OurFuture.org Blogs: Roger Hickey

A Dangerous Plan for Health Care

Roger Hickey — Tue, 14 Oct 2008 12:12:51 -0400

The global financial crash of the past few weeks has hammered home what should be common sense: A free market needs reasonable rules that safeguard the public interest. When you unshackle corporations and put the cops who would police them in handcuffs, ultimately everyone loses in the ensuing chaos.

As our Tuesday, October 14 op-ed ad in The New York Times points out, despite their spectacular “free market” economic failure, conservatives are still trying to use that recipe for disaster to reform an already failing health-care system.

Our ad points out that 116 million Americans are either uninsured, underinsured, or financially vulnerable to unexpected medical costs—now the No. 1 cause of family bankruptcies. Those who have insurance are paying higher costs for policies that often have gaping holes in coverage. And insurance companies flat-out refuse to sell coverage to those already sick. And businesses, large and small, are burdened with rising costs.

The unraveling in health care now is so obvious that politicians of every persuasion have to pretend to have solutions. But conservatives have taken their ideas off the shelf of right-wing think tanks. Instead of working to guarantee health care for those without insurance, they want to tax the health benefits of the 160 million people who get insurance on the job—even though they acknowledge this would gradually dismantle the employer-based health care system. Twenty million people would lose coverage pretty quickly, according to the EPI Policy Center and other experts.

These conservatives actually believe that group health insurance, provided by employers, encourages people to use too much medical care, driving up costs. Instead, they want all of us to buy insurance policies directly from private insurance companies. And they believe in this theory so strongly, they would also let those companies sell policies across state lines, effectively wiping out the minimal state regulations which require companies to do things like cover pregnancies and certain tests—or, in the best states, to cover people with pre-existing conditions.

Imagine a health-care system in which businesses decide to opt out of providing policies for their employees. Workers would instead search for policies in an environment in which costs aren’t constrained by the bargaining power of employers and in which insurance companies would do just what banks have done—set up shop in the states that would allow them to operate with the fewest constraints.

For most people, this sounds like more of the same. U.S. health care has never been heavily regulated, compared with other countries. But dismantling the one part of our insurance system that somewhat works, forcing everyone to buy health insurance on their own, hardly seems a step forward for most people.

So what’s the alternative? We believe that quality, affordable health care should be a right. A person’s ability to get health care should not depend on their ability to bargain in the free market, where only the strong survive. As we say in the ad, we need clear rules requiring private insurance companies to cover everyone—even those with pre-existing conditions. And we need the security of knowing we can keep our current health plan, or we can choose a public plan like Medicare, so we’re not at the mercy of the same profit-driven companies that got us into this mess!

The United States spends more for health care, and gets less for its money, than any industrialized nation. Our enormously wasteful and chaotically organized system is a drag on our global competitiveness as well as a drain on our wallets. Still, the millions of dollars the insurance and pharmaceutical industries spend on lobbying and political contributions have only served to prop up a failing system and drown out the voices for change. The silver lining in the economic shock we’ve experienced is that the country may be more ready than ever to contrast the false promise of an unregulated market with a bold, progressive approach that extends health care to every American.

The Institute for America’s Future is a member of Health Care for America Now, the nationwide campaign for health care for all. Our ad invites everyone to join the campaign. We are challenging the misguided power of the insurance and pharmaceutical industries. And we are building a people’s movement to shape a health care system that works for all of us. We invite you to join us.

A Progressive Plan for Health Care

Roger Hickey — Tue, 30 Sep 2008 14:21:30 -0400

Long before anyone had been nominated or elected, the voters of 2008 had gotten one message across loud and clear: Fix our dysfunctional health care system! For obvious reasons (and big reasons that aren't so obvious), the leaders of 2009 must heed that call.

America's health care system is in meltdown. More than 45.7 million of us have no health insurance. But even those with good insurance face rising costs and a growing risk of losing the protection they have. Every year, tens of millions of Americans go uninsured for long periods — when a layoff, a divorce, or illness itself disrupts their ability to get or pay for coverage. (Forty-one percent of working-age Americans making $20,000 to $40,000 per year lacked insurance for at least part of 2007.) Still more millions are seriously under-insured, though many don't realize it since insurance companies tend to be secretive about the conditions and procedures they refuse to cover — until we actually need the care.

Excerpted from New Progressive Voices: Values and Policies for the 21st Century, by the Progressive Ideas Network. Read the full chapter or download the PDF here.

In an economy that's gone bad and getting worse, countless American families — insured and uninsured alike — live in dread of being plunged into poverty or destitution by a major health problem. In fact, more than half of all individual and family bankruptcies are triggered by medical bills.

Health care is a momentous problem in its own right. It's also hugely important as part of the broader breakdown of economic security in our country, and as a symbol of political gridlock and unresponsive government. For all these reasons, it's an issue to be addressed boldly, decisively, and, at the same time, with an extra measure of care.

If we were starting from scratch, "single payer" might be the way to go. With one public insurance plan covering everyone, Americans could potentially realize hundreds of billions of dollars a year in savings on pointless bureaucracy and profits — more than enough to cover the uninsured and improve coverage for tens of millions of under-insured.

