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May 29, 2007

The Obama Health Care Plan Cont'd

Been working the phones and have a bit more detail. Here's where we are:

Mandates: I want to be very clear on this point. Obama's plan is not a universal plan. After it is implemented, it will not have 100 percent of the population covered. It will increase coverage by forcing some employers to begin offering insurance, but it is not particularly heavy-handed even there. This is a plan that makes universality possible -- that is budgeted for 100 percent coverage -- but does not use a government or individual mandate to force global buy-in.

The thinking goes like this: You need to get the system set up for universality before you actually demand it -- lest you find coverage remains too expensive, or too inaccessible, for some. So the hope is that by reforming the system, you'll be able to create universality softly, by just making coverage accessible and cheap. If not, the Obama campaign swears up and down that they're committed to 100 percent coverage, and if that means a second round of coverage-increasing policies in a few years, so be it. I don't particularly understand the thinking here, but the end result is this: The Obama plan will not bring us to 100 percent coverage in the short-term. It just won't. But it will take us much further along the road, ensure full coverage for all children, and create a system in which mandates could be more easily added later on.

The Public Option: Unlike in the Hacker or Edwards plans, the public option is not a general purpose insurer. Major companies cannot choose between insuring their employees on the private market and buying into the national program. Rather it is an insurer of specific groups, in the way Medicaid covers many of the poor, or SCHIP is targeted at children. In this case, it's looking at small businesses, the self-employed, the unemployed, and those employed by companies who don't offer insurance.

Employer Responsibilities. When large employers don't offer insurance, they'll have to pay into the national plan. But that's a penalty payment, not an alternate method of ensuring employees. Their workers will have to purchase their own insurance.

Insurance Markets. I'm still searching for an answer on whether the insurers will have to participate in the regulatory structure (the national health insurance exchange). In my opinion, this is key, as an optional program will just invite its own destruction as insurers work to undercut it from the outside, just as they did with the original Blue Cross, or the Washington state reforms in the 90s. Will let you know when I achieve clarity. Any other questions folks have?

(Cross-posted to Tapped)

May 29, 2007 | Permalink


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