ Parent ]

Re: I'll bet Hillary's anonymous source (none / 0)

I don't like her... but you do have to give her credit... In the general if she is attacked, she is going to come back at the GOP candidate with a vengance.  Once she is defeated, I hope the winning Dem can still her response network.  It would be an asset.


http://www.imvotingrepublican.com/ McCain Sucks!
by yitbos96bb on Mon Feb 05, 2007 at 04:16:45 PM EST
[ Parent ]

Re: The marker (none / 0)

I don't know Adam... I see this plan and it does NOTHING to excite me.  It might be better than the current system, but it doesn't seem to be all that much so.  I was expecting him to be Single Payer in approach... which is what many Edward's supporters have been saying on here... This just seems way to complex, feels like its going to squeeze small business more, which are pretty much the middle class of the business world, and while the healthcare centers are an interesting idea, I'm not sure he could force the Health Insurance industries to do them... so he would have to have their cooperation and to get that might cost him a lot. All one of the other candidates has to do is come out with a simpler plan and Edward's goes down the tubes.

As of now though it is at least a start in the right direction to bring this debate front and center... This and Iraq need to be the top 2 planks of any Dem candidate in 2008.


http://www.imvotingrepublican.com/ McCain Sucks!
by yitbos96bb on Mon Feb 05, 2007 at 04:15:27 PM EST
[ Parent ]

Re: The marker (3.00 / 1)

I disagree.  The Health Markets part of the plan is something I've been advocating for quite some time.  It basically cuts the insurance company middle-men out.  

However, it is missing one important thing.  The gov't should cover all catastrophic costs to stabilize the health market.  That would bring premiums down and that is the one of the main reasons people end up filing for bankrupcy.


by dayspring on Mon Feb 05, 2007 at 07:12:57 PM EST
[ Parent ]

Re: The marker (none / 0)

feels like its going to squeeze small business more

On analysis it will reduce the squeeze on those small businesses that try to provide health care coverage. In effect, every small business in a state (or group of states) has the option of joining a community-rated pool, including a public insurance program to keep the private insurers in line.

Of course, "small businesses" that employ 400 and offer no health coverage will feel a bit of a squeeze ... which of course is the other side of the  reducing the squeeze on those small businesses that try to cover their employees, in reducing the competitive advantage presently offered to those not providing coverage.

while the healthcare centers are an interesting idea, I'm not sure he could force the Health Insurance industries to do them

A little more analysis would be useful here as well. There's nothing to force Health Insurance companies to do anything here ... if they wish to withdraw from a large and growing segment of the market and leave it entirely to the public health insurance package, that would be their prerogative. Not a very aggressive growth strategy, mind you, to cede a big chunk of the market, so it seems likely that those Health Insurance companies that do play ball are the ones that will be the ones growing their market share at the expense of those who choose not to play ball.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Mon Feb 05, 2007 at 07:20:30 PM EST
[ Parent ]

I run a small business with 5 employees (none / 0)

and very high health insurance costs (even as we switched to a less comprehensive plan with higher deductibles last year). I should think getting to pool with thousands of others would bring our costs down.


"We are building a political movement - not one that wields the power of lobbyists and corporate interests, but the power of millions... who seek change." -Dean
by Jim in Chicago on Mon Feb 05, 2007 at 09:54:41 PM EST
[ Parent ]

Re: I run a small business with 5 employees (none / 0)

The Hackett plan had a 6% payroll premium for businesses that did not provide comprehensive insurance, and this Health Market plan seems very much like the Hackett plan except for additional funding at the margins where Hacketts plan "improved coverage", in order to get to actual universal coverage. Well, also a consolidated billing and premium payment system to all participating plans, to roll back some of the admin overheads of the current plan.

That additional funding is where the tax increase above $200,000 comes in.

Would 6% on payroll for a broad coverage package with reasonable deductables be a back breaker?


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 01:44:10 AM EST
[ Parent ]

Re: I run a small business with 5 employees (none / 0)

I shouldn't think so. Remember the defunct Walmart bill in Maryland said that employers with more than 10,000 workers had to pay into the health care fund if less than 8% of their payroll went to pay for health care. Since the bill only applied to walmart, that means that all other large businesses were already devoting at least 8% of their payroll to health care. So 6% should be doable for large businesses. I don't know about small businesses. We also don't know if it will be 6% or 3% or 1% or 9% at this point.


by adamterando on Tue Feb 06, 2007 at 07:45:42 AM EST
[ Parent ]

Re: I run a small business with 5 employees (none / 0)

Oops. Sorry, I see now that 6% is the number being floated as a potential ceiling for costs for middle class families. So I guess we would expect most businesses to pay a 6% payroll tax if they don't have their own plan.


by adamterando on Tue Feb 06, 2007 at 09:42:15 AM EST
[ Parent ]

Too complicated--and Business should be OUT OF IT! (3.00 / 1)

I am opposed to any plan which places the burden of health care on employers.

It is that fundamental mistake which has doomed not only health care but US jobs for decades.