But we are not starting from scratch. During World War II, U.S. employers began providing health insurance as a way to attract scarce workers at a time of strict wage-price controls. Tax laws went on to codify our employer-based system, which even now provides health care for 160 million Americans — a majority of those not on Medicare. Their support was the critical missing piece in 1993. That's when the Clinton administration set out confidently down the path of health care reform — only to see its proposal cut to shreds by insurer-sponsored TV spots in which a middle-class couple called "Harry and Louise" warned of a sinister plot to "force us to pick from a few health care plans designed by government bureaucrats."

The good news is that Americans are much more suspicious of the insurance industry now than they were then. Many people have wised up to the way insurers compete by cherry-picking younger, healthier workers and employing armies of agents to deny claims — sometimes even when it means condemning someone to premature death or a lifetime of chronic illness. Of all the world's nations, the United States spends by far the most money on health care per capita and in total. Our health care system is enormously wasteful and chaotically organized — and Americans know it. About two-thirds of all voters are prepared to see taxes increase in order to provide high-quality health insurance for everyone. Even a majority of those who are satisfied with their coverage now grasp the need for major reform.

The sticking point for many, however, is the ability to keep the insurance they have. The answer is to guarantee that option, building it into a plan that also lets people choose from a menu of private insurance alternatives (with regulated benefits and costs) or sign up for a Medicare-like public plan, which can act as a benchmark for its private competitors. That's the concept behind Health Care for America, a proposal put together by the political scientist Jacob Hacker with the support of the Economic Policy Institute.

Health Care for America is simple and flexible enough to appeal to a majority of Americans, but bold enough to do the job of covering everyone and controlling health price inflation. And it holds the promise of becoming better over time, as more and more Americans shift over to the public plan, lured by its higher efficiency and more generous benefits.

Real Health Care Solutions

Roger Hickey — Thu, 15 Nov 2007 19:15:22 -0500

Editor’s Note: “The 2008 election campaign is almost sure to be a health care election — even before we’ve done much organizing at all,” said America’s Future co-director Roger Hickey at a conference sponsored by New Jersey Citizen Action on November 13. “So imagine what will happen once we get going.”

In this keynote speech at the “Conference on Health Care for All: Real Solutions for New Jersey and the Nation” in New Brunswick, N.J., Hickey outlines what he sees as possible.
Progressives — armed with facts and a compelling philosophy about the nation’s obligations to its senior citizens — were able to organize and beat back an effort by the Bush administration and conservatives to privatize Social Security. In the health care debate, progressives have even more ammunition — not just a sound principle, but a specific framework for providing health care to every American.

By using that ammunition smartly, the next president will have a strong mandate for radical moves toward universal health care. Hickey explains how.

♦ ♦ ♦

Thank you, and good afternoon. I want to thank New Jersey Citizen Action - and the New Jersey Statewide Health Care Coalition - for organizing this important conference.

I am honored to be invited because our country is on the brink of another historic debate about health care for all. We seem to have this debate every 20 years, and organizations like yours will make sure that voices of America's working families are not only heard in that debate - you will insist that the people you represent have a big hand in designing the reforms that will get us affordable, quality health care for everyone in America.

I am proud of my long history with New Jersey Citizen Action - and Phyllis Salowe-Kaye and her colleagues. Years ago I spoke at a big USAction meeting - to sound the alarm about conservative plans to privatize Social Security and urged that we work together to stop them. Phyllis Salowe Kaye and New Jersey Citizen Action were already on the case, educating their members and telling the entire New Jersey congressional delegation that they had better sign our pledge to strengthen, not privatize Social Security. And during the 2000 elections, Phyllis and I were proud to stand together with a political newcomer running for the U.S. Senate - named Jon Corzine - as he signed our Social Security pledge. Turned out the kid was a natural. He knows how to talk about ideas and win a few elections.

In 2004, when President Bush declared privatization his number one domestic priority, Jon Corzine was his chief opponent in the senate and New Jersey Citizen Action made sure that Bush couldn't come into the state without negative headlines about his plan to destroy Social Security. Together, working through a coalition called Americans United for Change, we defeated privatization, made Bush a lame duck - and we have since gone on to challenge Bush around a more positive goal - expanding SCHIP - the Children's Health Insurance Program. As you know Bush has stubbornly used his veto on SCHIP - with another one coming before Thanksgiving - forcing his party, as an election approaches, to vote against insuring kids. [Bush seems suicidal - but then Bush doesn't have to run again, just the rest of them.]

Encouraging news

Today you have gathered with us to talk about what we need to do to achieve a system of health care for everyone in our country. I know that most of you share the same vision of social insurance that brought us Social Security in the 1930s and passed Medicare in the 1960s. I know that most of you are at this conference because you want to enlist in a movement to guarantee health care for all. Perhaps your only worry has to do with whether we can pull it off. And that's a real concern. Anyone who has been awake in recent years has seen the power of the special interests to foil or pervert social progress again and again - as they did in 1993 and 1994.

