Democratic candidates on health care
The following table summarizes the basic elements of a plan that would provide affordable, portable, universal health insurance to all Americans, and indicates whether the candidate's proposals include that element.
(1) Obama's plan is mandatory for children only
(2) Dodd's plan calls for "automatic enrollment"
(3) Biden's plan to reduce exclusions is incentive based
Gravel also has a plan that involves "vouchers" paid for with a "national sales tax" that would cover everyone, but it is short on details and you have to sit through a rambling YouTube video to even get that much info.
While Kucinich is considered a "fringe" candidate, his is the only plan that includes all the elements, and his is the only plan that has actually been introduced into Congress (HR676).
Kucinich's proposal (which is to basically end traditional health insurance and open Medicare up to all Americans) is also the only plan that would remove employer-provided insurance from the equation, and for that reason is the only fully portable plan. While the others offer alternatives to employer-provided insurance, they focus on perpetuating the current system of employer-provided health insurance, which by definition is not portable if you change jobs or lose your job.
There is also a distinction between "universal coverage" and "universal access". Only Kucinich's plan and the other plans that are mandatory would provide universal "coverage". Plans such as Obama's and Biden's would provide universal "access."
Contrary to scary propaganda disseminated over conservative "news" and talk radio channels, none of the Democratic candidate's proposals involve "socialized medicine", and none take away any choice of providers (unless you are in an HMO or PPO plan v. a fee for service plan, which is exactly the same as it is now). The top-tier candidates all let you keep your current insurance if you prefer, and offer more options for the unemployed, the self-employed, low-income families, and the uninsured.
Following are summaries of the Clinton, Edwards, and Obama proposals:
Hillary Clinton:
Clinton's "America Health Choices" plan (modeled after Edwards' plan) would let you keep your current employer-provided or individual health insurance, or opt-in to the Federal Employee Health Benefit Program (FEHBP) which is the same plan offered to members of Congress, or let you purchase insurance from a menu of private plans or a new public plan modeled after Medicare.
Clinton's plan would establish uniform "insurance rules across states and markets," to ensure that "no American is denied coverage, refused renewal, unfairly priced out of the market, or forced to pay excessive insurance company premiums." Under the Clinton plan, enrolling in one of the health insurance offerings is mandatory for all citizens.
Clinton would require employers to help finance the system, with large employers required to provide health insurance or contribute to the cost of coverage and small employers receiving tax credits to continue or start health insurance plans. Medicaid and SCHIP would be "fixed" to ensure that low-income, uninsured are covered.
Working families would receive refundable tax credits to help pay for health insurance, and the tax credits would be designed so that premiums would not exceed a fixed percentage of income. Tax credits would be paid for by eliminating the Bush tax cuts for the wealthy. Clinton's plan would also provide tax credits for retiree health benefit plans.
Clinton proposes to improve the quality of health care and control costs through preventive medicine, better use of information technology, eliminating overpayments, funding for independent research into the effectiveness of treatments, and allowing Medicare to negotiate prescription drug prices,
John Edwards:
Edwards' proposal focuses on employer-provided health insurance, saying "Businesses have a responsibility to support their employees’ health." The Edwards and Clinton plans are similar, except that Edwards does not offer buy-in to the Federal Employee Health Benefit Program. There would be regional "Health Care Markets" purchasing pools offering a menu of competing plans, with at least one public plan modeled after Medicare. Edwards would make health insurance mandatory once all these offerings are in place.
Edwards' plan also focuses on improving the quality of healthcare, with emphasis on "evidence based medicine", best practices, information technology, public-private research partnerships, and reducing medical errors.
Edwards also proposes to reward higher quality health care by paying higher rates to plans and providers that deliver the best health care, and to penalize plans that "fail to meet critical, easily quantifiable goals."
Edwards would create a "Consumer Reports" for health care to "help Americans evaluate hospitals’ effectiveness in treating injuries and diseases." Edwards would also fund programs to eliminate health disparities among low-income and minority populations.
