The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Archive for September, 2007

Agents Need to Deliver Value — And Let People Know About It

Posted by Alan on September 29, 2007

It’s not that anyone wants to do away with agents. OK, let me rephrase that. Single payer advocates would like to do away with agents. They also want to do away with insurance companies, too, so it would be wrong to take this personally. Most of the folks working on health care reform don’t think that way. In fact, part of the problem is they don’t think think about agents — and the value we add to the system — much at all. As a result, a lot of the reform proposals out there are likely to eliminate agents and brokers from certain market segments,  or at the very least, greatly diminish what we can contribute. This isn’t intentional, but it could be the result. And, of course, from the squirrel’s rabbits point of view, whether the truck runs them over intentionally or inadvertently, it’s still roadkill.

But it’s not only the truck’s fault. As insurance professionals we need to take responsibility for selling our value. And for earning it every day in our interactions with our clients.

Ross Pendergraft, who is Media Relations Chair for the Los Angeles Association of Health Underwriters recently circulated an email which is spot on, so much so, I’ve reprinted it below. (For those who aren’t aware of the background, Oprah devoted a recent show to health care reform. Her guests included Michael Moore, director of the film Sicko,and Karen Ignagni, president and CEO of America’s Health Insurance Plans, a trade organization. NAHU is the National Association of Health Underwriters, a professional organization representing insurance agents and brokers). 


After viewing The Oprah Winfrey Show, “Sick in America: It Can Happen to You,” I have a NAHU challenge. The America public needs to know that there are Health Insurance Agents able to assist people with their insurance claims especially when they are too sick and vulnerable.

Case in point: 1. The Oprah show highlighted three individuals with severe medical conditions, each having a battle with their insurance carrier. There was not one single mention that a Health Insurance Agent could have assisted these individuals with their ordeal. 2. Karen Ignagni, president of America’s Health Insurance Plans, in her commanding performance supporting the health insurance industry, never once mentioned anything about a Health Insurance Agent and the support the agent could have provided.

I would encourage everyone to read the transcript from the show (Summary of Oprah program, “Sick in America: It Can Happen to You) and, better yet, to watch the show.

When I watched the movie Sicko I was extremely disturbed by the many half-truths that Michael Moore broadcast leaving me very little respect for Mr. Moore. However, I have to say after watching Oprah, I found myself starting to resonate with some of the beliefs that Michael Moore has with regards to our country’s health care problem.

Rather than accept my comments, go to the Oprah Message Board and see what the American public has to say after viewing the show. I would also encourage all health insurance agents to respond to the Oprah show.

I love this from the show: Although Karen Ignagni admits that America’s current health care system has its faults, she says a government takeover is not the answer. “There’s no perfect system. What we need to do is craft something that’s uniquely American. We have to take responsibility in insurance plans of doing a better job dealing with mistakes, dealing with people who are falling in the cracks, good physicians and good hospitals,” she says.

Ross Pendergraft


Agents can make a huge difference in the health care outcomes for their clients. We serve as counselors when consumers shop for coverage and advocates when they encounter problems. Both NAHU and CAHU strive hard to get this message out to decision makers and opinion shapers. The reality is, however, that every agent needs to take responsibility for delivering this message. It starts with asking the question, “Do I add value to the products I sell?” If the answer is “yes,” then make sure your clients — and their legislators — know (CAHU’s current Operation Drumbeat communication provides a sample letter your clients can use as a starting point). If the answer is “no,” then it’s time to turn your business over to an agent who can provide meaningful services to your client or to change your ways before legislators, inadvertently or not, changes your business for you.


Posted in Health Care Reform, Healthcare Reform, Insurance Agents, Politics, Single Payer | Tagged: , , , , | 5 Comments »

Canadian Health Care as Reported by Canadians

Posted by Alan on September 28, 2007

We read so much about the problems facing the American health care system I began wondering what folks in other countries complain about. After all, advocates for single-payer systems are always pointing to Canada or Europe to show how much better things are elsewhere. Yet reports on other health care systems are always filtered through the political prism of the presenter.