So let me start with some encouraging news: despite the fact that so far we activists have done very little - beyond our campaign to expand SCHIP - the issue of health care has already become the number one domestic issue of the upcoming political campaigns.

Now how did that happen?

Well, the great thing about elections is that they force the politicians to talk with real Americans. Or else their pollsters have to talk to us, and we real Americans have told them that - while struggling to make ends meet and hold families together - we have had to deal with a health care system that is unraveling - in which employers are either dropping coverage or raising the costs of deductibles and co-pays. More and more people are changing jobs and discovering that their new employers' health plan is either more expensive or non-existent.

Or they take up the self-employed or free-lance life in this brave new economy - and they discover they either cannot afford to buy a decent health plan - or that old illness from the past is declared a pre-existing condition, and insurance companies won't cover them. And of course, as Michael Moore's brilliant movie, SiCKO, showed us so well, millions of Americans who think they have health insurance are shocked to find that when they really need health care, their insurance company can deny their claims.

And so the American people have put the issue on the table - and now suddenly the politicians and the pollsters and the media are all talking about reforming health care once again. And the 2008 election campaign is almost sure to be a health care election - even before we've done much organizing at all.

So imagine what will happen once we get going.

People are ready for change, but…

Now I've been working with a group of people to make sure that this time we are successful when we do get in gear with our campaign for health care for all. The group includes Diane Archer (who you will hear from this afternoon), your colleagues at USAction (and Richard Kirsch who runs New York Citizen Action) and friends in the labor movement and other organizations like Moveon.org. We've been doing research to craft a positive plan that makes sense to Americans - and to forge a message that puts our enemies on the defensive.

We've discovered that most Americans - about two-thirds of all voters - support major changes to provide good insurance for everyone, even if that means raising taxes. But we also know that different people experience health care problems in different ways. Over half the voters like their current health insurance plan, and while they may altruistically want to cover everyone, their self-interested concern is about keeping costs from rising - and making sure they personally don't lose their good coverage. [We've looked at polling by the AFL-CIO, Stan Greenberg and his Democracy Corps, SEIU, Hart Research, Celinda Lake and American Environics.]

The good news is that people are ready for big change. But the hard reality, from the point of view of all of us who understand the efficiency and simplicity of a single-payer system, is that our pollsters unanimously tell us that large numbers of Americans are not willing to give up the good private insurance they now have in order to be put into one big health plan run by the government.

Pollster Celinda Lake looked at public backing for a single-payer plan - and then compared it with an approach that offers a choice between highly regulated private insurance and a public plan like Medicare. This alternative, called "guaranteed choice" wins 64 percent support to 22 percent for single-payer. And even the hard core progressive part of the population, which Celinda calls the "health justice" constituency, favors "guaranteed choice" over single-payer.

Now I tell you this as someone who understands the wastefulness and downright immorality of our private sector health insurance system. I know that if we let private insurance companies offer policies as part of an expanded system of health care for all, we are going to have to regulate them so much that we force them to change their business model - insuring everyone who applies for coverage and not cherry-picking to insure just the young and the healthy - and preventing them from denying coverage to those with pre-existing conditions. And I know full-well that even in the best of circumstances these companies will never be able to match the low overhead and cost controls that a public system like Medicare has historically achieved.

Health Care for America

The model for the simple "guaranteed choice" plan that we've been testing with the pollsters is the "Health Care for America" plan written by political scientist Jacob Hacker at Yale. For more than a year, Richard and Diane and I have been working with Hacker to refine his ideas - and to use them to engage the Presidential candidates.

Hacker's "Health Care for America" would guarantee health care for everyone. He would require employers to provide health insurance for their workers (with a good benefit package) or pay into a public fund to cover their employees. Individuals and families would be able to choose between several private insurance plans - all with a regulated set of benefits and costs -- or a public plan, similar to Medicare, that would compete with the private insurance companies. An analysis of the Hacker plan by the Lewin Group found that at least half the population would eventually choose the public plan, due to its better efficiency and better benefits.

Starting in January, we began to take Jacob Hacker to see the presidential candidates. We started with John Edwards and his advisers -- who quickly understood the value of Hacker's public plan, and when he announced his health proposal on Meet The Press, he was very clear that his public plan could become the dominant part of his new health care program, if enough people choose it.

Edwards got a lot of credit for being the first top-tier candidate with a comprehensive proposal. But, in a virtuous competition, Barak Obama soon matched him with a remarkably similar plan, developed (with our advice) in a process guided by Mark Alexander, who will speak on the next panel. Obama was even more explicit that, while his plan is also full of choice, people would be automatically signed up with his public plan, unless they specified one of his private insurance options. And then on September 17, we sighed a sigh of relief when we heard Hillary Clinton roll out her health care package.

Perhaps still cautious from her experience in the early 1990s, Hillary had started this campaign for the White House talking vaguely about insuring all kids in her first term and trying for universal health care only in her second term. Thanks to our prodding, and the competition of her democratic opponents, she is now talking about a major push for health care for all in her first term, with a plan with all the key elements outlined by Edwards and Obama - and Jacob Hacker.

