Crash Course in the Candidates’ Health Insurance Plans
In BlogHer’s Voter Manifesto, we asked, “How do you intend to make sure that everyone gets health insurance?” Here I try to explain how. You can also view a table here.
The other day my mother went to the emergency room to have her sore throat looked at. I exploded. A middle class Jewish woman in Miami can certainly find a GP! But she hadn’t yet, and so she went to the emergency room to get antibiotics. Now, my mom has health insurance; I guess she had her own reasons for going to the ER. But in my mind, this episode is an example of why our rules on insurance in this country need to be very, very clear. There are millions of middle class Americans who cannot afford health insurance, or to whom it does not feel urgent enough. There is always the emergency room. And yet this system is bankrupting us, because the cost structure of ER care is inflated by insurance companies and by a wasteful system. So even if you don’t have insurance, when you go to the ER, you’re availing of services whose prices are inflated by the health insurance companies.
There’s no free lunch. To make sure the cost of lunch is spread out and more equitable, Hillary Clinton supports a health care policy that enforces a requirement that everyone have health insurance, or mandates. Obama’s plan supports mandates for children only, but he proposes lowering the cost of health insurance and, like Hillary, proposes a new health care plan similar to that of Congresspeople’s, with lower premiums, in which no one is turned away for pre-existing conditions. John McCain wants to lower the cost of care, so that more Americans can buy insurance. Three very different approaches.
Both Clinton and Obama follow a model like this:
If you have private insurance and you want to keep it, you can. You can stay with the doctors you trust and the coverage you choose. Costs will be lowered and quality of care improved through the modernizing of our health care system. Those covered by Medicare, Medicaid, or the Children’s Health Insurance Program, will keep their coverage, and holes in the health care safety net will be mended and reinforced. If you don’t have health insurance or are unhappy with what you have, you’ll gain access to the wide variety of private plans in the Federal Employees Health Benefit Program, the same plans that members of Congress receive. You’ll also have the choice of a public plan that will provide a stable, competitive alternative to private insurance.
But Hillary’s plan includes mandates. So why did Barack Obama use mandates as an attack against Hillary, saying “In order for you to force people to get health insurance, you’ve got to have a very stiff penalty, and in order to do that, you’ve got to go after their wages?” He’s wrong here. Mandates are all about meeting deadlines. If you do not sign up for health insurance by a deadline, you may have to pay back monthly premium costs. In Massachusetts, for example, where mandates came into play this year, the state only charged $219 to those who did not sign up for health insurance by the deadline. Hardly a big stick, and only half the state’s uninsured signed up by the first deadline. Hopefully Clinton will learn from this lesson.
This weekend, Hillary Clinton retorted, “Shame on you, Barack Obama” in Ohio for his “Harry and Louise” esque attacks on her plan. Because Hillary’s point is that “the only way to make the marketplace fair and efficient, is to require that everyone have insurance.” Subsidies, government intervention, corporate compliance, and group efficiencies will ensure people find the level of health insurance they need and can afford, she says. Indeed, because health insurance companies now only make money by being able to pick and choose who they cover, charging huge premiums to employers and the self-employed, and by minimizing benefits, the argument is that when they have to cover everyone, companies’ priorities must reset. My view is that insurance companies continually lose money, the state will have to step in and we will eventually move to a single payer system.
Clinton’s program is most closely linked to the current Massachusetts model; it aims to be universal healthcare but it is NOT single payer healthcare. It is not the same as Clinton’s 1993 “Hillarycare” experiment. Clinton says Obama’s will leave out at least 15 million people; Massachusetts’ experience would hint this is true. Clinton’s position that if you don’t force people to sign up, many won’t, and the insurance system will remain unbalanced. Obama says people can enter a purchasing pool with subsidies, and if you make insurance affordable enough, people will sign up. He also stresses that Americans will want to sign on to his proposed insurance plan, or if they prefer to keep their private insurance, his plan will regulate the private insurers.
For John McCain, personal freedom and health insurance are linked. He will ensure Americans have health insurance by…wait, he won’t ensure Americans have health insurance. He says that’s too expensive and will increase government’s size and raise taxes. I actually like McCain’s take on health care, which focuses on lowering costs and lessening the national bill for common ailments like diabetes. He contends that rather than providing everyone access to a broken system, we need to fix the system so that everyone can access it.
Here’s a great quote:
Has any candidate warned that we have a personal responsibility to take better care of ourselves and our children? Yet that is the only way to prevent many chronic diseases. Has any candidate insisted that genuine and effective health care reform requires accountability from everyone: drug companies, insurance companies, doctors, hospitals, the government and patients? Yet that is the truth upon which any so-called solution must be based.
More: “We should pay a single bill for high-quality health care, not an endless series of bills for presurgical tests and visits, hospitalization and surgery, and follow-up tests, drugs and office visits,” McCain also wants to extend tax credits for the self-employed who buy coverage by giving a tax credit of $2500 per individual, $5000 per family for purchase of health insurance.”
Bad news, from Joe Paduda: “he’s a fan of HSAs, repeating the tired cliches about the ability of families to decide which providers and procedures are best. “American families know quality when they see it, so their dollars should be in their hands. When families are informed about medical choices, they are more capable of making their own decisions.” I’m not sure which American families McCain is referring to; this looks to be a paean to make us feel smart. (in direct
More bad news- McCain won’t force insurers to change their behavior. He won’t ensure they extend coverage. Before New Hampshire McCain said, “We should give additional help to those who face particularly expensive care. If it is done right and the additional money is there, insurance companies will compete for these patients – not turn them away…The federal government can help fund this effort … (and) develop methods to augment Medicaid and tax credits for more expensive care.”
On Saturday, Maria Niles wrote a fantastic summary of the terminology surrounding American health care. Below, I present bullets, straight from the Brookings Institution of the health insurance plans of the main candidates for president.
| Hillary Clinton | Barack Obama | John McCain |
| Clinton Mandates and Penalities: “Requires individuals to have health-care coverage (i.e., an “individual mandate”). Specific penalties imposed on individuals for not buying health insurance are no provision. Employer responsibilities Large employers would be required to provide and subsidize workers’ health care coverage or contribute to the cost of the public insurance pool. Smaller employers would not be required to offer or provide funding for coverage, but would be provided tax credits to encourage them to do so. The plan also caps the federal income tax exclusion of employer contributions for health benefits for households earning over $250,000 annually” |
Obama Mandates and requirements:”Individual responsibilities Requires children to have health-care coverage. Specific penalties imposed on families whose children are not covered are no provision. Employer responsibilities Employers would be required to provide and subsidize workers’ coverage or contribute a percentage of payroll toward the costs of the national plan.” |
McCain Mandates and Penalties:”Individual responsibilities No provision Employer responsibilities No provision” |
Finally, no candidate enforces providing health care for undocumented immigrants. This would require a single payer, non-insurance based universal health care system. I hope we get there some day.
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About Me
Morra Aarons-Mele utilizes social media strategies to help employers, employees and communities connect. She also consults with leading organizations on how women can use the internet for professional and personal development. In her spare time, Morra enjoys blogging about women and politics. Read her full bio >>
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