No other economy asks businesses to pay for its employees' health care. Perhaps the single most powerful disincentive to hiring American workers is the requirement of paying health care costs. This is one of the major pillars of the globalization that is destroying the American middle class.

Furthermore, the political key to passing universal health care is dividing and conquering the business lobby. The only way to offset the lobbying clout of the insurance companies is to get GM and Ford and other big companies to stand up for their interests, which are to be relieved of the burden of paying for health care.

Finally, complexity is death in a proposal like this.

Keep it simple: government pays for health care and businesses are freed up to hire more Americans and pay them better wages because they are freed from the burden of health care.

I don't like this sneaky approach.

I am disappointed.


by Thresholder on Mon Feb 05, 2007 at 03:46:41 PM EST

single payer is the only other way (3.00 / 1)

and I'll eat my shorts if Hillary or Obama propose full on single payer..

as last talk Obama was for universal by the END of his first term


McCain - a serial Opportunist, from marriage to policy positions
by TarHeel on Mon Feb 05, 2007 at 03:49:30 PM EST
[ Parent ]

Not my point (3.00 / 2)

This isn't about Hillary-Obama-Edwards. Actually, I am leaning more toward Edwards than toward anyone, and I am pretty deeply opposed to Hillary. I don't trust the bunch running her, nor do I think she can win anything. She's a lousy candidate.

I am simply reacting to the concept as laid out.

I want someone to lead the Progressive movement in an approach to US Business: guys, here's the deal. We let you off the responsibility to do squat for your employees' health care. In return, you help us hold off the insurance company backlash.

That's a winning political move.

Are any current DEM candidates willing to do it? Probably not.

But I don't think this approach will work any better.

Principle (IMO): you cannot fend off the clout of the insurance and health care corporations until you enlist the clout of the rest of US business.


by Thresholder on Mon Feb 05, 2007 at 03:57:48 PM EST
[ Parent ]

hear ya (none / 0)

there is some political reality - I've heard edwards say single payer cost more in the short term , less in the longterm,  given the raise taxes meme already out, this option at least allows transition to single payer over the long run


McCain - a serial Opportunist, from marriage to policy positions
by TarHeel on Mon Feb 05, 2007 at 04:06:48 PM EST
[ Parent ]

Re: hear ya (none / 0)

Weren't you the one saying your BIGGEST issues were single payer Healthcare and college costs?  In fact I was pretty sure you were saying Edwards was proposing Single Payer.  Now you seem really enthused by this plan... I would think this would bother you.


http://www.imvotingrepublican.com/ McCain Sucks!
by yitbos96bb on Mon Feb 05, 2007 at 04:09:49 PM EST
[ Parent ]

can look for my posts (none / 0)

but yes Healthcare and college education.

I don't think I ever said "single payer"  which is a full on transition to government only healthcare.(and politically would be labeled communist rationed healthcare -but it is not)

so I'll apologize in advance but unless I was sloppy with word choice I don't remember saying single payer which is technically different than universal..


McCain - a serial Opportunist, from marriage to policy positions
by TarHeel on Mon Feb 05, 2007 at 04:20:53 PM EST
[ Parent ]

Re: can look for my posts (none / 0)

I could be wrong.  I am willing to admit that when I am.  No big deal.  


http://www.imvotingrepublican.com/ McCain Sucks!
by yitbos96bb on Mon Feb 05, 2007 at 04:53:24 PM EST
[ Parent ]

Re: can look for my posts (none / 0)

Look here.

Obama's too timid for me (none / 0)

I don't really care about his skin tone..
and I really don't want to get along with everyone to build bridges..

I want single payer health care and college for everyone.

no one should vote for anyone just because of their appearance or even assume their political positioins based on appearance.

www.actblue.com/page/edwards-obama Stop the MSM Hillary Coronation
by TarHeel on Fri Feb 02, 2007 at 10:01:56 PM EST


Visit DebateScoop
by demondeac on Mon Feb 05, 2007 at 08:51:20 PM EST
[ Parent ]

read Ezra Klein (3.00 / 1)

http://www.prospect.org/weblog/2007/02/p ost_2685.html

What they will have to match is full community rating, a public insurance option, total universality, scaleability towards more public involvement, and a willingness to propose something comprehensive enough to require revenue increases to fund. In other words: The goalposts have been moved. To the left.

the plan has a trojan horse like ability to become "more" single payer like..

FYI - the US costs of insurance administration is 32% of the total bill, in Canada its 16%,  (HMOs taking that chunk)


McCain - a serial Opportunist, from marriage to policy positions
by TarHeel on Mon Feb 05, 2007 at 04:34:39 PM EST
[ Parent ]

Universal coverage ... some people ... (none / 0)

... seem to have internally translated universal coverage into single payer ...

... but Japan, France and Germany, to name a few countries, have universal or near universal coverage multi-payer systems.

(1) If you get comprehensive coverage at work and you like it, you can keep it
(2) If you are forced into the private market, or closed out of the private market, you can choose from a range of standard plans with no gimmicks or tricks at a fair price in the Health Market.
(3) If you cannot afford the price, a tax credit will help you out.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 01:50:44 AM EST
[ Parent ]

Re: Not my point (none / 0)

Agreed.  I am not a fan of this plan... But I am open Minded to be convinced.  I just see it burdening small business more, which frankly are already being squeezed on most sides by the government and the big corporations.  