Making the problem worse

Now, you won't be surprised that none of the Republican presidential candidates have responded to our offer to brief them or their advisors.

But they do their own polling and they know that voters want to hear health care solutions from all candidates. But all of the Republicans have adopted an ideologically blind right-wing posture that is completely in keeping with George Bush's opposition to government and friendliness to the drug and insurance industry.

Romney and Giuliani and McCain and all the rest of them have adopted proposals that sound good on first blush - until you realize they will actually make our health care problems worse.

They all talk about tax deductions to help individuals and families pay for health insurance. Not tax credits that would go to everyone - or refundable tax credits that would go to low income people who don't pay income taxes. So far all the GOP health tax proposals would only benefit higher income people who want to reduce their taxable income.

But there is another side to their tax proposals, they would all get rid of the tax deductions that businesses now get for providing health insurance for their employees. This kind of shifting of tax breaks would accelerate the already growing trend of companies getting rid of their health care responsibilities and dumping them on their workers. Now you may think that we should rethink the World War II American system that depended on companies to provide health care, but the Republicans would force that transition very rapidly. [And although it is a declining percentage, still 60 percent of workers still get their health care from their employer. Imagine them all having to fend for themselves in the private insurance market.]

You see, the problem is that the conservative world-view sees no role for government.

No role for guaranteeing coverage.

No role for regulating their friends in the private insurance and drug companies.

No role for group purchasing or risk pooling.

No role for controlling the price of premiums, deductibles and co-pays.

In fact, the conservative ideology sees high costs for families as a good thing, as a way to discourage excessive or wasteful health care spending by forcing people to be smarter "health consumers."

Of course, what it means in practice is that families put off needed preventive doctor visits until health conditions get really bad - and by then, when you are in an ambulance to the hospital, it is pretty hard to ask which hospital has the lowest-priced surgeons for your emergency.

So to summarize, in the pithy words of American Prospect blogger Ezra Klein:

"The Republican vision is for a world in which the sick and dying get to deduct some of the cost of health insurance that they don't have -- and can't get -- on their taxes. The democratic vision is for every American to have health insurance." Are we clear?

So the 2008 election debate has begun. Iraq will be number one on voter's minds - but health care will be a strong number two. But to put things in context, listen to pollster Stan Greenberg summarize a national polling conducted just last month:

If Americans have ever been angrier with the state of the country, we have not witnessed it. The scale of today's discontent is evident in the 70 percent who now say the country is off on the wrong track and in George Bush's job approval ratings, now at their lowest levels ever. But that number is a superficial read of the contempt and deep frustration with the leaders of the country and our times; a period that leaves America trapped in an unnecessary war, while neglecting to take care of things at home and protect its own jobs and living standards; a period that leaves the average middle class person struggling with rising costs, medical and gas bills, while politicians and big business special interests take care of themselves, not the country. They believe America is losing ground to countries around the world, while our leaders are rudderless. The biggest challenge and opportunity one year out from the 2008 election is whether the Democrats will become the voice of that change.

Now I didn't intend for this presentation to be partisan. I guess I feel a little like Harry Truman when someone yelled, "Give 'em hell, Harry." He said, "I just tell the truth and it sounds like I'm giving them hell."

But the point is, if you care about health care for all, we need to tell the truth about the state of our health care system and the public will know what we are talking about - because everybody has a story about how dysfunctional it has become.

What we are doing

The most nonpartisan of 501c3 organizations can simply report accurately about what the various politicians are promising, and the pattern becomes very clear to potential voters. And while it is easy to engender feelings of fear when we talk about our health care system - it is more important to motivate anger and a proud and righteous feeling that "it doesn't have to be this way in America, the land of the free and the home of the brave." And we can do something about health care.

And it is in that spirit that my organization, the Campaign for America's Future, is joining with other organizations, national and local, to build a powerful coalition that can empower the American people to take charge of the debate about health care.

We are reaching out to statewide citizens groups, like New Jersey Citizen Action, who will anchor our grassroots outreach and contact with your congressional delegations. And state and local health care coalitions.

But the campaign for health care for all can and will include everyone who needs change in the US health care system - everyone who isn't part of the problem. Organizations representing women and Hispanics and African Americans and young people. Doctors and nurses and small business people. Seniors and religious congregations (including the evolving evangelical movement) and civic empowerment groups like the League of Women Voters. We envision a broad and powerful coalition of forces, each of which will work in their own way - together where appropriate and separately where necessary, to make sure that we give a strong voice and constant visibility to the growing public demand for health care for all.

Phyllis, in some ways this campaign to change the health care system is much more ambitious than our victory against Social Security privatization. But when we started, the media portrayed some form of privatization as inevitable - and they kept reporting that young people were all for it.

With health care, even though we are talking about restructuring 16 percent of the U.S. economy, everyone - even the mass media - understands that the country wants change.

And we can be pretty confident that the nominee of one political party will be campaigning on a health care plan that we can rally behind. And the other party's candidate will go to the voters as the friend of the unpopular insurance industry, and the drug companies and the super-wealthy. That's a contrast we can work with.