So I found a Canadian news service — CNW Group (“the nation’s number one resource for time-critical news and information from more than 10,000 sources coast to coast and around the world.”) It’s sort of a Canadian Associated Press. On eof the recent headlines caught my eye “Ontario Party Leaders message to cancer patients: Keep waiting.” It seems a grass roots campaign launched a cancer patient support group sent letters to the leaders of the province’s three major parties. They noted Ontario ranks poorly in funding new intravenous cancer drugs (British Columbia funds 20 while Ontario fully funds only four). Further, Ontario ranks last among Canadian provinces when it comes to funding PET scan imaging (Quebec funded 209 PET scans per 1000,000 population; Ontario only six).

The party leaders failed to commit to improving Ontario’s ranking, instead offering reassurances of their commitment to health care for all Ontarians. Or as one of the consumer advocates noted, “All three leaders have been talking about their commitment to health care on the campaign trail, but none of them seem to be willing to be accountable for measurable results.” The consumer group intends to demonstrate at public meetings of the candidate to educate their fellow citizens on the subject.

This all got me thinking about how a politicized health care system would work in America. Would we have candidates making the round of disease-focused associations pledging increased funding? Would incumbants be attacked for long waits for services? When health care costs continued to rise (as they will given the aging population, the cost of new technologies, and the like) would the rascals in charge be thrown out of office?

Even if voters punished politicians for failures in the health care system, I’m not sure much would change. The challenges facing the American health care system is about far more than the financing mechanism. It’s about making tough choices about what adequate health care is. It’s about making objective investigations into waste in the system and having the skill and tools to eliminate that waste.

A wise man once told me you never really fix problems, you just replace them with new ones. Folks who look to Canada and Europe for answers should subscribe to services like CNW. Because health insurance reform is only the beginning, not the end, to the challenges we face.

Posted in Canadian Health Care, Health Care Reform, Healthcare Reform, Single Payer | 1 Comment »

State Children Health Insurance Program Problems Don’t Bode Well for Health Care Reform

Posted by Alan on September 27, 2007

Most of the health care reform packages likely to be considered by the Legislature during its current special session will include provisions to expand the State Children’s Health Insurance Program (SCHIP). SCHIP is known as Healthy Families in California. So the political drama unfolding in Washington concerning SCHIP is critical to the state. It also should serve as a warning, especially to those advocating a central role for the government in delivering health care.

Here’s where SCHIP currently stands: On September 25th the House of Representatives reauthorized SCHIP on a relatively bipartisan vote (45 Republicans voted for the bill; eight Democrats voted against it).  The legislation, H.R. 976, provides additional monies for the program and, most importantly, continues the program past it’s sunset date of September 30th — yes, as in this coming Sunday. The Senate will now consider the bill and is expected to pass it as written. This means no conference committee will be required, the measure simply goes to the President’s desk. So far, so good.

However, President George Bush has committed to vetoing the bill. One reason is the cost: the President wants to increase SCHIP spending by $5 billion over five years; Congress is seeking to increase spending by over $35 billion during this time-frame. More significantly, the White House objects to expanding eligibility for the program beyond it’s current income levels, arguing that doing so is “an incremental step toward the Democrats’ goal of a government-run health care system.” Even with Republican support, the House is unlikely to overturn the President’s veto. HR 976 passed with 265 votes in favor; it takes 290 votes to override the President.

The good news is that the SCHIP program is unlikely to end on September 30th. Congress will either tack on short term funding to an existing continuing resolution. If that doesn’t interim funding could be passed as stand-alone legislation. Then the battle for long-term continuation of the program will start-up again.

There’s more than a political soap opera going on here. What we’re also witnessing is a warning. When the government controls health care, it means health care is political. Decisions are not made to respond to market pressures or consumer demand, but to satisfy the politics of the moment. There likely will be an short-term extension of SCHIP. But then again, maybe not. Remember when President Bill Clinton and the then-Republican Congress shut down the federal government they reached a budget impasse?