I agree that Businesses help are needed to win this fight... Frankly though, I think you have to appeal to their bottom line.  If you tax them at a rate less than what they are paying now for their employees cost, you would probably win them over.

I don't know if it is feasible, But I still thinkt he best way to pay for it is to remove the SS cap, add 1% there and give half the money to SS and half to Universal Healthcare.  


http://www.imvotingrepublican.com/ McCain Sucks!
by yitbos96bb on Mon Feb 05, 2007 at 04:08:35 PM EST
[ Parent ]

Re: Not my point (none / 0)

Why would you give any money to SS? Social Security is at present giving money to the general fund.

The "shortfall" is based on government projections that the present system of all income gains going to people earning above the SS cut-off ... if present trends do NOT continue, and instead we return to a normal distribution of income gains, there's no shortfall.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 01:53:00 AM EST
[ Parent ]

Re: Too complicated--and Business should be OUT OF (3.00 / 2)

I understand the criticisms but look at it this way:

1. Businesses do not have to offer health care. They can opt out and pay into the fund. Any single-payer system (i.e. Medicare) would have such a mandate. This is no different. If the UAW and GM decide to scrap the health plan and focus on a 10% wage hike, then so be it. The union members can buy into the federal plan then.

2. It's complicated in the method to pay for it, but not so much as in the HRC plan of '93. It's also comprehensive. It addresses payment and cost containment. One problem I realize with just proposing Medicare for all, is that while it's simple, it's also simple to organize against it and to shoot it down. The insurance industry and Pharma industry are EXTREMELY powerful players in this country. Getting enough politicians and enough support to pass a plan will require a way to go around these lobbies that will mute much of their force. This allows for that because it gives insurance companies a place at the table (but not the entire table as Bush and the MA plan do) at least for now. It's a very attractive frame because people can choose if they want to stick with the private market, or the public plan. If the public plan wins out, well that's just will of the people and we can let the private insurers whither on the vine.


by adamterando on Mon Feb 05, 2007 at 03:53:19 PM EST
[ Parent ]

Re: Too complicated--and Business should be OUT OF (none / 0)

" Businesses do not have to offer health care. They can opt out and pay into the fund."

That's the problem: THEY STILL HAVE TO PAY!

As long as business is asked to pay, they won't have an incentive to reverse their fanatical commitment to laissez faire predation and help beat back the clout of the health care/insurance industry.

As long as business has to pay, it's a non-starter, IMO.


by Thresholder on Mon Feb 05, 2007 at 04:00:10 PM EST
[ Parent ]

Re: Too complicated--and Business should be OUT OF (none / 0)

Are you sure that businesses do not pay a tax for health care in any industrialized countries that offer single-payer? I would be very surprised if that was common.

The big disadvantage for employers is not that they pay anything at all for health care, it's that they are paying 10%-20% of the payroll (except for WalMart of course) or more for health care costs. For GM the problem is retirees. So instead of each employer fending for itself in trying to pay for a health insurance plan, they can throw money into a HUGE pot which, by means of its huge size, will cover all employees at a cheaper price for said company.


by adamterando on Mon Feb 05, 2007 at 04:08:20 PM EST
[ Parent ]

Businesses in the other countries do what this (none / 0)

plan advocates.  They pay in taxes for the health and pensions of employees, but the government is the single payer of the bills.  The big companies would much rather pay taxes than pay benefits. Especially when a dingle payer can cut costs. This is a great back door into single payer.  


Join the Feral Cats of Freedom Coughing Up Hairballs of Truth in the Montana Underbrush
by Feral Cat on Mon Feb 05, 2007 at 04:59:31 PM EST
[ Parent ]

Re: Businesses in the other countries do what this (none / 0)

Yeah somewhere along the way, apparently many people got it into their heads that single-payer meant businesses pay nothing for health care. But the whole point is that if we went to Medicare for all (or eventually Medicare for all with the edwards plan), businesses would just stop providing health insurance, but they  (and individuals) would pay higher payroll taxes to fund the system. I hope people understand that now.


by adamterando on Mon Feb 05, 2007 at 05:08:51 PM EST
[ Parent ]

Re: Businesses in the other countries do what this (none / 0)

THose who think that never understood the single payer system.  I think there needs to be a guarentee though that this won't RAISE employers insurance costs... If you can GUARENTEE a lowering then I think people would hop on board.  I'm not sure if it is possible to guarentee though.  Also, what about Part-timers?  Are employers required to pay for them as well?  If so, now you see an increase in many small business owners costs.  If not, then cool.


http://www.imvotingrepublican.com/ McCain Sucks!
by yitbos96bb on Mon Feb 05, 2007 at 06:06:04 PM EST
[ Parent ]

Regardless, Insurance companies (none / 0)

will not want this because it probably takes their profits


McCain - a serial Opportunist, from marriage to policy positions
by TarHeel on Mon Feb 05, 2007 at 06:17:52 PM EST
[ Parent ]

That's Why You Need to Pay for It With a Pay Roll (none / 0)

In that case, you can cover part timers without creating huge fixed costs for the employer.  The same is true for the working poor.  If the premium is a percentage of one's income then everybody can afford health insurance and do their fair share.


by Hellmut on Mon Feb 05, 2007 at 10:53:54 PM EST
[ Parent ]

The guarantee that this won't raise insurance ... (none / 0)

... costs is simple. Any company providing comprehensive insurance can opt out of the system.