So our job is to give voice to the powerful majority that wants real health care change. Mostly, we can be positive, showing how we can cover everyone while reassuring those who have good health care that they won't lose it if they want to keep it. But some of our campaign goes on the offensive against the special interests and the politicians who support them - and we can expose the enormous costs and human suffering that will result from continuing to base our health care system on unregulated private insurance companies.

And we have to demand that every candidate running for office - Republican and Democrat and Independent - tell us very clearly whether they will support our plan for health care for all - if they are lucky enough to get our votes.

Harry and Louise today

We hope to have funds for TV spots and sophisticated media, but the real model for this big campaign is the way you got all New Jersey Democrats - and all but three of the New Jersey Republicans in Congress to abandon Bush - to vote for an expanded SCHIP. And I can't help but note that of those three, Jim Saxton has decided to retire, and Garrett and Frelinghuysen have strong opponents running against them.

Our job is the job of creative and aggressive organizers: building on where public opinion already is on health care, we've got to hold public events, release reports and generate news stories, and confront and question candidates in their offices and on the campaign trail. And if we do our job well, the mass media will report that the 2008 elections represent a mandate for the new president and the next Congress to pass legislation to achieve health care for all. And after that health care mandate election, that's when our heavy lifting really begins.

I want to leave some time for discussion, but I want to leave you with an encouraging image.

Most of you remember Harry and Louise. They were the characters in the TV ads against the Clinton health care plan in the 1990s. In those ads, Harry and Louise claimed the Clinton health care plan would force them to lose their good insurance coverage, change doctors, and force them into a government program.

A friend of ours has found the actors who portrayed Harry and Louise. Several years ago they did a TV spot in favor of stem cell research. And Louise is supporting Hillary Clinton. It looks like they might be ready to completely change sides. So imagine the new spots. Harry is 59 and has just lost his job in a corporate downsizing and he's not sure how long he can keep up their COBRA payments. Louise has developed a chronic condition and is terrified that if they lose their coverage, she will never get health insurance again. They talk excitedly about the new progressive Health Care for All plan as something that might save them. And they ask each other how health care in America ever got so bad. Finally, they look into the camera and repeat the tag line of that TV spot they starred in twenty years ago: "There's got to be a better way."

The American people now understand how the conservative agenda for health care in unhealthy for our whole society. And they are looking to us to show them that better way.

SCHIP Vote: The Record Is Clear

Roger Hickey — Thu, 18 Oct 2007 14:26:33 -0400

One hundred and fifty-six House Members declared themselves enemies of children and families with this vote. Ignoring the will of the people, a conservative minority in the House sustained the president's veto and denied nearly 5 million children access to health insurance. Upholding the president's veto is only the latest obstruction to progress by Washington conservatives.

An overwhelming majority of Americans support bold reforms in health care and other important areas, but conservatives have repeatedly used filibusters and vetoes to block this progress and then they hypocritically blame others for a lack of congressional action. The record is clear. Congressional conservatives and the president are the culprits who have stood in the way of a new progressive direction for our nation. Our children will pay a steep price for their cruel politics.

Conservatives celebrate the veto at their own peril. Voters are calling on their government to solve the health care crisis for Americans of all ages. Where legislators stood on expanding children's health care is a good indication of where they will stand on critical reforms needed to provide affordable health care for all — an issue that will be at the center of our political debate in next year's elections.

Hillary Confirms Commitment to Health Care for All

Roger Hickey — Fri, 21 Sep 2007 16:16:49 -0400

The big news from Sen. Hillary Clinton’s Monday health care speech in Iowa is that she is going to make a campaign for health care for all — not just small changes but fundamental reform — a central element of her campaign for the White House.

Before the speech Jonathan Cohn was not the only health care reporter asking the question, “Will she flinch? . . . Would she settle on something less than universal coverage, figuring the political support for it was too weak?” She didn’t. She responded to the American majority clamoring for bold leadership to achieve health care for everyone.

Clinton would achieve universal coverage by offering an array of private insurance plans that meet the standards for benefits and premium costs set by the Federal Employee Health Benefits Program — the quality plan covering members of Congress and other federal workers. And she would also offer a public health care plan similar to Medicare.

All of these plans would be portable through life changes, such as when you leave or lose a job. Employers would be required to provide their employees health insurance or pay into a fund to defray the cost of covering those employees. (Small businesses with fewer than 25 employees would be exempt, while getting tax breaks to encourage them to offer coverage.) All Americans would be able to buy into any one of the available private insurance or public plans — with a graduated system of tax credits designed to make sure that no one pays more than an (unspecified) reasonable percentage of their income on health premiums.

It is no coincidence that the basic elements are similar to those already proposed by her main presidential primary competitors. The “ideas primary” between the candidates has been shaped in part by our unique effort — chronicled in this blog all year — to engage the candidates around Yale Professor Jacob Hacker’s progressive health care plan, “Health Care for America.”

