Ezra Klein: Thursday Think Tank Round-Up

May 24, 2007

Thursday Think Tank Round-Up

A fresh new edition over at Tapped.

May 24, 2007 | Permalink

Comments

I'm looking forward to seeing your analysis of the new and improved HillaryCare healthcare thingy announced today in a speech and with a paper (pdf) backup. I refer to it as s 'thingy' because it seems she seems to excellently avoided some minor things like 40 million uninsured, and any significant restructuring of health insurance. I can't quite call it a plan, unless the word plan covers only mostly cosmetic, around the edges, proposals.

If this is the preview of her Presidential campaign ahead, she might be out-progressived from the Republican candidate.

Posted by: JimPortlandOR | May 24, 2007 5:37:03 PM

it seems she seems to excellently avoided some minor things like 40 million uninsured

If you mean she didn't address the uninsured, her proposal mentions that problem on page 1, and the very first sentence of the proposal is:

Today, Senator Clinton laid out a major plank in her framework for providing affordable, quality health coverage for all Americans: her 7-step strategy for lowering spiraling costs.

"Coverage for all Americans." This, however, is her plan for lowering costs, not for universal coverage, though the plan does note the connection. Did you actually read any of it, or just intuit that it must not be progressive? It looks to have some good ideas to me, though I'm no expert.

Posted by: Sanpete | May 24, 2007 6:40:50 PM

Sanpete: You got it right (and I did read it): she's for lowering costs, not fixing the health insurance 'system' - which is clearly fairly broken.

Bill Clinton was famous for very modest programs that he proposed - it was called triangulation. Not too hot, not too cold, just riiiiight. DLC-progressivism. Don't offend anybody.

Posted by: JimPortlandOR | May 24, 2007 7:51:11 PM

she's for lowering costs, not fixing the health insurance 'system'

She in fact gives some proposals to do that, but this is her plan to lower health care costs, not fix the insurance system. The more natural place to deal with that will be in her universal coverage plan. I see no substance to your charge (though I see how it connects with an overwhelming groupthink about Clinton among the netroots). If you can explain what progressive proposals should be in her plan to lower health care costs rather than in her universal coverage plan, which are in some other candidate's plan, that might at least be a start at showing something about how progressive or not the plan is. It seems promising to me.

Posted by: Sanpete | May 24, 2007 8:51:18 PM

Sanpete,

To your address your question, on her ideas for lowering health care costs versus others (an important note, no other candidate has come out with a plan on lowering health care costs specifically as she has, so your comment is technically true whether her positions are deemed progressive or not).

1. Administrative costs: her proposal focuses on reducing insurance companies' abilities to manipulate underwriting and patient cherrypicking, which adds admin costs. Others, such as Edwards, are advocating for a single payer alternative altogether, claiming lower administrative costs.

2. Risk sharing: Her plan calls for sharing risk "extensively" but pointedly does not go as far as "community rating" as others advocate.

3. Drug importation: HRC dedicates little space to this, and is vague on specifics. Given how much detail is given in other areas, this was clearly an intentional omission. Others clearly believe that drug importation should be done on a large scale.

4. Health IT: HRC promotes its use, many progressives are for a nationalized, VA-style system.

5. Malpractice reform: HRC made this one of her seven pillars, many progressives believe this is a red herring.

If you've read my prior posts, you'd know that I'm personally not in support of many of the "progressive" positions I noted above. But on the factual merits, HRC's positions on lowering health care costs are clearly to the right of the so-called progressive position.

Posted by: wisewon | May 24, 2007 10:25:56 PM

Wisewon, the way I read her proposal it implies community rating:

A “guarantee issue” system will build on the concept of shared responsibility by allowing anyone to join a plan. It would not relegate high-cost people to separate plans or public programs. In addition, insurance companies would not be allowed to carve out benefits or charge higher rates to people with health problems or at risk of them.

She doesn't promise a single-payer option, but we don't know yet what her universal coverage plan will be.

She supports and has voted for reimportation of prescription drugs.

Besides the fact that the VA-type system would be a government program, is there something more progressive about it than the HIT system?

Her malpractice reform amounts to support for out-of-court settlements, with no caps, limits on suits or anything like that mentioned. Some progressives consider malpractice reform a red herring because it's main effects are indirect enough to be dismissed, and because they don't like the idea of caps and restrictions on suits, but in fact it would still be a useful thing.

If Clinton doesn't include the option of single-payer when she presents her universal coverage plan, that will be a significant thing for progressives. As far as what we do know already, though, I don't see much to warrant the conclusion that her proposal is less progressive. And her plan includes progressive points not yet included by others, such as the best practices institute, which sounds like a good idea.

Posted by: Sanpete | May 25, 2007 12:51:53 AM

Sanpete,

Besides your point on community rating (FYI-- your excerpt is NOT community rating, but something short of it, which was my point. Community rating is shared risk regardless of who the purchaser is), everything else you wrote did not refute differences I pointed out between HRC and a traditionalist progressive position on health care.

Put your preferences aside, you made a factual statement that HRC's position was no different than a progressive position-- (i.e. "Besides the fact that the VA-type system would be a government program..." hello? that IS the difference!) you personally may not think these are important differences, others do. I'm just pointing out what they are.

Posted by: wisewon | May 25, 2007 6:37:06 AM

Community rating is shared risk regardless of who the purchaser is

And how does that differ from what her plan implies? I can't tell what difference you see here. For the rest, as I pointed out, there's not much to refute in what you say, because it's just speculation. As I keep pointing out, this isn't her universal care plan, so we shouldn't expect any position on single-payer in it. We'll see about that later. The drug reimportation will undoubtedly be part of the plan, as she's on record supporting it, has voted for it, and she says it's in the plan. Really, there's nothing solid in what you've said that I can see.