The only companies who see their insurance costs go up are those like Wal-Mart who have been taking a free ride on the rest of the system.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 01:55:34 AM EST
[ Parent ]

The point is, everyone will opt for... (3.00 / 1)

...the single-payer government option that Edwards' plan also includes.

Actually, I think that's the ingenious part of what he's doing. Rather than say, "Socialized medicine for everyone!" he's saying, "Let's put ALL of the alternatives on the table, and let people choose the plan that helps them the most (hint: it's going to be the single-payer one)."

Let people actually SEE the alternatives in action, and we all know what they will do.

The Republicans will come after Edwards harder and harder because their masters in the insurance companies do NOT want the people to see that a far better option than for-profit murder-by-spreadsheet exists.


John Edwards 2008
by MeanBoneII on Mon Feb 05, 2007 at 03:56:38 PM EST
[ Parent ]

Ezra likes it! (none / 0)

Ezra Klein, the left blogosphere's leading health care policy wonk, says that it's a good plan, better than the Massachusetts and California experiments, because it mandates that one of the options for consumers has to be a broad public plan.

In other words, the public sector will finally be allowed to compete with the private sector, and consumers will be able to decide which style they prefer.

This moves the goalposts, he says, to the left.


by DaveMB on Mon Feb 05, 2007 at 03:56:56 PM EST
[ Parent ]

Re: Ezra likes it! (none / 0)

Oh, well that's that, then.

Look, I don't want to be either snarky or obstructive.

I have 2 main concerns:

1. What can work politically

2. The nexus which connects health care costs to the malaise of the American job market.

To me, both concerns demand that you begin by offering that US business be allowed to salivate over the prospect of hiring people without worrying about health care.

Now, will this approach get us there? Well, I dunno. Maybe. If so, cool.

But I am very skeptical of this concept.

START by going to Corporations USA and offering them a pass on health care. Then go from there.

Is anyone willing to do this now? Probably not. But I doubt that we are ready as a nation to deal with this now or that Edwards' plan has any more chance than anyone else's.

In the end, it's my sense that until some leader offers Corp. USA the deal I have articulated, it will be impossible to beat the clout of the health and insurance industries.


by Thresholder on Mon Feb 05, 2007 at 04:06:01 PM EST
[ Parent ]

Re: Ezra likes it! (3.00 / 1)

I keep going back to the Hackett plan, which is the one that I have a complete write up on ... the payroll premium is 6%, firms with comprehensive plans with a certain minimum level of coverage can opt out.

So say its roughly like that. That is a divide and conquer strategy. For firms with comprehensive plans that are going to keep on providing comprehensive plans, it reduces the ability of competitors to undercut them through free-riding -- that is, the Wal-Mart strategy. For firms that are struggling to provide coverage and falling behind, it provides an escape hatch as a predictable payroll cost item.

And of course, the free-rider firms like Wal-Mart are going to oppose the Democrat anyway, come hell or high water, so there's no reason to worry about the fact that they will squeal like a stuck pig.

So it puts high value added, high skilled growth firms on the same side as traditionally unionized rustbelt firms, pro-plan, and cost-shaving Walmartification firms on the other ... and they are political antagonists anyway no matter what we do.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 02:03:03 AM EST
[ Parent ]

Re: Too complicated--and Business should be OUT OF (none / 0)

No other economy other than Japan, France and Germany, you mean (just of the top of my head)?


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Mon Feb 05, 2007 at 07:21:26 PM EST
[ Parent ]

It's never simple (3.00 / 2)

You are exactly right. The business community has to take a stand against the burden of the insurance lobby.

In fact, labor and business will have to combine to fight to have health care delivered to our citizens in the most efficient and effective manner, which is; single payer.

The Edward's plan provides a transition towards that goal while business and labor rally the masses to demand single payer.

And inspite of my inclination towards a preference for simplicity, it just doesn't happen that way. Single payer coverage is going to take a fight, a battle. If labor and the business community can unite on this, the battle will be shorter, and if not, the fight will take longer. But it won't be simple.

Do you really think that without the cost of health care that businesses will automatically, simply, pay their employees better wages....don't count on it. It's the non-union companies now who don't provide health care, and don't provide good middle-class wages who are placing the unfair burden upon the companies who do bargain collectively and recognize unions.

It's not simple, and it won't be easy.

John Foster
GCC/IBT Local 4C


by jfoster on Mon Feb 05, 2007 at 09:29:46 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (3.00 / 1)

I like Edwards.  But the fantasy being indulged here is that once the public gets to see the private system and the public system competing side-by-side, they'll realize single-payer is the way to go.