I’ve been part of a team of experts and advocates who (however reluctantly) agree that political reality requires a health care system that sacrifices the undoubted efficiency of single-payer in order to offer Americans more choice of health insurance systems — including the right to stay with their current private insurance policy if they are happy with it. Having made that decision, the Hacker approach — creating a strong “Medicare-style” public insurance option — establishes universal coverage without keeping us under the thumb of private insurance companies. The plan became our gold standard and our method of stirring a productive debate among the candidates.

The approach worked. Soon after the January release of the Hacker plan, former senator John Edwards unveiled his plan on February 5. It quickly set the standard for the other candidates. The American Prospect’s Ezra Klein observed: “it has widened the field of the debate, and unless the other candidates want to explain why they lack the boldness of Edwards’ plan, they’ll have to offer similarly comprehensive proposals. What they will have to match is full community rating, a public insurance option, total universality, scaleability towards more public involvement, and a willingness to propose something comprehensive enough to require revenue increases to fund. In other words: The goalposts have been moved. To the left.”

Cohn in the New Republic reported that features of the Edwards plan correspond to “the essential idea behind another health care reform plan that has been quietly generating a great deal of enthusiasm among reformers--a plan composed by Yale University political scientist ... Jacob Hacker.”

On May 29, Illinois Sen. Barack Obama unveiled his ambitious health care for all plan. It was instantly obvious that his plan owed a lot to Hacker — as he was determined to stay competitive with Edwards. Obama’s plan offers one particular advantage: if your employer doesn’t provide insurance, you are seamlessly enrolled in the public plan, ensuring coverage. Obama health economist, David Cutler explained how it would work on our America’s Future blog:

Here’s how it works: If you don’t have health insurance through your employer, you will be enrolled into a new, comprehensive public health insurance plan that emphasizes prevention, chronic care management and quality care. The benefits will be similar to those available today to every federal employee. This plan will enjoy the great efficiencies we see in public plans like Medicare but, if you still cannot afford it, you will receive a subsidy to pay for it. Of course, you can choose private insurance if you prefer but the private plans will have to compete on a level playing field with the public plan—without the extra payments that tip the scales in favor of private Medicare Advantage plans today.

This admirable clarity about how the system would work for workers whose company decides to “pay” into the public fund rather than “play” by maintaining the company insurance plan is the kind of reassuring detail that is so far missing in the Clinton plan. We can hope political competition will tease out this kind of detail, because it is not unimportant.

At one end (the “you’re on your own” end) of the spectrum, paying into the public fund could simply be a way for employers to wash their hands of their responsibilities to their workers. At the other, more progressive end, employers would continue play an active role in enrolling workers, making options clear — and presumably providing supplementary health insurance benefits available through continued collective bargaining.

As in everything involving new health care systems — from the design of benefits, to the cap on premiums, to the quality of public information, to the strength of public health and prevention programs — will depend on the mobilized power of the majority of Americans who want the public sector to lead the way on health care for all.

Single payer advocates, like Ohio Rep. Dennis Kucinich, condemn the consensus Democratic approach, warning that we will never have an efficient health care system until the wasteful (and predatory) business practices of the private insurance system are outlawed and health care is made a nonprofit public responsibility.

Edwards, Obama and Clinton start with the goal of creating a mixed system, with an optional public insurance system setting the standard, and a pretty rigorous set of standards and regulations designed to get the private health insurance system to essentially change its business model. Clinton can sound as populist as Michael Moore when it comes to the abuses of the health insurance and drug industries.

More importantly, she (like Edwards and Obama) declares that she is committed to setting the rules of the insurance companies' game so that they offer comprehensive benefits at affordable premiums and, as she promises in her newly published plan, we will have regulation that “ensures that no American is denied coverage, refused renewal, unfairly priced out of the market, or forced to pay excessive insurance company premiums."

Now that Clinton has rolled out her private-public plan for achieving health care for all, it is pretty clear that the Democratic party is not going to try to take the private insurance companies out of business. That would be politically hard to do. But the goal that they have set — to force the private insurance companies to equitably contribute to the solution to our health care problems — will not be a piece of cake either.

Clearly the citizen’s campaign for health care for all must seriously pursue the experiment of holding the insurance and drug industries to a high moral standard. And we’re going to have to make sure that the political power of the American majority is mobilized to make sure we have the power to enforce that high moral standard.

'SiCKO' Builds A Movement

Roger Hickey — Mon, 09 Jul 2007 11:58:00 -0400

Americans want big changes in our heath care system. And now Michael Moore's great new film, "SiCKO," is helping to turn a desire for change into a crusade for change.

Now breaking box office records in its second week in theaters, "SiCKO" conveys powerfully emotional stories of Americans trapped in a system controlled by insurance and drug companies that deny care and destroy lives in order to maintain their profits. We walk into the movie house as individuals with our particular gripes about the health care system. And we walk out wanting to be part of a national movement for health care for all. For example, read this great account of how spontaneous organizing literally occurred in the theater lobby—at a Dallas, Texas suburban cineplex.

So, what kind of movement should we be building?

Unlike this weekend's very expensive Live Earth rock-and-roll extravaganza, whose major message (in the face of looming global environmental catastrophe) seemed to be to make personal life changes—"Buy better lightbulbs, unplug your cellphone chargers, and run your tour bus on bio-diesel"—the thoughts of people who see Moore's movie turn immediately to institutional and political change.

