- Annette Murph (no relation)
- Kevin A. Smith
Lieberman's first case study was
Reading any one of these examples illustrates how inadequate the coverage of this issue has been (which is no doubt Ms. Lieberman's point). The networks have served up softball questions and the campaigns have responded with pat answers.
What I've read indicates that while Obama wants more people to have insurance – he's given us no reason to believe that that coverage will elevate the lives of the newly insured.
By contrast, McCain's plan of severing insurance from employer-sponsored benefit is tantamount to throwing hard to insure Americans to the wolves.
In my own limited experience, past employers negotiated insurance terms with insurers. The size of their business (and overall health of the worker pool) translated into leverage. My past insurers wanted a pool of business brought to them by my employer – so they made some concessions.
I didn't go to those negotiations; my HR person did on my behalf. They took their years of experience with employee benefits and fought for good terms.
As I read it, McCain would make us all lone wolves. Suddenly, I'll have to negotiate with the insurers. I am not an expert and I have no leverage. Is there any real expectation that those negotiations will be unlike all the other negotiations lone consumers have with large corporations?
They give you a number – and you take it or leave it.
This is so insane as to be beyond irresponsible.
If I were a one-issue voter on health care, my vote for Obama would have nothing to do with his fig leaf of a plan – it would be about preventing the disaster that McCain is advocating
6 comments:
You should be proud - you actually got me to look at McCain's web site, you made his plan sound so bad. Now, admittedly, you left out the several-thousand-dollar tax credit included in his plan to help families obtain direct insurance (just as McCain leaves out that critical element, who is paying for the credit.) Your concern isn't that, though, it's the idea that health insurance companies would drive up costs.
Right now, as the theory goes, insurance costs are limited, because the insurance companies' ability to raise costs is countered by companies, serving as collective agents of pools of the insured, negotiating from strong positions to reduce those same costs. In that regard, companies act in the same way as a union does, collectively bargaining for a pool of persons who, individually, have nearly no bargaining power. There are several problems with this model, though - one, it assumes you are an employee of a large company, which is able to serve this role. Two, it ties you down to the company, as once you break your connection to the company, you break your connection to the insurance. And, three, it relies on the will of the company to push for cheaper care for their employees; their self-interest only requires that they reduce the cost of health care to the company, not the employee, and a company could just as easily shift that cost to the employee as to the insurer.
There are several plans to respond to the problems listed above - helping small companies pool to increase their bargaining power, some efforts to increase portability of insurance, for example. Standing alone, the best answer is to remove the employer as the largest conduit for insurance, but this is not simple, and you're raising just one of the concerns. The question is, what factors could be introduced to inhibit insurers from raising costs? The usual solution is to provide some alterative to companies, to act as a collective agent of the insured. Some argue that agent should be the government. McCain's site talks about turning to State efforts to reduce costs (and this question is what he is talking about - he means, how have states provided collective bargaining for the insured. This is something that has been experimented with across the country.) Unfortunately, the specifics do disappear at this point in McCain's plan. But, it's a legitimate approach to the problem, and not as clear a disaster as you suggest.
Look here: http://www.joepaduda.com/archives/001214.html
and here: http://www.joepaduda.com/archives/001228.html
More general resources on health care policy: http://healthaffairs.org/blog/
http://healthpolicyandmarket.blogspot.com/
http://www.thehealthcareblog.com/the_health_care_blog/
Health care is an incredibly complex issue, and blue/red, dem/rep doesn't even begin to scratch the surface of it. In fact, if anything, those labels obscure the real issues.
I think my categorization of McCain's plan was overbroad – but there's no getting over the fact that while his plan will affect more people, it doesn't have an answer to a major concern – insurers raising costs when the insured can no longer have collective bargaining power.
Obama's plan is (I think) window dressing e.g. "look how many more people have (inadequate) coverage!"
Lame. I hope that he improves on it, but I get to ignore it either way.