In a perfect world, maybe it would work like that.  In the real world, people are not going to have perfect information, and they're going to have to deal with a powerful insurance/health care lobby that has every incentive to distort the outcomes available from the private system.

We already have an excellent single-payer model.  It's called Medicare.  If people don't already understand that Medicare offers better outcomes and is extremely efficient, how is Edwards' plan going to change anything?

I really think we netroots folks have to be uncompromising when it comes to single-payer, because it's not going to happen otherwise.


"Another problem we have...is that in election years we behave somewhat as primitive peoples do at the time of the full moon." --Harry Truman
by Steve M on Mon Feb 05, 2007 at 04:04:59 PM EST

Complete agreement. (none / 0)

"I really think we netroots folks have to be uncompromising when it comes to single-payer, because it's not going to happen otherwise."

Yep. I agree completely.

Eventually, some candidate will get it right. But until then ...

I refuse to get caught up in compromises that have no chance.


by Thresholder on Mon Feb 05, 2007 at 04:07:41 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (3.00 / 2)

"If people don't already understand that Medicare offers better outcomes and is extremely efficient, how is Edwards' plan going to change anything?"

Because nobody under 65 gets to experience Medicare first-hand. Who right now has a choice to use a public plan unless you are using Medicaid?

The insurance industry's main tactic is to scare people from enacting a competing government plan. Why do they do this? Because they know that if people had a public option, they'd be sunk. This is why this is ingenious. It undercuts their arguement by saying that they'll still be part of the system. If they fail people, then they will collapse. However, the public option, will not fail and will always be available as long as the federal government is around.


by adamterando on Mon Feb 05, 2007 at 04:13:17 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (3.00 / 1)

I don't see where first-hand experience would be good for much other than developing anecdotal evidence.

It seems like we liberals are always looking to build some pie-in-the-sky consensus, based on the notion that if people could only SEE our policies in action, everyone would suddenly realize they were better off.  The truth is, health care is an enormously complex issue, and the only sane course is to enact the policy you think is best and hope that people like it.  You're not going to magically win everyone over with a "Pepsi Challenge."

It's worth noting that FDR didn't feel the need to partner Social Security with a competing system of private accounts so people could decide which system they liked better.


"Another problem we have...is that in election years we behave somewhat as primitive peoples do at the time of the full moon." --Harry Truman
by Steve M on Mon Feb 05, 2007 at 04:25:50 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (3.00 / 3)

"It's worth noting that FDR didn't feel the need to partner Social Security with a competing system of private accounts so people could decide which system they liked better."

1. He also had a filibuster proof majority.

2. He also was NOT able to enact universal health care.


by adamterando on Mon Feb 05, 2007 at 04:32:25 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

You need to read this diary.

It is also important to note that the Regulars suck at policy - they are always pre-compromising bills. This matters, because pre-compromised bills don't perform properly. Allow basic health insurance to be sold by insurers and you don't get the GDP savings, for example, which are immense.

And if you don't get, you don't get the prosperity hit that fixing health insurance properly would give you. And if you don't get that prosperity, you don't get the popularity that comes from prosperity (or from a well functioning plan.)

Policy matters, and doing it in a compromised fashion leads to bad policy; and bad policy has an effect at the ballot box.

And the Regulars don't seem to get that.

Now, the counterargument is that never being willing to compromise is also a sickness and it leads to rigidity that makes it hard to win races. And that's also true, but that's not the weakness the Democrats have right now - their willingness to compromise, and compromise, and compromise, is not in doubt.

Going too far either way isn't good. And if the netroots are turning into enablers first, movement progressives second, that's not a good thing.

I'm not saying we should all become Naderites because no Democrat is in favor of single-payer.  What I am saying is that if you start applauding every Democrat who promises "a step in the right direction," then you open yourself to being played for a sucker.

Lots of us don't agree that single-payer is an impossible dream.  Don't expect us all to swoon over an incremental step just because you assure us it's the best we can do.


"Another problem we have...is that in election years we behave somewhat as primitive peoples do at the time of the full moon." --Harry Truman
by Steve M on Mon Feb 05, 2007 at 07:06:10 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

Let's wait to see what Obama proposes.

This is much more than incremental also. And you do have to recognize the political realities as well. How do we get to 60 votes in the senate? How do we get Ben Nelson on board? How do we get Gene Taylor on board?

I also don't think single-payer is an impossible dream. Neither does this plan. It's a transition to single-payer. But the transition takes place in a manner that undercuts the main free-market boogeymen arguments that have been lobbed at us all these year.

If this plan had no element of a single-payer plan, I would be VERY disappointed. But it doesn't. And I'm not.

Once again, I refer you to points 1 and 2 in my previous reply.


by adamterando on Mon Feb 05, 2007 at 08:31:07 PM EST
[ Parent ]

But this is not a step in the right direction plan (none / 0)

This is a coherent plan in its own right. The Health Market plans severely limit the ability of private health insurers to cherry pick.

(1) They can't exclude people for existing conditions (community rating).
(2) They can't price people out of the market for existing conditions (community rating).
(3) They can't skimp on coverage to drive away people who need it (standardized coverage).
(4) They can't game billing to make it difficult for health care providers to get paid for insured services they would rather not be paying for (consolidated billing through the Health Market).