2007 has provided advocates of government-run health care with lots of cautionary tales: the California budget stalemate; a California budget which slashes funding for mental illness programs and outreach for health programs like Healthy Families; and now the veto of SCHIP funding. There are problems with the current system, but I can’t help but believe that politicizing health care would only make things worse.

Posted in Health Care Reform, Healthcare Reform | Tagged: , , | 2 Comments »

Sicko — Again

Posted by Alan on September 25, 2007

I thought, or at least hoped, we were done talking about Sicko, Michael Moore’s film on America’s health care system. But with a lull in the action up in Sacramento, the movie is having a bit of renaissance — or maybe it’s just the inevitable backlash. Recently, John Stossel of ABC’s 20/20 news program took Mr. Moore to task for distortions and inaccuracies in Sicko. The first segment focused on Mr. Moore’s claim in the film that Cuba’s health care system is superior to America’s. It’s less than six minutes long. The next week, however, the entire program was devoted to Stossel versus Moore in an examination of health care systems here and abroad.

Who won depends on where you stood before the interview, but most neutral observers seem to think Mr. Stossel came out ahead.  The interview can be viewed at on You Tube in six segments: Part 1. Part 2; Part 3; Part 4; Part 5; and Part 6.

For the past several months, if not years, advocates of government run programs have been bombarding the public with horror stories about health care in the United States and, especially, about the evils of our current insurance system. ABC’s 20/20 is the first national broadcast I’ve seen questioning this drumbeat. To defenders of the current system it will be reassuring. To those attacking the system it will be an example of corporate America defending one of its own: the insurance industry. To non-partisans I think it will be eye opening and educational. It’s also the kind of program agents will want to share with their clients. Those wishing to can buy a DVD of the program at ABC’s online store.

For those in Los Angeles, there’s Sicko-related event worth taking a look at. On Thursday, September 27th, the Pacific Research Institute and Americans for Free Choice in Medicine are presenting  a program entitled “Sicko and Its Malcontents: Health Care on Film” Promised is a debate on the accuracy, impact and purpose of films like Sicko and of others which attack the Canadian and European health care systems as vehemently as Mr. Moore attacks America’s. PRI and AFCM are both conservative/libertarian-leaning groups, so the emphasis is likely to be that government-run systems increase taxes while reducing access to health care. Interestingly, however, the moderator will be Los Angeles City Councilman Bill Rosendahl. For many years before entering politics, he hosted a cable talk show and is, I believe he is a single payer advocate. The event should be interesting — and it’s free. (Really free. Taxes will not rise as a result of the event. OK, parking at the event is $8.00, but you might find something on the street).

Soon the Legislature will fully engage in health care reform again. Until then, well, we’ll always have Sicko.

Posted in Health Care Reform, Healthcare Reform, Politics, Single Payer | Tagged: , , , , , | 6 Comments »

Tea Leaf Time for Health Care Reform

Posted by Alan on September 24, 2007

The health care reform debate in California appears to be in a bit of a lull — at least in public. Appears is the operative word. There’s a lot of negotiating and maneuvering happening behind the scenes, but not much happening in public view. (It’s like watching synchronized swimming on television — things look organized and relatively calm above the water, but below the surface they’re kicking like mad).

So with little real news emerging, those who care about the issue are left reading tea leaves. Every utterance by the key negotiators are parsed like it’s a pronouncement from the Federal Reserve Chair. This can drive folks who care passionately about the issue crazy. Based on the emails I’m copied on, that’s exactly what’s happening.

My advice: take a deep breath. Stay calm. Stay tuned. Stay active, but stay calm. Remember, it’s only tea leaf reading.  Like with Professor Trelawny in Harry Potter’s world, there’s a lot of predicting going on, but very few actual prophecies.

