02 March 2008

The Sin of Omission

A.D. Freudenheim, The Editor

The proposals presented by both Senator Hillary Clinton and Barack Obama to reform America’s health care insurance systems – in order to guarantee quality and affordability – are misleading, inadequate, and probably unworkable. They may be the best Americans can expect , but that still is not good enough. The bottom line: neither candidate is willing to define publicly what affordable means, and for whom. Both candidates have wasted thousands of words on the issue, but neither of them provides an estimated, projected cost for insurance per person (or family) per month, based on their plan. To state the obvious: that makes it difficult to judge whether these programs would, if enacted, be affordable – even though affordability is claimed as a hallmark by each candidate.

When Hillary Clinton says her plan is about “Improving Quality for All and Achieving at least $120 Billion Per Year in Savings Nationwide,” or Obama addresses the “$2 trillion” spent on medical care and notes that “Prescription drug errors alone cost the nation more than $100 billion every year,” well ... these numbers may be right, but I suspect they are essentially irrelevant to most people. To the extent that Americans budget at all, they surely do not do so in years, or in a manner that takes into account the GDP of the United States, how much health care costs in total across the country, or even whether interest rates will rise or fall a half-point in the next quarter. Most people budget in weekly or monthly increments, while even sophisticated people have a hard time understanding what $2 trillion really means in practical terms. Much as with Social Security, health care is both an emotional and practical issue; the practical component is about what kind of information people understand. What most citizens want to know is: what’s it gonna me cost each month?

Health care, you will recall, is supposed to be Hillary Clinton’s issue, the big one on which all of her I-care-about-people attitude, and her I-have-experience message points, were supposed to converge. Still, a review of the Clinton health care plan – on her web site, here, and in a downloadable PDF – reveals a distinct lack of specifics, especially where costs for the average family are concerned. Right now, I’m paying about $4,800 per year – $400 per month – to insure myself and my child. Will Clinton’s plan raise or lower my insurance premiums, and if so, by how much? The best we get from Clinton is an unspecific quote from someone else’s research: “The Business Roundtable estimated $2,200 in national health savings for the typical family,” based on making some of the changes Clinton proposes. This is buried on page 11 of the PDF of her plan, and it is not exactly a comforting or promising statistic.

Despite Clinton’s complaints that Obama has been weak on specifics, his plan is clearer than hers, and the Obama campaign has put together a separate document of Frequently Asked Questions which seems to recognize the complexity of the issue in a way that the Clinton camp misses. However, the best we get from Obama is this: “Through partnerships among federal and state governments, employers, providers and individuals, the Obama plan will save a typical American family up to $2,500 every year on medical expenditures...” (The Obama plan PDF, page 2.) Again, this seems better than the Clinton plan, not only because it’s $300 more, but because it comes on page 2 (and is repeated several times) rather than being buried on page 11, amidst many of Clinton’s other hifalutin’ statistics. Read the sentence again, though, and there is still a lack of clarity in its intent: it will save on medical expenditures, but does not say whether that includes health insurance premiums, nor does it explicitly say what the premiums would be, per person or per family per month.

In a ridiculous column in the New York Times a few weeks ago, Paul Krugman sided with Hillary Clinton’s plan because “the difference between the plans could well be the difference between achieving universal health coverage — a key progressive goal — and falling far short.” He then quotes a study by an economist who specializes in this area, and writes “Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.” That does sound like a big difference. But notice that phrase “newly insured”? Krugman wrote it but does not explain it. By implication it seems to mean that those of us already with insurance – and paying more than $4,400 or $2,700 – won’t see much discount. In effect, our higher existing premiums will be subsidizing the costs of the cheaper plans. Excuse me, but: how is this better?

Largely unmentioned in all of this is the political reality of legislation in the United States. The Clinton and Obama plans read like pie-in-the-sky wonkery, as if an 11 year old was writing about his legislative intentions. So much here is dependent on Congress that it is almost hard to take it seriously as a campaign issue. Presidents, even power-abusing ones like George W. Bush, still have limitations.

If the candidates – either of them – want to win on this issue, they need to talk specifics. Clinton and Obama should stop quoting outside experts, and instead put better numbers to their health care plans. Tell me, now, what you project my insurance premiums will be, per person for a family of three, for the first year your plan rolls into action. Tell me, now, what your plans will cover, specifically, and what my out-of-pocket deductible will be. Come up with a number and stick to it. Commit yourself to it. Campaign on it. And then let the rest of us – the voters – decide whether these plans are actually “affordable,” according to our family budgets, not yours.


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