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May 30, 2007

HillaryCare

Rather embarrassingly, I haven't had time to sit down with Jon Cohn's new article revisiting and defending HillaryCare. But that's no excuse for you to be similarly tardy on your reading.

While on the subject of Hillary, she's released her plans for cost control (though not, as of yet, her plans for coverage or quality). I've sort of been waiting for the whole proposal before diving into it, but those who want to go piece-by-piece should certainly do so. My snap reaction is that Hillary knows a helluva lot more about health care than any of the other candidates, and her initial focus on cost control is actually quite smart. If given a choice between passing mediocre health reform and strong cost control measures, I'd go with the latter, saving universality for another day and not discrediting the goal by wrapping it in a plan that's likely to fall apart. I haven't spent enough time looking into her proposal to decide whether it's strong enough on controlling costs, but it's an interesting approach, and a strain of incrementalism I could actually imagine getting behind. More later, as they say.

May 30, 2007 | Permalink

Comments

In regard to stand-alone cost control vs. cost control integrated with reform:

Politically this stand-alone cost control doesn't seem to me to be good strategy. Any substantial reform of health insurance is going to cost money to cover those not covered who can't afford to pay the premiums - if universality is a desired goal.

So, to make those structural reforms palatable in an era of huge annual budget deficits and out of control long-term national debt, the reform plan will need to find ways to pay for it - cost controls being a major component.

If the cost controls have already been enacted and absorbed into the picture, then the structural reforms will likely never happen because they are un-affordable because they are without offsets.

Some problems can only be attacked wholeistically, since one part depends on other parts. I assert that significant health care insurance/financing is very probably one of these problems.

Posted by: JimPortlandOR | May 30, 2007 12:36:14 PM

It's that "forgotten middle class" thing.

The cost control business is about broadening the constituency for your health care plan. If you sell your plan as "health care for the uninsured", you are only getting the votes of liberals who think it's important (who will vote for you anyway) and people without insurance. If you sell your plan as starting with cost control, you can tap into people unhappy with their existing insurance as well as employers.

Of course, this makes for less compelling oratory, and sort of looks like a Penn-esque micro-initiative, but it obviously would have a big impact. You could use the savings to fund insurance for other stuff.

Posted by: Nicholas Beaudrot | May 30, 2007 1:07:23 PM

When I hear "cost control" I think "less service". That's a really big turnoff.

Posted by: fiat lux | May 30, 2007 1:19:49 PM

Now having read Jon Cohn's piece on HillaryCare, and being old enough to recall that era pretty vividly (lol), I mostly agree with the thrust of his article: the plan was mostly direct on point.

He leaves out some key points:

Once past the early days when all were praising her, and the Harry and Louise ads were pounding TV views day after day, the Repub. pushback began.

First, note that the Harry/Louise ads were never countered. The White House had forgotten politics. There was no grand coalition in support of reform generally and Hillary's plan specifically - with big money to spend on selling the plan and countering the attacks that surely should have been anticipated.

Second, the Dems in Congress were never involved deeply and therefore not committed to success.

Third, once the blood was in the water, the Repub. leadership jumped the shark and decided to make this a major political issue, first by offering Bob Dole's 'plan' (which he himself voted against in the end), but more importantly, they made the Repub. position that no plan should be approved. None of this was countered by the Dems.

The Hillary plan was an orphan baby pet laying in the street all dirty and smelly, ready for any and all to kick it into the gutter. And they did. Bill Clinton hauled down the banner and left the field and Gingrichism prevailed.

The Dems then, and maybe now, were cowardly lions. They wanted to compromise so badly they came up with a plan that started with middle-right ideas and no political support from the left (that wasn't mobilized) and then they found out that the acceptable compromise with the Repubs was no plan at all.

Bill and Hillary got their butts kicked because they tried to be above politics in the most political city in the world, dominated by special interests, and with no organized and spendy support.

Jon has one thing very right: Hillary will never come up with a plan that is to the left of the Chamber of Commerce or the Natl. Assoc. of Manufacturers, or Pharma. Her plan will maybe have some neosporin for the gaping wounds of US healthcare, but not even a bandage or more. She lost a big one, and her soul is destroyed for any future battle.

Posted by: JimPortlandOR | May 30, 2007 1:47:07 PM

Whaaaa?

If given a choice between passing mediocre health reform and strong cost control measures, I'd go with the latter, saving universality for another day and not discrediting the goal by wrapping it in a plan that's likely to fall apart.

Just a few minutes ago I got through reading your article on Obama's plan, which you described as not bold enough with universality and its lack of a mandate, not strong enough public option, etc.

But you'll dump universality for Hillary's efforts at "cost-containment". Wow. If that's not a double standard, then I don't know what is. By your standards Obama has to be the "super-incredible" politician on healthcare to be credible, but Hillary can be boring and safe. And people wonder why we end up with the politicians we do.

Posted by: rashomon | May 30, 2007 3:38:13 PM

cost-containment... sounds familiar... ahhh, I remember. control costs by controlling recoups by patients wronged. stop those greedy trial lawyers from getting a big payday.

Problem was, malpractice issues were only 2 cents of the health care dollar. Michael Moore, in the Time article in the issue with Al Gore on the cover, Moore talks about administrative costs for health care: 3+ per cent in the medicare system, 1+ per cent in Canada, and more than 20 per cent in private health care. It takes a large staff to review and deny all those claims to maintain that profit margin.

Yet lawyers, greedy patients (or in Hillary's time, physicians, who were specifically excluded from discussing changes she recommended in the early 1990s), or someone other than the Insurance Industry gets vilified as the source for out of control prices.

Here in Minnesota, former Texan Bill McGuire finally stepped down after earning 1.6 billion dollars from his own United Healthcare, doing it by cutting benefits for his insured and also his employees. All to give himself a much, much bigger piece of the pie.

As a primary care doc, I don't make all that much money -- less, actually than the higher paid certified nurse anesthetists (CRNAs). I'd certainly like to be compensated reasonably for giving up the whole of my 20s to get trained and sleep deprived, etc. But I don't need a 12 bedroom or even 6 bedroom home for a small family. I don't think anybody can do anything to deserve the kind of money CEOs and CFOs and COOs can manipulate out of their companies. But as long as there is a major profit margin and unequal power, there's hardly anyone who will set things up that don't ultimately maintain the status quo for the power holders.

Posted by: vome MN | May 30, 2007 4:54:59 PM

Re health care in America, My neighbor's son and family emigrated to Sweden 15 years ago, because he couldn't get insurance here, for a reason I don't know. Do we need "National Health Insurance"? Comment?

Posted by: Frank Riklan | May 30, 2007 5:38:14 PM

Clinton has already promised universal coverage as part of her package. The cost containment is only part of her plan. (Who knows if it will really be universal coverage, like Edwards', or just universal access to coverage, like Obama's.)

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Posted by: judy | Oct 6, 2007 12:03:41 AM

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