Consider the tea leaves offered in the Los Angeles Time today. George Skelton has an interesting interview with Speaker Fabian Nunez.  On health care reform, Mr. Skelton quotes Speaker Nunez as saying he and the Governor are about two weeks away from agreeing on a compromise bill. He says what they come up with will require only a majority vote. The Governor and Democrats would then sponsor a 2008 ballot initiative to fund their reform package. Speaker Nunez states his belief that passing the ballot measure, which will probably face voters in November 2008, will be a challenge. While leaving open the possibility of settling for more modest reforms (presumably expanding children health programs) if more comprehensive changes aren’t possible, the Speaker says it’s too early to consider settling for less right now. All in all, Speaker Nunez recognizes that enacting meaningful health care reform won’t be easy, but he remains optimistic it can be done.

So tea leave readers, what does this all mean? Nothing new. Negotiations continue. Progress has been made. Substantial differences remain. Differences will be resolved in two weeks. Unless it takes longer. Or unless no compromise is ever reached. If there’s no compromise, the Legislature will consider less comprehensive action.

Of course, when the only thing on TV is synchronized swimming, you’ve got to do something to stay awake. The reality is, we’ll know something substantive soon enough. Reading tea dregs can be fun from time to time, but all-in-all, I’d rather read a good book. 

Posted in California Health Care Reform, Health Care Reform, Healthcare Reform, Politics | Tagged: , | Comments Off on Tea Leaf Time for Health Care Reform

Another Poll on Health Care Reform

Posted by Alan on September 22, 2007

There’s a new poll out on the attitude of Californians on health care reform. The Public Policy Institute of California (PPIC) is the latest survey contributor. The survey shows health care reform is now neck-and-neck with immigration issues at the top of issues Californians care about. Like the recent Field Poll, the PPIC reports a strong demand among voters for substantial changes to the state’s health care system.

Like that Field Poll, this shouldn’t surprise anyone. After months of public pronouncements by Governor Arnold Schwarzenegger, Democratic presidential candidates, the media, Michael Moore and others proclaiming the system to be broken, Californians are coming to the conclusion that the system is, well, broken. (For an excellent analysis of the poll, check out Frank Russo’s post at The California Progress Report.)

This doesn’t mean these polls should be ignored. First off, we couldn’t if we wanted to. Both Governor Schwarzenegger and Legislative Leaders have already issued press releases trumpeting the poll as evidence their health care reform plans have voter support. And in the echo chamber that is Sacramento, the poll will strengthen the conventional wisdom that reforms are needed.

As I posted yesterday, I agree that California has a tremendous opportunity right now to make constructive changes to our current health care system. My prediction that we’d see the Governor’s proposal in bill form on Friday was wrong (although now the rumor is we’ll see it sometime this coming week). I’m anxious to see what the Governor is proposing. Until then, most of the discussion will be on the politics of health care reform. Once the Governor’s plan becomes concrete, the focus should change to the policy of health care reform. Then polls should matter less and the effectiveness of proposed solutions should matter more. “Should” being the operative word.

Posted in Arnold Schwarzenegger, California Health Care Reform, Health Care Reform, Healthcare Reform, Politics | Tagged: , , , | 1 Comment »

Carpe Diem — or at Least Seize the Special Session

Posted by Alan on September 21, 2007

There are actually two special sessions in Sacramento right now: one on water; the other on health care reform. For reasons due to the timing of potential initiatives, water is the first focus. And from what I hear it’s not going well.

But that’s legislation under the bridge (sorry). In a few weeks the Legislature will turn it’s attention to health care reform in earnest. There will be tremendous pressure to do something. After the budget fiasco, the failure to address reapportionment, perhaps inaction on water, Governor Arnold Schwarzenegger, Speaker Fabian Nunez and Senate President Pro Tem Don Perata need a victory of some kind to salvage the reputation of the the 2007 Legislative Session. This is especially important for the Legislative Leadership who will be asking voters to approve a change to term limit laws on the February ballot. If the initiative passes Speaker Nunez and Senator Perata will likely remain in their positions for several more years. If it fails ….

So health care reform might be the last lifeline left to our heroes. Which means something is likely to emerge from the special session. What’s not known is what.