And using a tax credit to take the "working poor" out of the safety net programs and into the normal Health Market means that it is possible to retie the safety net to its support poles ... at the moment, our medical safety net programs are basically rope lying on the ground, making it easier to move people around once they slam into the ground.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 02:11:07 AM EST
[ Parent ]

You Have Spitzer's Proposal Wrong (none / 0)

"Spitzer talking about cutting funding to public hospitals to balance the budget?"

No.  Spitzer is proposing taking inefficient state subsidy funds for private hospitals and redirecting them to expand coverage for 400,000 children in NY.  The hospital subsidies include funds for graduate medical education which is already subsidized by the fed govt, indigent care subsidies based on historic usage at hospitals rather than actual usage and revising Medicaid payment formulas that haven't been updated in over 20 yrs.

Spitzer is taking money that now goes to support institutions and redirecting it to people who actually need health care coverage.  It is excellent public policy and the state will be better for it.  

It should be noted that NY spends two times per capita on Medicaid what California does for virtually the same benefits package.  The program has become a subsidy for powerful healthcare interests in NY.


by John Mills on Mon Feb 05, 2007 at 04:57:31 PM EST

Re: You Have Spitzer's Proposal Wrong (none / 0)

Thanks.


by adamterando on Mon Feb 05, 2007 at 05:00:18 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

Interesting proposal.  Health Markets - sounds like a new name for the old Clinton health care purchasing coops to me.  I find it fascinating that almost all the new universal coverage proposals include them.  

They aren't a bad idea - the Federal Employees Health Benefits program, which covers fed employees, is one and it is very successful in giving choice and keeping costs down.  Politically, they are easy to pick apart as we saw in 1993-94.


by John Mills on Mon Feb 05, 2007 at 05:01:39 PM EST

Re: John Edwards releases his health care plan (none / 0)

Actually, as far as I understand it, its a market, not a coop. To enter the market you must have a coverage package that meets the standard, and if you are in the market, you have to accept the people that pick your plan.

The Health Market consolidates premium collections and billing for services, which both reduces admin overheads and also gives the government valuable health service delivery information that is presently hidden inside a thicket of private insurance paperwork.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 02:14:32 AM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

This is what used to be called managed competition and most of this was part of the initial Clinton design in 1993-94.  As I said above, not necessarily a bad concept but a hard sell politically as it is complicated and easy to pick apart.


by John Mills on Tue Feb 06, 2007 at 09:50:21 AM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

CalPERS, which provides health coverage to public employees in CA, operates in this manner.


by John Mills on Tue Feb 06, 2007 at 09:51:39 AM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

Then Edwards better find someone with the ability to get to the emotional heart of complex issues and bring ordinary Americans over to his side.

Like, maybe a really successful trial attorney ...

Single Payer
(1) You trade your coverage in for the government provided plan
(2) Taxes pay for the plan
(3) There are savings so the taxes are less than the premiums are today.

Health Market
(1) You can keep your present plan, or move into a Health Market plan.
(2) You are guaranteed a choice between private and public plans in the Health Market.
(3) Everyone is covered.

I remember when Hillary's first plan was produced ... I already understand Edwards's plan better than I every understood Hillary's.

And after seeing Hillary at the DNC winter meeting, I have no faith that she has learned how to sell a complex plan to the American people.

Meanwhile ... well, Edwards did not call it managed competition, did he? He called it a Health Market.

And he has the opportunity to retail this plan over the next year. He will have a chance to it in IA, NV, NH and SC. Meanwhile Hillary is spending the immediate future on a "listening tour" where seems likely to be giving health care answers as lame as those she gave the first few days of her campaign.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 11:25:26 AM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

Not against Edwards plan just calling it what it is.  Everyone seems to be using this concept now from Edwards to the Mass plan last summer to Awnold's plan in CA.

I think a better, simpler alternative would be to enact an employer mandate for large employers and establish a play or pay system for smaller employers where they either provide coverage or they pay into a pool and their employees are covered by Medicare.  You may need a subsidy program for really small businesses/individuals.  

Large businesses buy in since they already provide coverage to their employees and 60+% of small businesses should buy in b/c they already provide coverage and get a more even playing field.  It's a lot cleaner than Health Markets or whatever you want to call them which will portrayed, rightly or wrongly, as another health care bureaucracy.  I have often thought if Clinton had gone that route we would have gotten universal coverage in 1993-94.

Single payer makes the most sense but I just don't see it happening in the US.  The bills in Congress never get above 80 cosponsors in the House which is less than half the votes you need to pass something.


by John Mills on Tue Feb 06, 2007 at 12:14:30 PM EST
[ Parent ]

How is pay or play across the board ... (none / 0)

... more complex than one system for employers with 500 or fewer employees and another for employers with more than 500 employees?


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 07:13:07 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

I see what Edwards is trying to do in giving people a choice between the public and private systems, but I worry about the complexity compared to say (single-payer medicare for all).