McCain's plan is coming after me. His plan happens - my health care is going to change. I didn't ask him to take away my bargaining leverage and tax my benefits, I wanted him to help lower costs and get better coverage for more people.
How can a candidate propose doing this WITHOUT spelling out how he's going to keep insurers from taking advantage of their customer's diminished leverage?
Insurers will have an opportunity to put the screws to a more insureds who have little understanding of medical insurance. By not saying how this will be addressed, the McCain camp is asking everyone to take a huge risk and hope for the best.
That's not just lame – that's dangerous. And you shouldn't screw around with people's health care.
Yes, we will get tax credits, but the credits require better consumers to be better at budgeting – something we are notoriously bad at. That first month when your health care premium jumps is going to be a real thrill for millions of people.
To use that Smith guy's example: McCain asks Smith to go out and buy it (do more work), pay more for it up front (assuming he's got that cash handy), and saying we'll make it up to you at tax time. Oh, and by the way we'll try to find a way to keep your rates from getting much higher.
And we'll try to keep your tax credit in line with rising premium costs over time – even as your premium goes up because of your age.
The whole meme that's driving this train is that more people get insurance. Do you see any mechanics in there that make people rush out and buy more insurance?
That's assuming you can qualify for insurance. Those with pre-existing conditions are just where they are today – out shopping for plans that won't accept them.
People gripe about the employment based model, but people are more likely to take plans that come to them.
Repeat after me: People hate dealing with insurance.
It's depressing, embarrassing and very hard to understand.
If I can have an employer gift wrap coverage: i.e. bring me the right forms, pay for it out of my check every month – I'm more likely to get on a plan and stay there. If I get sick when I'm in my pool – I'm less likely to be dropped.
People want to augment the employer model by merging pools, I'm all for it. Sounds like a helluva lot better solution than removing employers incentive to insure their workers and punishing employees who take them up on it.
The criticism that employer plans are only as good as they make them is a fair point. It's also a big part of why Americans are so underinsured – but it's hardly the fault of the employer based model. Does anyone think that individual consumers are going to do any better?
The same pressures employers feel now will exist for individual consumers of insurance. Do we really feel that people are going to navigate the Byzantine endorsements, limits and coverages and buy truly comprehensive coverage? Hell, no. They're going to look at bundled plans, glaze over the fine print – then bet against getting sick to keep their premium low. If their luck is poor, they get ruined. They pay more regardless.
The presence of employers in this equation is irrelevant to the larger issue. How do people get good coverage without having it devour their budget?
The sad fact of the matter is that McCain is endorsing a free market model, something that is notoriously bad at giving high value health care to sick people who are poor.
I think this is a particularly interesting and insightful discussion of the issue of universal coverage:
The UNINSURED: 47 Million Hostages — Our Dysfunctional Health Policy Process from the Health Affairs blog.
The one critical part of Murph's thoughts that I disagree with is this - that a health care insurance system dependent on the employer is OK. It works for Murph, who works for a large employer, and it works even better for me, working for a large government agency. However, many of the problems of our health care insurance system come from using employers as the primary conduit of insurance, and those problems can't be solved so long as the system remains as it is today.
That all being said, removing the employer from the system is phenomenally complex, which is why big attemts to reform have failed, and current attempts at reform just pick away at the edges of the system. It's also why McCain's position, such as it is, suggests health care will not be a big priority for his administration. It's far too general to provide any workable agenda. If you want to criticize his position, that might be a more fair concern.
Just so we're clear:
I don't get health insurance from my current employer. I get insurance from my spouse's employer.
My discussions of negotiations about insurance (and my overall favorable impression of the HR person assigned to do battle with the insurance companies) refer to my days with a non-profit that had a staff of about 60.
McCain's plan is messing with everyone who gets insurance from their employer - which is my second biggest objection. You put all those people at risk.
My chief objection is that he says nothing about how he'll address the risk he's subjecting us all to.
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