Many observers I’ve talked to are increasingly pessimistic that comprehensive reform will move forward. They think some insurance market reforms may pass, specifically the requirement that 85 percent of premiums be spent on health care services. But when it comes to insuring more Californians, they consider expansion of Healthy Families eligibility to cover more children is the only likely accomplishment (this would be ironic since approximately $66 million promised for enhancing Healthy Family and MediCal outreach programs was cut from this year’s budget).

This may sound reassuring to those who are concerned lawmakers, in their great need to pass some health care reform legislation will pass bad health care reform legislation. Certainly there’s a lot to be worried about. The 85 percent heatlh care services mandate, as currently proposed, will likely increase premiums and decrease competition, especially in the individual and small group market segments. A requirement that carriers accept all applicants, regardless of their risk profile passes, without an effective mandate for individuals to purchase coverage before they’re on their way to the emergency room, individual insurance premiums will skyrocket and carriers will flee the state. The purchasing pool could become a black hole, sucking up more of the marketplace than is healthy for the state’s economy or the private marketplace. And that’s just the start. There is plenty to fear from getting health care reform wrong.

There’s also much to fear in doing little, or even worse, nothing. There are real problems in today’s health care system. Insurance reforms are a part of what’s needed. It’s not the only part needing a fix, far more important is the need to deal with escalating health care costs.  Yet politics being what it is, the focus now is on the insurance industry. If not changes emerge from Sacramento, the demand for “doing something to stop the evil insurance companies” will continue unabated. Doing something, if it’s done right, will enable politicians, the media and the public to focus on deeper and more serious problems.

Another reason to do something right now is to deflate the momentum of building behind single payer alternatives like SB 840. There is likely to be an initiative next year to bring a Canadian-style system south to California. It will be much easier to defeat — as it should be for a host of reasons — if voters perceive lawmakers as addressing their health care worries.

Finally, it’s important to do something constructive on health care reform because it’s the right thing to do. In unveiling his reform package, the Governor state, “The status quo can no longer be everyone’s second choice.” He’s right. The issues have been on the table long enough. What we need now is to address those issues and then move on. What will be interesting to watch is whether the way lawmakers seek to address health care reform is aimed at scratching their political itch or in enacting constructive, meaningful public policy. We’ll know in a few weeks.

Posted in Arnold Schwarzenegger, California Health Care Reform, Health Care Reform, Healthcare Reform, Politics, Single Payer | Tagged: , , , , , | Comments Off on Carpe Diem — or at Least Seize the Special Session

Governor’s Health Care Reform a Bill at Last

Posted by Alan on September 19, 2007

Cue the music (not sure if it should be the theme to “Jaws,” “The Twilight Zone” or “Happy Days,”). Rumor has it Governor Schwarzenegger’s health care reform plan will emerge in legislative form as early as Friday, September 21st. Several spot bills have already been introduced in the special session called to consider reform proposals. (A spot bill is one introduced initially with little, if any, substance awaiting a later date when the complete text  is “dropped into” the bill).

For months the Governor has forcefully outlined the principals he believes must be a part of any health care reform package. For the first time the public will how the Governor and his staff translate these principals into the detailed place where devils dwell.

There are unlikely to be many surprises. It will contain an individual mandate, create the California Cooperative Health Insurance Purchasing Program (“Cal-CHIPP”), a state-run purchasing pool for individuals receiving premium subsidies, require carriers to spend 85 percent of premiums on health services, promote wellness and preventive programs, and speak to containing health care costs.

It will not include any funding for the above. That will be left to an initiative the Governor and his allies will qualify for the November 2008 ballot. This means the bill could be passed on a majority vote of the Legislature. Including taxes and/or fees means it would need a two-thirds majority in each house.