That a program is government program doesn't make it progressive, and that it isn't doesn't make it not progressive.

Posted by: Sanpete | May 25, 2007 12:48:16 PM

Sanpete,

Your point that we don't know her position on single payer until her reveal of her universal health care plan is 100% wrong. You, like others, are confusing the universal health care issue with the single payer issue. Single-payer is proposed as a potential solution to lowering administrative costs that is offered by progressives. The rationale for single payer is based on unnecessary cost/waste in the current system (e.g. Medicare/Medicaid administrative costs vs. private insurers). It should have been included in this plan to lower administrative costs if there was one.

Posted by: Wisewon | May 25, 2007 2:33:31 PM

On community rating, its possible her plan is the same as community rating, but as currently written it doesn't say the same thing. Her focus on the risk question was reasonable access for small business. The plan is clear that you can't change risk levels between individuals, but the same isn't said for groups i.e. large employers that contract directly with insurance companies, vs. small business employers that join an insurance pool. The insurance pools could have higher levels of risk compared to the rates given to large employers, which would not be the same as "community" rating.

Posted by: Wisewon | May 25, 2007 2:43:46 PM

You, like others, are confusing the universal health care issue with the single payer issue.

Not in the least. You're right that single-payer is proposed as a way to cut the administrative costs of an often redundant array of providers, plans and so on, but no major candidate is proposing instituting a single-payer program that will eliminate the profusion of providers and plans and so on, at least not directly, and I'm sure Hillary won't either. Edwards is proposing an option to join a single-payer program such as Medicare. We don't know yet what Hillary will propose about that option, but we'll know when her universal coverage ideas are announced.

As you know, community rating doesn't have to have a pool the size of everyone. It can be done on a company, union, local, state, regional or national level. Seems her 1993 plan was organized regionally, if I recall.

Posted by: Sanpete | May 25, 2007 3:43:55 PM

Providers have nothing to do with single-payer issue. It has little to do with redudancy as well. The proposal is about the getting rid of overhead due to profits, cherrypicking patients/underwriting, haggling actions with patients/providers to maximize float, etc.

Again, as I've said before, if HRC was going to proposed a single-payer plan, it would have made sense to put it here. So we do know that she isn't proposing it, because if she was, it would be touted as part of her plan to lower costs.

Posted by: wisewon | May 25, 2007 4:06:05 PM

Community rating, as has been used by progressives in 2000's, refers to geographic splits. HRC's plan alludes to having tolerance for more than that, i.e. large/small employer splits.

Posted by: wisewon | May 25, 2007 4:23:37 PM

Providers have nothing to do with single-payer issue.

Whoops--meant insurance providers--sorry.

Again, as I've said before, if HRC was going to proposed a single-payer plan, it would have made sense to put it here.

And again, as I've said, it makes just as much sense to keep it for her universal coverage plan. And this isn't only a matter of what logically fits, but also what's politically advantageous. No doubt she wants to hold some important ideas for later so she can stay in the news about this, thus the multi-part announcement. The option to join a single-payer plan is a major point that will suck up much of the attention from whatever else comes out with it.

So we do know that she isn't proposing it, because if she was, it would be touted as part of her plan to lower costs.

"We" means you. I'll wait and see.

HRC's plan alludes to having tolerance for more than that, i.e. large/small employer splits.

I don't know what you're referring to.

Posted by: Sanpete | May 25, 2007 6:51:41 PM

I love how the rationalization continues to evolve in order to maintain the story. (no difference --> not a solid difference --> differences due to political strategy, not real differences)

Anyways, let's simplify the story for you:

3 key differences:

1. No single-payer (I know you said let's wait, but when its not there, its not because I guessed right-- you simply don't appreciate the appropriateness of that being in this plan versus the universal one)

2. No nationalized health care (a la VA system)

3. Medical malpractice as a key cost driver (one of HRC's seven pillars) versus red herring.

You may not think these are big differences, but for those that really follow this closely, these are HUGE differences between her approach and a progressive one.

Posted by: wisewon | May 25, 2007 8:13:57 PM

Wisewon, the evolution you see is in your imagination. You won't find it in what I've said. I've already responded to your other points, which I don't accept as you give them, nor draw the same conclusions from.

Posted by: Sanpete | May 26, 2007 12:05:02 AM

Here are you two quotes that are the key takeaways:

"It looks to have some good ideas to me, though I'm no expert."

That is clear. I'm happy to have you not draw the same conclusions as me.

"Besides the fact that the VA-type system would be a government program, is there something more progressive about it than the HIT system?"

Nothing here needs to even be said.

The thread stands as is, and I think its very clear that your preconceived biases are getting in the way, along with your relative lack of knowledge of health care. I've got no horse in this race, as I don't currently like any of the candidates. I'm just speaking the facts.

Posted by: wisewon | May 26, 2007 7:54:31 AM

Your last post is something that I would expect to read from a Bush supporter. Ignore reality and say things like "don't draw the same conclusions."

Wow.

The facts are clear-- your original statement (HRC not different that progressives) is wrong.

FYI-- Don't bother writing back because I won't be reading-- was curious to engage you once, but this was clearly a waste of my time.

Posted by: wisewon | May 26, 2007 7:58:40 AM

Again, wisewon, I've already responded to your substantive points, such as they are. The ad hominems aren't relevant.

Posted by: Sanpete | May 26, 2007 1:46:10 PM

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