After seeing Moore's film, most people want to pose a big question to all politicians: Will you work to guarantee health care for all, not incrementally—one disease at a time, or one group (like kids) and then another group (like their parents) in another program—but through a universal system of health care for everyone?

Here's a second crucial question we should ask politicians: Will you pledge to cut the big insurance and drug companies out of a central role in the design of your universal health care plan?

Last week the Campaign for America's Future joined with MoveOn in a campaign to urge our members to take friends to see "SiCKO" and then to communicate with all the candidates for president, asking them to reject contributions from big insurance and drug companies. We will publicize the answers.

The good news for those of us who come out of "SiCKO" inspired to change our health care system: Several of the presidential candidates—John Edwards, Barack Obama, and Dennis Kucinich—have already pledged not to take contributions from the insurance and drug companies, their political action committees and their lobbyists. And each of those Democratic candidates has already put forward a plan to achieve health care for all. Hillary Clinton has announced she will come forward with a plan for universal health care in the coming months—a big step forward from her original posture of just covering children first. It appears that Clinton's campaign is taking insurance and drug industry money, but she is under pressure to change that—which is the one of the goals of our email campaign. (Click here for information on how to reach her campaign and others.)

This is where two different tendencies in the health care movement diverge. Some people want to understand which of the possible nominees has the best plan—or discuss how we put pressure on him or her to get better. The other reaction—which I've gotten in person and in angry emails—says don't even bother talking about the promising proposals coming from politicians like Edwards and Obama. They are just not as good as Kucinich's plan (H.R. 676) which would create one national public (single-payer) health plan for everyone. Michael Moore, although he has generally wisely stayed above the details of specific policy, has given a few interviews dismissing Edwards and Obama as fatally flawed because they preserve a role for private insurers.

Now, there is nothing wrong with unremitting public pressure. If everyone who sees "SiCKO" is enlisted in the Kucinich campaign—and if everywhere the other candidates go, they are confronted with crowds chanting for single-payer, it could (in theory) convince Obama or Hillary or Edwards to embrace H.R. 676. Or failing that, if a Democrat gets to the White House anyway, he or she (or the more progressive new Congress) might be forced to support a pure single-payer plan sometime after the election. The debate about health care for all won't be over on Election Day, it just begins. And everyone should energically raise their voices. Tell the politicians that we want a comprehensive health care plan that covers everyone. And those who think HR 676 is the only way to achieve that goal, should be vociferous—and they will. That kind of democracy in action is good.

But one big problem with "single-payer or nothing"—or Dennis Kucinich or nobody—is that it runs the risk of ignoring potentially important differences between the candidates who actually have a chance to win the nomination—and it takes the pressure off those candidates to try to improve their health care plans if they think that all the ""SiCKO" voters" are going to give our votes only to Kucinich.

Now, I happen to think that the health care plans put forward by Edwards and Obama represent pretty important proposals—much more understandable than Clinton's 1993 plan or John Kerry's undecipherable health care proposals in 2004. The prospect of debating Kucinich before audiences of progressive primary voters probably made Edwards' and Obama's plans somewhat more progressive—but they also got better because some of us paid attention to the details of what they and their advisers were saying—and pushed them in the right direction. (See links below.)

Do the Edwards or Obama plans remove the private health insurance industry from any and all roles in expanding health care coverage? No. But both Edwards and Obama create a public program, similar to Medicare, that would play a central role in making sure all Americans have coverage. Here's a description of Obama's plan from David Cutler, one of his key advisers:

If you don't have health insurance through your employer, you will be enrolled into a new, comprehensive public health insurance plan that emphasizes prevention, chronic care management and quality care. This plan will enjoy the great efficiencies we see in public plans like Medicare but, if you still cannot afford it, you will receive a subsidy to pay for it. Of course, you can choose private insurance if you prefer but the private plans will have to compete on a level playing field with the public plan—without the extra payments that tip the scales in favor of private Medicare Advantage plans today.

It ain't pure single payer, and people have a choice of regulated private insurance, but the plan people are automatically enrolled in would end up being a pretty big single-payer public insurance program—like Medicare.

Edwards has a similar public insurance plan, and when he rolled it out for public discussion (well before Obama), he told Tim Russert of "Meet the Press": "One of the choices . . . is the government plan. So people who like the idea of a single-payer insurer health plan, that is actually one of the alternatives that people can choose."

We don't know what Hillary Clinton's plan will look like. She could cautiously aim at covering everyone only if she is re-elected for a second term (as she has hinted). And she could aim at achieving that goal incrementally, insuring all poor children first in one program, and middle-class children in a separate program, and all adults in a third program. That would be a disappointment. And people who think of themselves as "health care voters" should be letting her know that RIGHT NOW.

In this crucial primary season, some in the movement for health care for all will dismiss the differences between candidates, embracing only Kucinich and single-payer. But the rest of us, more realistically, should emphasize the most progressive elements of the Edwards and Obama—and Kucinich—proposals, while trying to use them to leverage a better, more progressive plan out of Hillary Clinton.