A couple of tea leaves to look out for:

  1. Is there anything in the bill Republicans can get behind? Leaving out taxes and fees is a good start, but he’ll need to do more to capture any GOP support. My guess: it offers Republicans something from their reform package. Including a few of the Republican proposals would be a show of good faith to his own party. And  even if the Governor doesn’t really support those provisions, he can count on the Democrats to be the bad guys and eliminate them later.)
  2. Does it reflect the compromises the Governor has already reached with Speaker Fabian Nunez and Senator President Pro Temp Don Perata or does it take a few steps back towards the Governor’s original proposal? If it’s the former, it’s a sign a final deal is close; if the latter then there’s more than cigar smoke filling up the Governor’s tent. My guess: they’re close to a final deal and this bill will reflect their progress.
  3. Does it specifically spell out how the reforms would be structured or does it leave the nitty gritty to regulators? It will be easier to pass a bill that avoids contentious specifics for now. My guess: it will include a lot more detail than we’ve seen before, but regulators will still have plenty to do.

Seeing the Governor’s proposal in bill form is a huge step toward acheiving comprehensive health care reform. It also will invite everyone and their cousins to start a new round of sniping. However, there’s something the Governor said when he unveiled his plan back in January, “The status quo can no longer be everyone’s second choice.” He’s right. There will be plenty to argue about as the Governor ratchets up the specificity of his vision. But the goal should not be to defeat any health care reform. The goal should be to come up with the right reforms.

Posted in Arnold Schwarzenegger, California Health Care Reform, Health Care Reform, Healthcare Reform, Politics | Tagged: , , , | Comments Off on Governor’s Health Care Reform a Bill at Last

The Governor’s Health Care Reform Plan and the Goldilocks Factor

Posted by Alan on September 18, 2007

Whether it was intentional or not, Assembly Speaker Fabian Nunez and Senate President Pro Temp Don Perata did Governor Arnold Schwarzenegger a huge favor in pushing Assembly Bill 8 through the Legislature last week. They positioned the Governor’s health care reform plan as both more the more moderate and more comprehensive alternative. The result increases the Governor’s political momentum and his negotiating leverage.

Supporters of AB 8 claim the legislation will bring nearly 70 percent of the state’s current uninsured into the system. It’s primary source of funding is a fee on every business in the state equal to 7.5 percent of their Social Security-adjusted payroll. It gives an unelected state agency the ability to raise this fee by any amount once a year (yes, by any amount). Many in Sacramento believe the agency would need to invoke that power almost immediately.

Speaker Nunez and Senator Perata claimed there’s was the reasonable compromise between the Governor’s proposal and the single-payer approach championed by Senator Sheila Keuhl. However, their context was political. Yes, the Governor’s plan needs a two-thirds majority and with Republicans holding back support that was not going to happen. Yes, the Governor vetoed Senator Keuhl’s bill, SB 840, last year and he’d do it again. Yes AB 8 only requires a majority of Legislators to pass. All of this positions AB 8 as the politically viable alternative.

Yet politics is not positioning. Consider things from Goldilocks point of view. Like most Californians outside Sacramento County and a few newsrooms scattered across the state, Goldilocks doesn’t think politically. She does, however, instinctively understood positioning. SB 840, the Papa Bear of reform, represents a government takeover of health care. That sounds scary (or too hot as Goldi would say). AB 8, the Mama Bear, fails to deliver on universal coverage and is expensive to boot. Too cold.

Then there’s the Governor’s plan. Universal coverage and no government takeover. It even spreads the cost of expanding health care beyond business which seems just right.  Meet the Baby Bear.

With this kind of positioning it’s not surprising that the Governor’s proposal is gaining support. For example, last Friday a broad coalition representing business, labor, doctors, insurers, hospitals and consumers endorsed the Governor’s plan. Yesterday the Los Angeles Chamber of Commerce lined up behind it. While possible, it is unlikely the Chamber would have endorsed a plan imposing a four percent tax on their members if it were not for the specter of AB 8’s 7.5 percent tax looming in the background, especially since AB 8 accomplishes less. No doubt more supporters will be joining the Governor in front of the cameras in the next few weeks.

