The Health Care Priority


In policy terms, and even now in messaging terms, the campaign between Clinton and Obama is becoming less about change and about experience than it is about two issues.

The War in Iraq and Health Care.

I've watched this with great interest. Obama has a slightly better record on Iraq than Clinton (he was against it in a speech when he had no power, then when he was in power had an essentially identical vote record on the issue with Clinton.)

His current plan to end the Iraq occupation is somewhat better than hers, but not much. So the real problem with Clinton, and it's a big one, is that she won't admit she made a mistake voting for the war.

In terms of health care, Obama's plan is not universal, and everything I know about underwriting and actuarial science tells me the same thing Krugman has been saying, that it will cost a lot more per capita to cover people under Obama's plan. Paying more to get less, it's just a continuation of the American way in healthcare. On top of that, indications are that universal healthcare is simply not a serious priority for Obama.

I have often said that Americans want universal health care. The polls back me up, sometimes even if it would require an increase in taxes. But just like with anything else in a world where you can't have everything, real demand for something means making choices.

The choice that Democratic primary voters are making is for the man who doesn't offer a universal healthcare plan at all. Debate everything you want, but even Obama doesn't pretend his plan is universal.

I've lost a close friend and a friendly acquaintance in the last 4 years because they lived in America and didn't have insurance and I don't even live in the US. I'm sure most Americans know far more than two people who have died or had their lives ruined by health care costs. Why Americans aren't up in arms about this, why this isn't something that Democratic primary voters care enough about to force Obama to at least suggest a universal plan, I don't know. But I guess people get what they vote for, and right now democratic primary voters are voting against universal health care.

The voters are speaking, and what they are saying is being heard loud and clear in Washington: that even the hardest of the hardcore on the left, people who care enough to vote in democratic primaries, don't prioritize universal healthcare. Clinton has hammered the issue, it has been something she has repeatedly worked Obama over on for weeks now, and it hasn't worked.

So clearly it isn't that important an issue.

Duly noted by the people who matter, you can be exactly sure. And next year, when I'm arguing with insiders about universal healthcare, and I will be, because I have for years, I will be told "they had a chance to vote for it, and they didn't. Americans just don't care that much about it. Heck, even most Democrats don't."


Ian Welsh February 22, 2008 - 2:23am
( categories: Miscellany )

It's not that the people don't want it—we do—it's that only Krugman is talking openly about how the two candidates differ on this and who, besides us and the "elite" who read the NYT are aware of this?

Obama will get the nod because the corpo powers that be have anointed him. They would not have done so if they felt in any way threatened. That's why you an I and so many others who hang out here and FDL and Kos and all the other places where high information people go were for Edwards.

Sad.

*Comforting the Afflicted and Afflicting the Comfortable*

RevDeb February 22, 2008 - 9:22am

so I'm glad the first post I saw was yours.

Spotted this at Kos yesterday. It's still up today with a staggering number of comments and recommends.

A Kossak who goes by the charming name of Grassroots Mom went to the Library of Congress website and looked up the respective histories of what Hillary and Obama actually accomplished as U.S. Senators.

She didn't bother looking at votes. She just focused on which bills each candidate cared enough about to introduce and how successful they were in getting support and getting their legislation passed.

http://www.dailykos.com/storyonly/2008/2/20/201332/807/36/458633

someofparts February 22, 2008 - 9:39am

the visceral level of hatred for hillary clinton. even people who make healthcare a priority may not vote for clinton because they simply can't stand her. the level of vitriole surrounding her candidacy is really shocking.

that even the hardest of the hardcore on the left, people who care enough to vote in democratic primaries, don't prioritize universal healthcare. Clinton has hammered the issue,. . .

it is my number one issue and i voted for clinton and her health care plan is why i did so. i have lost people because of the fucking system here and i have narrowly escaped bankruptcy as a result of my husband's serious illness. my stepdaughter was between jobs when she broke her neck in a car accident. she was unable to get the treatment she needed and now lives in constant pain. my sister and her husband were forced into bankruptcy as the result of medical bills. my husband before i met him as well.

we pay $1300 monthly for health care for two people: premiums, copays, pharmacy copays. i think that's insane. the only real way for people to understand this issue on a gut level is to experience it. i wouldn't wish that on anyone. being sick in this country is a living nightmare.

lynette February 22, 2008 - 10:17am

Edwards would be ahead. IMO, mandates isn't universal health care, no matter how many times Clinton says it is. Face the fact: both of their plans suck.

