I first must apologize to Edwards for second billing as his plan came out first. But I couldn’t resist the Two…Too thing. I will get back to Edwards later…
I am also going to bypass the individual mandate that is the central policy adopted by both as I have already commented on it in a previous post. And again I’m going to emphasize that all of these presidential plans have stark gaps or unknowns. None of the plans are viable as they stand now and that is because of political calculations. I’m confident that Clinton is aware of this as she has proven her health care expertise before. And I am also confident that Edwards and Obama are aware of this as they have health care advisers that reign over the field.
So Clinton’s plan. I’ll start with what I like. She has strong measures – individual mandate, standardization of plans, and guarantee issue – that reduce (not eliminate) selection issues that exist in today’s health care system that are to blame for the pre-existing condition exclusion and other nasty features of our current situation.
I like her tax proposals, but they don’t go far enough. The refundable tax credits, which help to ensure that premiums remain affordable, are progressive, but I would like to see the current health care tax deduction (regressive) replaced totally by the refundable tax credit. She doesn’t go that far. She proposes eliminating the deduction for rich plans held by those earning more than $250,000. Her tax policy is a step, but too timid for my taste.
Clinton proposes establishing a Health Choices Menu that would be run through the Federal Employee Health Benefit Program in which private plans will compete with each other and one public plan. The plans would have to be at least as good as those offered to the U.S. Congress. Individuals and employers can choose to buy from the Menu or keep their current situation. How exactly this will work is a bit unclear. There will be purchasing power indicating pooling, but I’m unsure of the exact pooling mechanism. And the details here are important. I’ll have to call this section a wash.
Her plan also targets numerous areas that need fixing, but that alone don’t amount to comprehensive reform. I consider them to be important, but not central. They are also politically popular. These include electronic health records, prevention (this can be expensive), chronic care coordination, and comparative effectiveness research.
The biggest issue I see with her plan is costs. She has a lot of cost-savings features and they are real, but maybe too optimistic. My concern is that the plan does not address the real causes of rising health care costs. The reason – any real solution would be a like cough syrup. The taste would be so bad that during a political campaign few could stomach it.
There is more here, but these are the main points. Her plan is safe while still offering comprehensive reform.
The Edwards plan is almost identical to the Clinton plan or more accurately, the Clinton plan is nearly identical to the Edwards plan. I don’t want to bore you with a repeat of the details so I’ll leave it at that.