As in the fairy tale, there is a danger here for health care reform Goldilocks. Governor Schwarzenegger’s health care reform plan is just that: a plan. It’s not legislation yet. The coalition forming behind it are endorsing a concept. In the next few weeks as the details emerge in that devilish way details do, some members of the coalition may start squirming. After publicly standing beside the Governor of the California it’s tough to walk away. The last thing anyone wants is the Governor publicly calling them  or their group “lying, backstabbing cowards,” or, in more politically acceptable language, “undependable and disappointing.” This is especially true if you’re a business, labor, doctor, insurer, hosptial or consumer who needs something from the state government in the next two years or so.

The Governor, whose political skills should never be underestimated, got a double win from the Legislature’s passage of AB 8. His health care reform plan looks moderate — even post-partisan. And he gains substantial negotiating leverage across a broad spectrum of stakeholders.  Which means he’s another step closer to living happily ever after.

Posted in Arnold Schwarzenegger, California Health Care Reform, Health Care Reform, Healthcare Reform, Politics, Single Payer | Tagged: , , | 3 Comments »

Clinton Unveils Her Health Plan

Posted by Alan on September 17, 2007

That was then. This is now.

Then was when, as first lady, Hillary Clinton led the charge for health care reform. Her proposal was so unwieldy,  politically naive and arrogantly promoted that it helped Republicans take over control of Congress for the first time in over 40 years and set back the cause of health care reform by over a decade.

Now is when, as presidential candidate, Senator Hillary Clinton needs to put that history behind her and talk to the future. Which is what she did in Iowa today, unveiling the 2007 version of her health care reform plan.

Her approach this time is to be less original, less ambitious and less arrogant. Instead her new plan shares much in common with several other proposals making the rounds — including those of her rivals for the Democratic presidential nomination. This isn’t a bad thing; quite the contrary. It not only lends her plan credibility, but it provides political cover when it comes under attack.

So, for example, she shares with Governor Bill Richardson the concept that if people are satisfied with their existing coverage, they can keep it. She borrows from both Governor Richardson and Senator Barack Obama the idea of using refundable tax credits to help lower income Americans pay for their coverage. And, like Governor Richardson and former-Senator John Edwards she incorporates the idea of a requirement that all Americans obtain health care coverage and expanding MediCare eligibility.

Like many health care reform proposals — at least Democratic reform proposals — Senator Clinton would require insurers to accept all applicants without regard to their risk profile. As previously noted, she wisely balances this with a requirement that all Americans obtain coverage. What’s unclear is how she would enforce this requirement. Poor compliance by consumers would lead to the burden Senator Clinton’s state of New York bears: average insurance premiums roughly 350 percent higher than those in California.

Senator Clinton makes a major point out of avoiding the creation of new bureaucracies (another approach she shares with Governor Richardson). However, there’s something a bit disingenuous about this claim. True, instead of creating a new government health care program she would open up the Federal Employee Health Benefit Program to all Americans. However, the expansion required of the FEHBP to manage such growth would be the actuarial equivalent of creating a new bureaucracy. But with the added downside of probably disrupting the agency’s current mission.

As with all the health care reform plans put forward by presidential candidates, Senator Clinton’s proposal is more a window into her thinking than a blue print for reform. The new president will need to work with Congress to fashion a detailed reform structure. There will be plenty of debate and shaping of ideas in that process. The outcome may resemble what’s being described today, but then again, it may not.

Yet this glimpse into the approach of Senator Clinton is illuminating. By avoiding a single payer approach she demonstrates her willingness to take on the most liberal elements of her party. By imposing requirements on both corporations and individual she invites attacks from conservatives concerning a heavy-handed government approach to health care. In short, given the context of the health care reform debate as it exists today, Senator Clinton’s package is somewhere in the middle (ok, maybe a bit left of the middle, but close enough for government work). This positioning might be expected in the general election, but its a risky move in the primaries. However, it also demonstrates that Senator Clinton learned something then and she’s applying those lessons now.

Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election | Tagged: , , , | 2 Comments »