Getting Universal Health Care Done
After months of waiting, and taunts from Edwards and Obama, Hillary put forward the broad outlines of her universal health care approach today. The proposals are a set of principles that reflect months of work talking with stakeholders, many of whom who sunk her last attempt at reform. Her principles, like those from Edwards, Bill Richardson, and Chris Dodd include an individual mandate and no opt-out, whereas Obama's plan does not. She would offer tax credits to individuals and families to offset the cost of health insurance premiums, and for low income earners would provide a federal subsidy so that total premium costs wouldn't exceed a certain percentage of earnings. Like many of the others, she wants large employers to either provide coverage or pay towards such coverage. But unlike Edwards, she doesn't want to force the mandate on small businesses, and instead wants to offer them tax incentives to keep providing coverage or to start doing so. And as Ezra Klein notes, she provides a public insurance option to compete with private insurance companies, you know, competition.
It is inevitable that some of her Democratic opponents and the netroots will say that she doesn't go far enough, supposedly because she is too cozy with the insurance companies, the drug companies, and the lobbyists, and doesn't push to blow up the system for single payer. Sure enough, the first thing out of Edwards’ mouth was an attack against Clinton for not getting tough enough with the insurance companies, whom Edwards will need for any solution if he ever becomes president. For his part, Obama said he could do better by, you guessed it, bringing people together on a consensus, yet Obama’s plan doesn’t cover everyone. As for Chris Dodd, he somehow managed to blame Clinton today for Dodd and Congress’s inaction on universal health care over the last thirteen years.
Yet no one should overlook one simple thing: she has been working with all of these interests over the last several years to generate an outline of shared responsibility, with many who were the same folks that sunk her last effort. And instead of pushing away from the table, these interests as well as the AMA and the hospitals are still at the table with her. Yes, she will continue to be criticized for taking their contributions, for not calling for single payer, for not blowing up the current system and getting tough with insurance companies, and for not telling Congress "do it or else".
But is the goal universal health care, or is it to waste another presidential administration arguing dogma while our businesses and workers jointly suffer? Clinton told David Broder today that passing universal health care would be her highest domestic priority in 2009. She is putting forward a balanced and politically viable approach, something that demonstrates she learned a great deal from 1993-1994. Instead of being really specific about the details and giving her opponents and Congress the ammunition to oppose it like Edwards is doing, she is investing the stakeholders and Congress in the outcome, another learning point from the last debacle. And unlike Edwards, she isn't threatening Congress or the industries, but instead wants partners to be part of the solution, a solution that starts and ends with the acceptance of universal health care as the way forward.
From where I sit, there are two legitimate concerns with the approach. First, I agree that consumers and labor have a right to question how balanced a final Clinton universal health care approach will be. But Clinton is not planning to give a final, detailed plan to Congress in 2009 but rather a set of principles and priorities for Congress to use as a template for them to get the final deal done. This is a major change from the 1993-1994 approach, as it allows Congress to be invested in the solution as well as the major stakeholders. There will be ample opportunity for labor and consumers to be heard through a new 2009 Democratic Congress, and Clinton’s focus this time was to neuter her opponents up front to the degree she could by making them part of an eventual solution, instead of proposing something that made it easy for them to stop it. And it that accrues to the benefit of maintaining and expanding Democratic majorities in 2010, so much the better.
Second, I am still troubled by an individual mandate and the efficacy of tax credits if working Americans can’t afford the insurance premiums in the first place. The devil will be in the details, but many agree that costs can be better contained and brought down through technology, better practices, quality measures, and universal coverage, all of which Hillary is advocating with broad support.
Yes, the criticism of her from Obama and Edwards about lobbyist contributions and industry involvement in the solution is expected and not to be dismissed. But the goal here is to get universal health care accomplished through the stakeholders and Congress, not to challenge both of them and waste another term on the pursuit of single payer. And if polls already show that voters trust her more than anyone else to get it done, given her past learning experiences, and if she has carefully worked to address potential opposition up front this time by investing stakeholders in the solution, then she and a Democratic Congress can actually get it done.