Tim February 22, 2008 - 12:07pm

But candidates aren't salad bars. As a voter, I can't take Obama's war stance, Hillary's health care plan, John Edward's plan for poverty, and make one candidate out of them. As they say: you picks your poison and you live with it. You can try to boil the entire decision down to Iraq and Healthcare, but that is oversimplification on a grand scale.

There are things I like better about Hillary, but on the whole I think Barak is a much better president for the USA at this time. I also take into account what Krugman says (writes), but it is not the sum basis for my decision.

zot23 February 22, 2008 - 12:46pm

Ian, I think one must give a little bit more credit to the American people. Perhaps they do realize that Clinton's plan is too "radical" (for Wall Street, that is) & consequently has a next to 0% chance of success in the first year of a presidency. Still, if she gets to the White House & succeeds in having it passed, so much the better. But Obama has an advantage, too. Obama's plan, according to a couple of evaluation that I've read*, has a step-wise quality to it that would make it less threatening to corporate interests and consequently he has a better chance of getting their cooperation without which, let's face it, nothing would get done. His is a case, I think, of "a bird in the hand is better than two in the bush."

[* I have not been able to retrace those. I'll give it a try later.]

FurGaia February 22, 2008 - 1:02pm

This is interesting:

Any of the three "theories of change" has to be tested not just as a description of the current political situation, but as a tactic for breaking it. Even the non-naive Edwards believes that the structure of power can be broken -- by a large, engaged social movement. Clinton's theory in a sense takes the status quo for granted more than the others, but it's appropriate in certain situations: I imagine her negotiating the fine points of a health care bill, having mastered every lesson from 1993 and every detail, and getting Senators McConnell and Grassley in the room, and them walking out having agreed to something they barely understand. Superior knowledge and diligence can be a tool of power. Both are sound theories, both represent essential elements of change, but neither one is sufficient, or on its face more plausible than Obama's. While there will have to be a constituency for large-scale health reform (and thanks to the similarities in the Democratic candidates' proposals, there will be), there is no large-scale populist uprising on the horizon. And while hard work and mastery of details is also indispensable in a president, work alone does not overcome unyielding political opposition." - Source

FurGaia February 22, 2008 - 1:39pm

Again, how is it that Hillary "Health Care Lobbyists Support My Campaign" Clinton is the one to deliver health care reform? 1( That doesn't make sense. 2) She stole Edwards plan just so she could look better, not cause she was serious about it. 3) She has a record of having failed in the fight for health care reform. So isn't trying the same thing (getting Hillary Clinton in there to head up health care reform) equivalent with the definition of insanity - trying to do the same thing again but expecting a different result? Only this time she has less credibility and is as polarizing as ever. So again, does anyone really think that SHE can get it passed, even if she were serious about it (which I doubt)?

Nominay February 22, 2008 - 2:45pm

You took the words out my mouth but made it sound better. IF Hillary could win the general, it would be with a minimum of enthusiasm. Even if she wanted to get it through, which I doubt too (getting re-elected will be job number 1 from moment she puts her hand on the Bible), she will not have the political capital.

Zman1527 February 22, 2008 - 4:08pm

You've dumbed down your reasoning to fit intended results.

First of all, the Health Care lobbyists have supported every contender's campaign ever since they had an organized lobby. They want a seat at the table like everyone else. If they get one and what priority they receive is another matter, yet to be determined. I'm not saying they won't have influence. I'm saying I have no idea to what degree, and that you don't either. So, what doesn't make any sense is you pretending otherwise.

Hillary stole Edwards plan? (see next graph)

"She has a record of having failed in the fight for health care reform."

I see. So, Hillary stole Edwards plan although long before he, she attempted to reform healthcare. Right. And although having tried it 15 years ago and making it the main plank of her current candidacy, she's not serious. Right.

Its true the past attempt at real reform did fail. So, of course, that automatically means she will fail again because, why? Are you saying she hasn't learned anything from the last attempt? Or that the political landscape is so similar? Or that she has less credibility now as a multiple term Senator than as a relatively unknown First Lady? Be serious.

Healthcare reform may indeed fail. I hope not. But if it does it won't be for lack of trying on Hillary's part, whether she's the President or continues as Senator. Entrenched interests and slimeball tactics are the culprits here. And also, of course, silly, unreasonable nonsense polluting the public discourse.

ww February 22, 2008 - 4:40pm

to remember is that the coming make up of the house and senate is key to any reform being passed. We need to also be focusing on getting more democrats elected, so we don't have to worry so much about the reaching across the aisle crap.