The single-payer advocates get the diagnosis of what's wrong with American health care correct: The for-profit drug and health insurance industries who profit by denying people care and by manipulating the system. But even if you would like to completely cut these corporate interests out of our basic health care system, it would be real progress to achieve a public health insurance plan like Medicare that covers over half the population. And some of us think there could be a political advantage—and a good reply to the "Harry and Louise" propaganda from the insurance companies—if we can show that people who like their private insurance plans will get to keep things just the way they are.

Michael Moore has generated a lot of very productive emotion by exposing how the insurance industry denies care to people who thought they were covered or keeps sick people from getting insurance. But we all need to get used to another populist attack on the private health insurance industry—but one not designed to take them out but to regulate them. You can see it in California, where Arnold Schwarzenegger is trying to cover everyone without a public plan, so he has to try to put strong new restrictions on private insurance companies (who want to participate) to get them to insure all comers—even people with pre-existing conditions—and to do it at affordable premiums.

If any of the leading Democrats—Edwards, Obama, or Clinton—get elected president, we are likely to see two parallel experiments with the insurance industry: displace them as much as possible with the best possible public plan AND regulate the hell out of them to try to get them to change the business model so well described by Clinton at the Las Vegas health care debate: "Insurance companies make money by spending a lot of money, and employing a lot of people, to avoid insuring you, and then if you're insured, they try to avoid paying for the health care you receive."

Our most important job is to build a strong movement with a clear goal: good health care guaranteed for all. And then we have to explain and re-explain how the business practices of the big health insurance and drug companies actually prevent us from achieving that goal. If we keep up pressure for strong reform and not just weak reform—perhaps we can build a health care system that puts people ahead of profits: the kind of system that—as Michael Moore showed us—the Canadians, the British and the French have enjoyed for decades.

Roger Hickey is co-director of the Campaign for America's Future.

Here are links to previous articles and posts on the health care debate:

The Great Rick Shift: Health Care For All

Health Care For America

Health Care For America Blog Roundup

Edwards Gives A Nod Toward Health Care For America

Blog Reaction To Edwards' Health Care Plan

The Universal Health Care Debate Is Over

Where The Health Care Debate Is Going

The Health Care Answers We Need

Universal Health Care: Getting The Right Mix

Obama's Health Care Plan

Obamacare: Clearing Away The Fog

Enough Tinkering

Roger Hickey — Tue, 10 Apr 2007 14:32:37 -0400

The following post is a part of this week's TPMCafe Book Club group discussion of the new book "Sick: The Untold Story of America's Health Care Crisis -- and the People Who Pay the Price" by Jonathan Cohn.

Kudos to Jonathan Cohn for his important new book. One of the reasons we are talking about what's the right approach -- or the most politically feasible approach -- to insuring all Americans is that millions of Americans are telling pollsters and politicians that the health care system is in crisis. The public has put this issue on the table for the political system -- not the policy wonks.

Individuals, like those profiled in "Sick," experience the health care crisis in many ways. But is there a explanatory diagnosis for why the health care system is not serving them?

Perhaps some people think the problem is not enough careful tinkering with the system we have. But increasingly, the diagnosis that makes the most sense will focus on the structural failures of the private health insurance industry.

If insurance companies make their profits by denying care, refusing to cover people who are expensive, spending more money on advertising than they do on wellness, and just passing along increased health costs, then the public may decide that tinkering with the private health insurance system (and subsidizing and regulating them to do what their business plan doesn't allow them to do) is not the way to go.

So I'm betting that the public, making the diagnosis that the private insurance industry is a key part of the problem, is unlikely to be impressed by tinkering.

And many experts and commentators (who do think in their heart of hearts that single payer is the way to go) may be surprised that the public won't see "regional buying pools" and individual mandates as giving them the kinds of guaranteed coverage the system doesn't currently offer.

This promises to be an exciting discussion. Many of us who think single-payer is the right direction have thought long and hard about step-by-step ways to get there.

Jacob Hacker's plan, recently published by EPI, is structured to allow lots of choice -- including ways to let Harry and Louise keep the private health plans they now have if they like them.

But the big question is the one Jonathan asks here: will tinkering, even at an ambitious scale, get us a health care system that covers everyone, affordably, and with the kinds of structural arrangements that can begin the reorganization of the health care system to control the spiraling health care costs our economy is now facing?

Enough Tinkering

Roger Hickey — Tue, 10 Apr 2007 14:32:00 -0400

Individuals, like those profiled in "Sick," experience the health care crisis in many ways. But is there a explanatory diagnosis for why the health care system is not serving them?

So I'm betting that the public, making the diagnosis that the private insurance industry is a key part of the problem, is unlikely to be impressed by tinkering.

This promises to be an exciting discussion. Many of us who think single-payer is the right direction have thought long and hard about step-by-step ways to get there.

Jacob Hacker's plan, recently published by EPI, is structured to allow lots of choice -- including ways to let Harry and Louise keep the private health plans they now have if they like them.