It also concerns me that it seems like the current plan he's put forth would have us spending more than we already are on healthcare. By setting up the whole "let the people choose private vs. public" tactic it's also leading to increased costs compared to moving to single-payer universal health care.

I don't know whether full single-payer UHC would be found acceptable by the public and whether it would be enacted by congress (or even make it out of the house for that matter). Perhaps the tactic he seems to be going for, along with the required cost, is what pragmatically has a chance of being enacted.


by Quinton on Mon Feb 05, 2007 at 05:32:01 PM EST

Re: John Edwards releases his health care plan (none / 0)

Interesting timing... Now THAT I will give ballsy credit.  Basically, once this passed the whole presidency would hinge on this bill... If he is elected and achieves the bills goal of 2012, he'd probably be a lock for re-election.  Screw it up, and its one termer status.  That does take guts to push the chips all in like that.


http://www.imvotingrepublican.com/ McCain Sucks!
by yitbos96bb on Mon Feb 05, 2007 at 06:09:04 PM EST

Re: John Edwards releases his health care plan (none / 0)

I did forget the Fair terms edict of the plan.  This will be what the insurance industry fights the most, but if it passes then THAT would be truly great for Americans.


http://www.imvotingrepublican.com/ McCain Sucks!
by yitbos96bb on Mon Feb 05, 2007 at 06:11:51 PM EST

Re: John Edwards releases his health care plan (3.00 / 2)

This is good. I gave the report a B+. My only concerns are with some of the details of the presentation. The report correctly makes reference to deficiencies in patient to doc/nurse ratios but isn't clear on how his plan will address the problem. Also, there is no clear, and specific references to prescription drug coverage. My assumption is that medication costs  will be covered. The question is to what extent, and how does this plan impact existing government susidized plans like, medicare, medicaid, verteran's benefits, etc. Also, there is no reference to long-term care coverage.

Otherwise, I think the plan lays out a do-able transition into a single payer system of health care.


by jfoster on Mon Feb 05, 2007 at 08:47:30 PM EST

Re: John Edwards releases his health care plan (none / 0)

Wait... Businesses are required to provide insurance or pay into a pool?  How the heck are small businesses supposed to come up with the money?

Why create more types of taxing structures?  Why not just use existing tax structures like the income tax.


by areucrazy on Mon Feb 05, 2007 at 10:06:45 PM EST

Re: John Edwards releases his health care plan (3.00 / 1)

The payroll tax is an existing tax structure. Paying into the pool would be done through a payroll tax.


by adamterando on Mon Feb 05, 2007 at 10:25:02 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

Not really - FICA, Social Security and Medicare taxes, are existing taxes.  This would be another tax.  Furthermore, it would be a regressive tax that the employee bears the brunt of, just like FICA and sales taxes.  As a progressive, I am against regressive taxes and prefer a more progressive income tax.


by areucrazy on Mon Feb 05, 2007 at 10:45:52 PM EST
[ Parent ]

It's a lot more progressive than . . . (none / 0)

. . . what we have now.

But you do have a point.  Even the European democracies charge the same percentage to all income groups (though often there are exemptions for very low and high incomes).


by Hellmut on Mon Feb 05, 2007 at 10:59:47 PM EST
[ Parent ]

Re: It's a lot more progressive than . . . (none / 0)

Its just that as an economic progressive, I believe in progressive taxation.  Regressive taxes such as value added taxes can be useful in certain situations where there is a public good in decreasing consumption (ie gas tax, cigarette tax, process foods tax (I wish).  Otherwise, I think it most benefits society as a whole to utilize income taxes rather than regressive ones such as payroll taxes.  Not that an income tax is necessarily progressive by itself (ie flat tax), but it can be made to be so.  Thats why edwards wants to repeal the tax cuts, its just a shame that he is pushing regressive taxes too.


by areucrazy on Mon Feb 05, 2007 at 11:25:01 PM EST
[ Parent ]

Re: It's a lot more progressive than . . . (none / 0)

The progressivity comes in the form of a tax credit that can be applied to the health plan you choose even if you have no taxable income.

Also, I get scared of tying major legislation to income taxes because then they are subject to the vagaries of whoever is in charge of the budget.

Yes, payroll taxes are regressive (although we could make them progressive, based on the paycheck amount), but at least they are a guarenteed funding source. Notice we have not had any cuts social security benefits throughout its history. Medicare cuts are few and far between. Medicaid cuts (part of the budget) get put on the table every year.


by adamterando on Tue Feb 06, 2007 at 07:55:32 AM EST
[ Parent ]

Re: It's a lot more progressive than . . . (none / 0)

I believe that the German public health care funds are funded by a progressive payroll tax.


Join us at Show Me Progress!
by clarkent on Tue Feb 06, 2007 at 08:03:05 AM EST
[ Parent ]

Re: It's a lot more progressive than . . . (none / 0)

Why don't we just eliminate the ceiling on FICA.  Boom - that fixes the problem w/o any new taxes to those earning 80-90k or less.