Barack Obama:
Obama's plan is similar to Clinton's and Edwards' except it would only be mandatory for children to enroll. It would establish a public program similar to the Federal Employee Health Benefit Program for those without access to insurance through their employer or a public assistance program such as Medicaid. There would be subsidies for low-income families and individuals who do not qualify for Medicaid or SCHIP. Medicaid and SCHIP eligibility would be expanded. There are also several proposals for overall improvement in public health.
A "National Health Insurance Exchange" would allow anyone to "enroll in the new public plan or purchase an approved private plan, and income-based sliding scale subsidies will be provided for people and families who need it."
Employers who do not provide health insurance would be required to contribute a percentage of payroll to help fund the national plan.
Obama would improve quality and lower costs by requiring data collection and reporting for providers who participate in the public plan, promoting patient safety, promoting best practices, providing incentives for higher quality health care, supporting disease management programs, coordinating and integrating care, promoting better use of information technology, and requiring full transparency regarding costs. Obama would also offset employer health care plans for costs related to catastrophic illness or injury as long as employers use the money to maintain lower premiums.
Obama would also increase competition through the National Health Insurance Exchange, and would "force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration" in markets that are not competitive. Obama would also allow drug reimportation, increase the use of generics, and allow Medicare to negotiate prescription drug prices.
Obama's plan also mentions "medical malpractice reform." He proposes to "strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance" and to "promote new models for addressing physician errors that improve patient safety, strengthen the doctor-patient relationship, and reduce the need for malpractice suits."
Conclusion
Clinton, Edwards, and Obama all propose essentially the same thing. They all focus on employer-provided insurance as the primary source of health care, they all expand or at least "fix" (in Clinton's case) Medicaid and SCHIP, they all propose a new national health care plan with access to portable, private plans for anyone, and they all propose a variety of measures to improve quality of health care and control costs.
The Dodd and Richardson proposals are similar. Richardson would also lower the eligibility age for Medicare to 55. Biden would also expand Medicare to cover those 55 and over, expand SCHIP, allow buy in to the Federal Employee Health Benefit Program, and also establish a "reinsurance" program to cover catastrophic costs if insurers agree to not exclude anyone from coverage.
You can review the other Democratic candidate's positions on health care here:
• Dennis Kucinich
• Chris Dodd
• Bill Richardson
• Joe Biden
| Clinton | Obama | Edwards | Richardson | Dodd | Biden | Kucinich | |
| Universal | • | • | • | • | |||
| Single payer | • | ||||||
| Mandatory | • | (1) | • | • | (2) | • | |
| Fully portable | • | ||||||
| No exclusions | • | • | • | • | • | (3) | • |
| Subsidized | • | • | • | • | • | • | • |
(1) Obama's plan is mandatory for children only
(2) Dodd's plan calls for "automatic enrollment"
(3) Biden's plan to reduce exclusions is incentive based
Gravel also has a plan that involves "vouchers" paid for with a "national sales tax" that would cover everyone, but it is short on details and you have to sit through a rambling YouTube video to even get that much info.
While Kucinich is considered a "fringe" candidate, his is the only plan that includes all the elements, and his is the only plan that has actually been introduced into Congress (HR676).
Kucinich's proposal (which is to basically end traditional health insurance and open Medicare up to all Americans) is also the only plan that would remove employer-provided insurance from the equation, and for that reason is the only fully portable plan. While the others offer alternatives to employer-provided insurance, they focus on perpetuating the current system of employer-provided health insurance, which by definition is not portable if you change jobs or lose your job.
There is also a distinction between "universal coverage" and "universal access". Only Kucinich's plan and the other plans that are mandatory would provide universal "coverage". Plans such as Obama's and Biden's would provide universal "access."
Contrary to scary propaganda disseminated over conservative "news" and talk radio channels, none of the Democratic candidate's proposals involve "socialized medicine", and none take away any choice of providers (unless you are in an HMO or PPO plan v. a fee for service plan, which is exactly the same as it is now). The top-tier candidates all let you keep your current insurance if you prefer, and offer more options for the unemployed, the self-employed, low-income families, and the uninsured.
Following are summaries of the Clinton, Edwards, and Obama proposals:
Hillary Clinton:
Clinton's "America Health Choices" plan (modeled after Edwards' plan) would let you keep your current employer-provided or individual health insurance, or opt-in to the Federal Employee Health Benefit Program (FEHBP) which is the same plan offered to members of Congress, or let you purchase insurance from a menu of private plans or a new public plan modeled after Medicare.
