Hillary Clinton released her plan for expanding health care coverage. I can't say I'm quite as excited as Exra Klein is, mainly because this plan doesn't have much to it right now. Sure, it outlines a structure for a different health care system (more on why that's not all that exciting later), but it leaves out a few key facts:
- People will be allowed to buy into the Federal Employee Health Benefit Program, the health care currently used by federal government employees, but the price isn't specified (mainly because these are private plans).
- A new public insurer will be "modeled on the traditional Medicare program" (I guess we don't want for it to actually be Medicare). Again, price isn't specified.
- This is an individual mandate program, where people will be required by law to get medical insurance, so premiums will be capped based on a percentage of family income. That percentage isn't specified. (Ezra's sure that it'll be reasonable, but then again, the plan doesn't say it.)
- She addresses part of the crux of the problem without giving any numbers:
Require Minimum Stop-Loss Ratios: Premiums collected by insurers must be dedicated to the provision of high-quality care, not excessive profits and marketing.
Does anyone think that "excessive" will be defined to actually prevent any insurer from bilking people for as much as they can?
Sure, those are details that would be worked out when the bill gets put together, but they're important issues that change the nature of the plan. If we're going to be forced to buy insurance, either through a public entity or a private one, a low-price makes that a reasonable request considering the burden that the uninsured can put on emergency rooms and the fact that there'd an option for them. If the cost is high, then it's just a round-about and in-your-face way of subsidizing the health care industry and insurance companies.
But I have some actual problems with the outline of the plan that she's provided so far, and they're after the jump.
Here are just a few things:
- The plan doesn't get rid of private insurance companies, the worst actors in the current health care system. It adds a few regulations and gives them a few indirect subsidies. First, "individual mandate" is a subsidy of insurance companies. The reason people don't have health care right now isn't, for the most part, because they're arrogant and selfish. It's because they can't afford it. Another subsidy is the tax credit offered to reduce the burden of health care costs on people. It does nothing to reduce the premiums or force anyone to be more efficient to actually reduce the costs of health care, it just passes along the cost to the government. Why doesn't Hillary just hand the CEO of Met Life a sack of cash?
- There's nothing in there about allowing the government to negotiate prices with health care providers or pharmaceutical companies. That's one of the major problems right now with Medicaid, so why doesn't she mention it in her plan?
- The plan does nothing to separate employment and health care. The plan still expects employers to be the primary means of distributing health care, it only gives a tax credit to small employers to help them get private insurance for their employees (another tax credit that goes straight to private insurers). But the fundamental idea that employment should have anything to do with one's ability to get health care is unchallenged. What about the unemployed, temporarily or otherwise? Tax breaks don't help those without incomes.
There are good aspects of her plan, like an increased focus on preventive care and a promise to do a lot of good (generally left rather vague).
I'm wondering what would become of private insurers. Considering that she'd create a public entity to provide "quality" health care, what's the point of private insurers anymore? I mean, if it's a really good public entity, then why would anyone go to a private company?
She lists out possible restrictions to be put on private insurers:
- Require Guarantee Issue: Insurers must offer coverage to anyone who applies and pays their premium. This protection, known as guarantee issue, will ensure that no one is ever denied coverage because they are sick or an insurer fears they will be.
- Require Automatic Renewal: Insurers will be required to automatically renew policies if the enrollee wishes to stay in the plan.
- Require Strong Rating Protections: Insurers would be prohibited from charging large premium differences based on age, gender, or occupation (for example, a standard set of modified community-rating protections).Require Minimum Stop-Loss Ratios: Premiums collected by insurers must be dedicated to the provision of high-quality care, not excessive profits and marketing.
If these actually get through in a way that isn't a joke, and they actually improve the system, these private companies aren't really doing much at all besides sitting around and collecting premiums (not excessive ones, of course). They won't be able to deny anyone who applies, they won't be able to spend too much on marketing, they'll be forced to renew (so that people don't have to fill out another automatically-accepted application, I suppose), and they won't be able to make large differences between people of different risks. These are all good things, but it begs the question: Why not just go single-payer?