"The progressivity comes in the form of a tax credit that can be applied to the health plan you choose even if you have no taxable income. "

And the tax credit comes from...?  Income tax?


by areucrazy on Tue Feb 06, 2007 at 05:55:01 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

Actually Medicare tax are neutral taxes. FICA is moderately regressive ... it was more regressive before the EITC.

The combination of the MTC and a payroll rate premium means that companies have the choice between providing their own comprehensive medical, or paying a portion of the Health Market premium in a payroll tax.

Those, like Wal-Mart, presently taking a free ride off the system would be forced to chip in.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 02:18:47 AM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

How is it neutral?  FICA is capped at $94,200 for 2006.  That's regressive.  The burden of Payroll taxes are shifted to the employees, so how would Walmart chip in?


by areucrazy on Tue Feb 06, 2007 at 05:58:47 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

Medicare is not capped ... that's how its neutral.

FICA ... well, as you know the EITC was originally a refund of FICA paid by low income earners, and has since been expended into a more general negative income tax. With the EITC added, FICA becomes moderately progressive at the bottom two fifths of the income ladder, and regressive in the top two fifths when the ceiling kicks in.

I still favor taking SSI off budget with a supplemental payroll levy that kicks in at the FICA ceiling and is set at whatever rate is required to cover SSI ... but that's a whole other story.


*John Edwards* ... and the JE08 Supporters Blog
by BruceMcF on Tue Feb 06, 2007 at 07:23:55 PM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

1. Big mistake calling for "increased taxes" for this plan.  The entire media has picked it up as a tax-increase issue.  Why not call a spade a spade: NON-RENEWAL of Bush's temporary tax cuts.   That is unless the money generated from the rollback of the enormous Bush tax cuts is not enough to pay for this.  In which case "tax increase" would actually be correct and politically dicey.  

2. The burden on small businesses is too great.  6% will indeed create a small-business hardship.  

3. Individuals HAVE to buy insurance or lose income tax deductions.  Many are squeezed and can't afford health coverage.  A middle-class couple may opt to buy it for their children and go without themselves.   They simply can't pay the extra $300 per month for the two of them.  Now we are going to mandate coverage or loss of tax deductions.  That is akin to a tax increase on middle-class and lower-middle-class working families.

This plan is a good start to get the debate going.  I'll wait for the Clinton and Obama plans.  The worst failing is that this plans puts additional burdens on hard working individuals and couples who simply can't afford health insurance although on paper they make too much money to qualify for Medicaid.  It does not take the current middle-class income squeeze into account, thereby appears more coldly calculating rather than giving me the "warm and fuzzies."    


by georgep on Mon Feb 05, 2007 at 11:47:11 PM EST

Re: John Edwards releases his health care plan (none / 0)

I think you're making too many assumptions. We don't know the details or how generous the terms will be to provide insurance.

Perhaps that middle class family of four making $60,000 a year will only have to pay $100 a month for the government plan. Wouldn't that be a significant improvement?


by adamterando on Tue Feb 06, 2007 at 07:58:29 AM EST
[ Parent ]

Re: John Edwards releases his health care plan (none / 0)

'Perhaps that middle class family of four making $60,000 a year will only have to pay $100 a month for the government plan."

Or perhaps that middle class family making $40,000 and barely surviving will suddenly have to pay out $250 more.

Idealism is good, nothing wrong with it.  But sometimes the best intended government plan is not as smooth as one would hope.  Happened a lot in the past.

Like you, I don't know what would happen with this plan.  But, this mandate will rub A LOT of people the wrong way.  Many, many people who could typically afford to buy health insurance for themselves (barely) are choosing not to, instead they "pay as they go" for checkups, pap smears, flu shots, etc.  They rather take that money they would have spent on their health insurance and put it in their kids' college fund or save for a family vacation.   There are a LOT of these people.  They would feel penalized by such a plan.

I am not saying it isn't a good  thing to mandate everybody be on insurance, the "responsible" thing, but don't be surprised if a lot of your "average people" oppose this plan because it forces them to do something that they currently forego as a choice.   If Edwards' plan is not very popular overall, consider these people.  There is strength in numbers, and  the "uninsured by choice" folks number in the many Millions, and they are not likely to warm up to a huge government health care proposal that removes money out of their pockets they have chosen to use for other purposes.


by georgep on Tue Feb 06, 2007 at 09:31:52 AM EST
[ Parent ]

Re: John Edwards releases his health care plan (3.00 / 1)

I agree, so for those of us that would like to see universal health care coverage enacted, let's wait and see how much it would cost those folks before we declare the plan DOA.


by adamterando on Tue Feb 06, 2007 at 09:45:21 AM EST
[ Parent ]

Edwards plan is A+ Excellent (none / 0)

Don't let anyone fool you that it..whine..can't...whine..won't..whine.. work.

We have Big Insurance and Big Pharma spending billions of buckaroos on advertising every year, not to mention the lobbyists who represent them on the Hill too.  Oy.

Even if they agree to suck it up, cut ads , we still have the MSM who will lose that revenue..hello!

Is it any wonder that Edwards' Plan will be stoned by the very people we trust to take care of us...physically, mentally and informationally?


by catchawave on Tue Feb 06, 2007 at 12:23:43 AM EST


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