Tina February 22, 2008 - 4:50pm

Unless we get a more advantageous composition in the Congress, no good health care plan will pass. And I still believe that if we get more democrats (hopefully better ones) elected to the house and senate (potentially a filibuster proof majority), we have a better chance to get more progressive legislation passed. I think the Bush dogs would also feel more pressure to support this legislation. The question to me is which presidential candidate can promise such a blow-out election. Obviously, there are no guarantees, but in my view, Obama would get more people out to vote, while Hillary would promise another Gore 2000 or Kerry 2004 type situation. We will see.

wulingren February 23, 2008 - 2:00am

... didn't create this climate, where people are pissed off enough to actually get up and do something about it. Bush has a 19% approval rating. Worse even than Nixon at his lowest point. Barrack had nothing to do with that.

The 2006 election foreshadowed what to expect. Barrack is the beneficiary of events, not the producer.

With the current mood and, I believe, now over a dozen Republicans leaving their seats under a cloud of one kind or another, the Dems are virtually guaranteed to pick up seats. How many, I dunno. Donna Edwards showed that the Bush dogs are not safe. I could be a significant number.

ww February 23, 2008 - 9:24am

Last I heard it was 29. Could well reach mid 30s.

Gordon February 23, 2008 - 11:36am

Americans truly do not 'get' the concept of universal health care, and their not getting it is helped if not actually caused by the health insurance & drug industries. Health insurance in the USA makes me think of the Hawaiian quip about the 19th century missionaries, "They came to do good and did very well thank you"

The first misconception is that with universal health care the quality of care will plummet and we will all be forced into a Kafkaesque system where we will all stand in line waiting to be denied essential care.

Nothing could be further from the truth if you have any experience of a universal health system. Even the UK national health, which is more rampantly socialist and rigid than most in the free world, allows if not encourages the concept of private insurance. If you are able to afford private insurance nothing changes.

I don't understand HOW anyone can say that the 47 million plus Americans who have no health coverage at all are be better off without universal coverage! A friend who is a health professional said "But they can always go to the emergency room can't they?" Obviously she has never been to an inner city emergency room. How is it better to do without health care if you have a life threatening condition? You die faster and leave more room on the planet for the privileged? How can you justify healthcare for a jailed convicted murderer but not for a minimum wage working single mother and her dependant children?

Apart from anything else it makes no sense at all to pay for emergency care (bottom line we all do just that via increased charges for those with insurance to cover the losses on those who don't) when we could pay much less for preventive care. It is a lot cheaper to give a diabetic insulin than to hospitalize him/her, or amputate limbs. How much more cost effective to prevent someone with pre-diabetes, who will become a Type 2 diabetic (80% - 90% of diabetics) from getting to the insulin dependent stage? This is done with lifestyle changes, diet, exercise and often tablets.

America is a wonderful place with wonderful people. How can you not be ashamed to be the ONLY country among those at the same development stage without universal healthcare? Not only is healthcare a basic human need but it is also a human right.

Henrietta February 22, 2008 - 3:20pm

The UK health-system is far from "one of the most socialist". Try France, Germany, Scandinavia and they are all significantly better than the UK and of course better than the US system. Moreover, living in Canada now I realize that compared to European systems liek the ones above it appears underfunded. It may be that living in quasi neo-liberal BC makes things different. Still, I do have access to healthcare and I am glad for that.

On the broader issue: how will Hillary, even if we assume she does want to implement her health-care plan, be able to pass legislation having won (if she wins) with the tightest of margins and setting the republicans up to get both houses as a response to her? One may criticize Obama all you want for this and you are probably right in doing so, but at least he has a chance of creating democratic majorities that allow for actual legislating.

And finally: half a million dead Iraqis count more on my book than anything she has to offer. A trillion dollars lost count more than anything she claims she would achieve. No excuses for the warmonger.

dimik72 February 22, 2008 - 4:48pm

She is not my preferred candidate.

Was her failure her fault? Who or what blocked the reform? Was the failure due to her lack of preparation, or vision, some essential flaw in the plan? Or was the failure due to a heavily funded and well organized campaign by corporations who's obscene profits were threatened by it?