Clinton's plan would establish uniform "insurance rules across states and markets," to ensure that "no American is denied coverage, refused renewal, unfairly priced out of the market, or forced to pay excessive insurance company premiums." Under the Clinton plan, enrolling in one of the health insurance offerings is mandatory for all citizens.
Clinton would require employers to help finance the system, with large employers required to provide health insurance or contribute to the cost of coverage and small employers receiving tax credits to continue or start health insurance plans. Medicaid and SCHIP would be "fixed" to ensure that low-income, uninsured are covered.
Working families would receive refundable tax credits to help pay for health insurance, and the tax credits would be designed so that premiums would not exceed a fixed percentage of income. Tax credits would be paid for by eliminating the Bush tax cuts for the wealthy. Clinton's plan would also provide tax credits for retiree health benefit plans.
Clinton proposes to improve the quality of health care and control costs through preventive medicine, better use of information technology, eliminating overpayments, funding for independent research into the effectiveness of treatments, and allowing Medicare to negotiate prescription drug prices,
John Edwards:
Edwards' proposal focuses on employer-provided health insurance, saying "Businesses have a responsibility to support their employees’ health." The Edwards and Clinton plans are similar, except that Edwards does not offer buy-in to the Federal Employee Health Benefit Program. There would be regional "Health Care Markets" purchasing pools offering a menu of competing plans, with at least one public plan modeled after Medicare. Edwards would make health insurance mandatory once all these offerings are in place.
Edwards' plan also focuses on improving the quality of healthcare, with emphasis on "evidence based medicine", best practices, information technology, public-private research partnerships, and reducing medical errors.
Edwards also proposes to reward higher quality health care by paying higher rates to plans and providers that deliver the best health care, and to penalize plans that "fail to meet critical, easily quantifiable goals."
Edwards would create a "Consumer Reports" for health care to "help Americans evaluate hospitals’ effectiveness in treating injuries and diseases." Edwards would also fund programs to eliminate health disparities among low-income and minority populations.
Barack Obama:
Obama's plan is similar to Clinton's and Edwards' except it would only be mandatory for children to enroll. It would establish a public program similar to the Federal Employee Health Benefit Program for those without access to insurance through their employer or a public assistance program such as Medicaid. There would be subsidies for low-income families and individuals who do not qualify for Medicaid or SCHIP. Medicaid and SCHIP eligibility would be expanded. There are also several proposals for overall improvement in public health.
A "National Health Insurance Exchange" would allow anyone to "enroll in the new public plan or purchase an approved private plan, and income-based sliding scale subsidies will be provided for people and families who need it."
Employers who do not provide health insurance would be required to contribute a percentage of payroll to help fund the national plan.
Obama would improve quality and lower costs by requiring data collection and reporting for providers who participate in the public plan, promoting patient safety, promoting best practices, providing incentives for higher quality health care, supporting disease management programs, coordinating and integrating care, promoting better use of information technology, and requiring full transparency regarding costs. Obama would also offset employer health care plans for costs related to catastrophic illness or injury as long as employers use the money to maintain lower premiums.
Obama would also increase competition through the National Health Insurance Exchange, and would "force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration" in markets that are not competitive. Obama would also allow drug reimportation, increase the use of generics, and allow Medicare to negotiate prescription drug prices.
Obama's plan also mentions "medical malpractice reform." He proposes to "strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance" and to "promote new models for addressing physician errors that improve patient safety, strengthen the doctor-patient relationship, and reduce the need for malpractice suits."
Conclusion
Clinton, Edwards, and Obama all propose essentially the same thing. They all focus on employer-provided insurance as the primary source of health care, they all expand or at least "fix" (in Clinton's case) Medicaid and SCHIP, they all propose a new national health care plan with access to portable, private plans for anyone, and they all propose a variety of measures to improve quality of health care and control costs.
The Dodd and Richardson proposals are similar. Richardson would also lower the eligibility age for Medicare to 55. Biden would also expand Medicare to cover those 55 and over, expand SCHIP, allow buy in to the Federal Employee Health Benefit Program, and also establish a "reinsurance" program to cover catastrophic costs if insurers agree to not exclude anyone from coverage.
You can review the other Democratic candidate's positions on health care here:
• Dennis Kucinich
• Chris Dodd
• Bill Richardson
• Joe Biden
Labels: Election 2008, health care
2 Comments:
They are all "politicians". Health care is a commodity, just like a car or a house. The poor and middle class do not INSIST on driving a Roll Royce or living in a big mansion, but they (as well as the rich who can really afford it) insist on Roll-Royce-level health care. Understandable? Yes. Uffordable? No. As long as health care is privately delivered by those with profit driven motives (e.g., doctors, hospitals, insurance companies, labs, etc) THERE IS NO NATIONALLY AFFORDABLE SOLUTION THAT DOES NOT INCLUDE SIGNIFICANT RATIONING OF CARE.
"Gravel also has a plan that involves "vouchers" paid for with a "national sales tax" that would cover everyone, but it is short on details.."
I'm happy to supply you with more information on Mike Gravel's FairTax proposal:
Economist Dale Jorgensen, Harvard University, was commissioned to find out what portion of current prices were represented by costs for complying with the federal income tax code (i.e., embedded tax costs). He concluded that 22% (average) of every retail dollar, spent by consumers, constituted a price-embedded tax. Thus, in addition to individual income tax and FICA withholding, individuals are unwittingly paying these unseen, embedded business tax costs with every purchase of a new product, or service.
Under FairTax, prices would fall, due to removal of embedded business tax-related costs. Concurrently, wages may rise due to a mix of factors, including reversion of withheld pay (or some portion thereof) to employees, advancement opportunities due to business expansion resulting from retained earnings, and/or increased demand for labor accompanying increased competition (from that expansion). Where profits (or wages) appear lucrative, competition will move into the market space, driving out excesses (immediately present after FairTax is enacted), arriving at new "market-adjusted" prices.
For FairTax to constitute 23% of new transaction cost (i.e., "market-adjusted" price plus FairTax), a mark-up of 29.9% (tax exclusive rate) on the new "market-adjusted" price is necessary. (Before balking, consider what we're paying now if income tax rates are converted to tax-exclusive sales tax rates on net income instead of percentage of gross income. The following figures can be compared to the 29.9% FairTax mark-up: Fifteen pct bracket = 17.6%, twenty-five pct bracket = 33.3%, twenty-eight pct bracket = 38.9% (! really), and thirty-five pct bracket = 53.8% (! that's how bad it is).
In order to make FairTax a progressive consumption tax (such as that recently called for by Warren Buffett), all citizen-families are simply sent a monthly consumption [tax] allowance, called a "prebate." This prebate is intended to reimburse taxes on necessities for every citizen family without need for record-keeping or reporting. Moreover, the direct payment bypasses the creation of a tax code specifying exempted products and services around which a lobbyist industry could grow. The amount is variable, based on family size, and is equal to the FairTax rate on poverty-level spending, as defined by the Dept. of Commerce. At present, a family of one would receive ~$200/month, a family of four, ~$500/month. Thus, the "effective" FairTax rate paid by citizens, will *never* equal the full 23%. Of course, U.S. visitors (legal, and illegal) will pay the full FairTax when they purchase anything new, at retail (used are not taxed again). Under FairTax, working families will have their whole paychecks (minus any state or local income tax withholding) plus their monthly family prebate.
Additionally, citizens will no longer have to spend the average 50 hours per year preparing their federal tax returns. Having more monthly income may result in using credit less, and saving more. Larger savings will make it easier to purchase a home, at a lower interest rate and monthly payment. (Thus, mortgage deductions are no longer applicable when income is not the basis for taxation).
But is FairTax actually "fairer"? To provide substantive answers, Prof.'s Kotlikoff and Rapson (10/06) have concluded,
"...the FairTax imposes much lower average taxes on working-age households than does the current system. The FairTax broadens the tax base from what is now primarily a system of labor income taxation to a system that taxes, albeit indirectly, both labor income and existing wealth. By including existing wealth in the effective tax base, much of which is owned by rich and middle-class elderly households, the FairTax is able to tax labor income at a lower effective rate and, thereby, lower the average lifetime tax rates facing working-age Americans.