Henrietta February 22, 2008 - 3:26pm

... the idea was swiftboated:

ww February 22, 2008 - 3:37pm

Regarding the statement: "So the real problem with Clinton, and it's a big one, is that she won't admit she made a mistake voting for the war."

She's actually admitted the vote was a mistake and said if she had it to do over she wouldn't vote that way. What she hasn't done is "apologize." Edwards did, and the media hounded Hillary to do that also.

kdmcconn February 22, 2008 - 3:50pm

clinton's health plan is better than obama's, but not by much. individual mandates is simply a crappy way to get universal healthcare (not only do they not work, but it maintains the stupid and wasteful private health insurance middle men that are the real problem in our system). frankly, i don't think either will do what it takes to fix our health care system, though both are better than the extremely sucky status quo.

and obama's better on foreign policy for more reasons that just iraq. the fact that he didn't vote for kyle-lieberman and would engage in direct talks with iran suggest that he is the only candidate who is willing to really ditch the destructive neo-con style of foreign affairs.

just my two cents.

upyernoz February 22, 2008 - 4:57pm

neither of them has a plan to fix the US system. the problem with the US system is that it's based on the idea of health care as a commodity, like flat screen TVs and iPhones. this is incredible because everybody in the country, when it comes right down to it, believes that every man, woman and child needs access to health care when they're sick. even (most?) republicans doesn't want to see people walking around on the streets dying from uncomplicated pneumonia - at the very least it's gross. the question is how to get there. hillary and obama are focused on expanding access to insurance. this misses the point, intentionally. as moore points out visually (i just saw sicko again this morning) and plenty of other people have pointed out and experienced personally, having access to insurance does not equal having access to health care.

the US health care system is set up to make money. the clinton and obama plans, although different, are both set up to reform a broken system that needs a revolution. improving coverage for poor kids, or improving pharmaceutical access for old people, or giving catastrophic coverage insurance to 20 year olds doesn't solve the problem. it gets rid of the most visible defects of the system - vulnerable people getting fucked. and it gets rid of the minor defects so that the rest of us, people with private insurance, will keep paying 50% more per person than the next most expensive country for more procedures and worse health care.

the US doesn't need health care reform. it needs a new health care system. the insurance industry knows this, which is why they're willing to debate Universal Health Care, which leaves them in the picture. obama and clinton are well aware of this; that's why the insurance industry pays them. neither candidate gives a shit about health care access for all americans if it comes at any significant loss of revenue for industry. yes, clinton's plan is slightly less bad than obama's. but both plans 1) continue to give private insurance an undeserved seat at the table, and 2) will be much more watered down by the time it gets into law.

hillbilly diaspora February 22, 2008 - 8:01pm

will need to happen is that a coalition of doctors, nurses, unions, and certain major companies (who can no longer afford pension and current employee healthcare costs) will have to call out the insurance industry, Big Pharma, malpractice attorneys, and do-nothing conservatives to rein in costs and cover all Americans.

The embarrassing facts are that our schools look more effective than our medical centers and clinics. Schools don't kill 90,000 students a year due to preventable errors. 47 million Americans don't go without education. We don't provide free education just to the poor and the elderly. What if we paid for schooling with about a $1000 a month per family charge, plus a 3% payroll tax we split with the schools, plus some co-pay for each time we visited or talked with a principal or teacher? Plus all our learning materials were very expensive and only partially reimbursed through an incomprehensible and byzantine assessment system. Of course, preschoolers, the poor, and the elderly would have little or lower costs, but we wouldn't exactly know why.

A full system change is required that takes the non-value-added insurance step out of the picture. Both trial lawyers and insurance companies become leeches (bad analogy?) on the healthcare system and get in the way of actual healing. And a dependence on high-cost, high-tech, high-risk drugs and procedures that show limited efficacy, is the deeper embarrassment. I don't know what's it going to take, but a joint general doctors/nurses strike might get the ball rolling...

trob February 23, 2008 - 9:56pm

Did you see the Bunk study stating 2/3 of doctors in America want National Health Care. The doctors who did this study also conducted one in 2002 and found that the majority of doctors did not want national health care, the problem with this is that the 2 question surveys drastically differ in there 2nd question. I found this article, 60% of Physicians Surveyed Oppose Switching to a National Health Care Plan, It's worth a read.

mosesgunner April 10, 2008 - 5:08am

The opinion of the physician in this discussion is only important inasmuch as the physician is a taxpayer just like me.

Uh. No. Transparently and idiotically wrong.

Gordon April 10, 2008 - 10:07pm

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