"Consider, as an example, a single household age 30 earning $50,000. The household’s average tax rate under the current system is 21.1 percent. It’s 13.5 percent under the FairTax. Since the FairTax would preserve the purchasing power of Social Security benefits and also provide a tax rebate, older low-income workers who will live primarily or exclusively on Social Security would be better off. As an example, the average remaining lifetime tax rate for an age 60 married couple with $20,000 of earnings falls from its current value of 7.2 percent to -11.0 percent under the FairTax. As another example, compare the current 24.0 percent remaining lifetime average tax rate of a married age 45 couple with $100,000 in earnings to the 14.7 percent rate that arises under the FairTax."
Further, per Jokischa and Kotlikoff (2005) ...
"...once one moves to generations postdating the baby boomers there are positive welfare gains for all income groups in each cohort. Under a 23 percent FairTax policy, the poorest members of the generation born in 1990 enjoy a 13.5 percent welfare gain. Their middle-class and rich contemporaries experience 5 and 2 percent welfare gains, respectively. The welfare gains are largest for future generations. Take the cohort born in 2030. The poorest members of this cohort enjoy a huge 26 percent improvement in their well-being. For middle class members of this birth group, there's a 12 percent welfare gain. And for the richest members of the group, the gain is 5 percent."
The current income-based tax system is also more expensive to run, because of the manner in which the tax code is gamed by politicians and lobbyists. Politicians realize great power, and attract constituencies for support, by granting tax favors (i.e., credits, deductions, exemptions) through lobbyists. Fully, fifty-three percent of Washington lobbyists are there because of the tax code! The tax code is continually changing, making it more complex - more difficult to understand. And, the salaries and costs of tax lawyers and lobbyists end up in higher prices of the products and services we buy. Additionally, the time and money required to keep records, file returns, report for audits, retain accounting and legal help, pay IRS penalties and interest, is time and money lost for other productive, or recreational, activities. Depriving us of the use of withheld wages increases our expenses through zero-interest withholding, inflation, return preparation time, and interest paid on credit cards and loans that otherwise may not have been necessary. Summed up, the cost of tax compliance, nationally, has been estimated to range anywhere from $265 billion to twice that amount, depending on the extent to which tax-avoidance consultation is sought and utilized. These expenses constitute a substantial hidden tax which is incomprehensible to the average working American. And the FairTax gets rid of all of it for most Americans, and most of it for business owners.
We, as FairTax advocates, believe that government should serve We, the People, with a fair tax system that will not enable politicians to pit poor against rich (creating barriers to achieve wealth, adding tax penalty to the sacrifices made for personal success). Nor do we want politicians to continue using business as a tool to hide taxes from consumers, often villifying business, which discourages entrepreneuship, personal achievement, economic growth. Liberty and happiness depends on restoring the fruits of labor to those who produce them. We believe that the tax function should align with economic growth, not against it, that government should be paid for in the same manner as working Americans - when, and because, something is sold!
As things stand at present, the system primarily benefits politicans who cater to special interests through lobbyists who game the tax code. The politician seeks to capture them as constituent voting blocks, dependent on continued syphoning of taxpayer dollars to their members' benefit. This is increasingly repugnant to the average working American who often finds it difficult to meet the needs of his, or her, own family in an environment where federal and state business income taxes substantially contribute to trade inequities resulting in the loss of American jobs! Thus, the Sovereign are continually degraded by features of Congress's income tax policy. The most rapidly-growing needs-based "special interest" group has become the Citizens! You see? Congress has nearly all the power; and We, the People, have become We, the Serfs, robbed and enslaved. Getting the federal government's hands out of our family paychecks is the single most important reason to replace the income tax with a consumption tax, the FairTax.
Many of us have joined FairTax.org in order to build a national movement to free ourselves, our family pocketbooks, and our businesses from confiscation of income, and punishment of productivity. And this we say to our federal representatives,
"Either scrap the code and enact the FairTax, or we intend on replacing you with someone who will."
(May reproduce in whole or part. - Ian)
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