Harry and Louise Now Support Sanders’ Medicare-for-All Plan. With Good Reason.
In the Comments thread today to my post yesterday titled “Clinton Announces When She Will Disclose Her Healthcare Insurance Improvement Plan: She’ll announce it just as soon as the Republican presidential candidates tell us theirs,” reader Urban Legend wrote, as part of a several-paragraph comment:
While a single payer plan is superior in theory — and has been proven in practice — thought should be given to the extreme political danger of offering a program at this time that can and will be painted by Republicans as one that will destroy half a million jobs in many different states. There was more than spite in Joe Lieberman’s objection to the public option. Think Hartford, Connecticut, insurance capital of the country. We would see “Harry and Louise” in spades. (Look it up if you’re too young to remember, and see what happened to Congress in the following election in 1994.)
I responded:
Guys, I’ve pretty much given up on trying to convince Dem baby boomers and silent generationers that it’s no longer the ’80s and ’90s and that the Bernie-is-a-SOCIALIST thing would mean a George McGovern-like trouncing and a Repub sweep in congressional elections. Finally, that argument is no longer being made by the punditry; instead it’s now the reverse: Can Clinton beat Trump, given the public’s now-obvious anti-Koch-brothers-Republican-platform mood.
But I do want to respond to Amateur Socialist’s concerns about Harry and Louise, whom I remember quite well.
The reason for the success of the insurance industry’s anti-Hillarycare ad featuring the young couple Harry and Louise was that the essence of Hillarycare was that it would all-but-force people who had choose-any-doctors-and-hospitals-you-want insurance into HMOs or PPOs that limit the choice of doctors and hospitals to those in a network, sometimes a small network, especially back then, and that sometimes required a referral by a primary care doctor for access to a specialist.
Most people back then had employer-provided insurance that did not have those limitations. Their insurance was like Medicare—usually like Medicare with a supplemental plan is now. The problem back then was that there still were tens of millions of people who had no access to insurance, many of them because of preexisting medical conditions, and also that premiums had been skyrocketing. And suddenly many employers were no longer paying the entire premiums.
But of course now, very few employers provide insurance that does not involve healthcare networks. And very few now pay the full premiums. And most policies have much larger copayments and much larger deductibles.
These are the really big problems with the ACA’s marketplace plans, too.
And these are the problems that Sanders’ Medicare-for-all proposal would eliminate. No provider networks, no large copayments, no large deductibles, and affordable premiums.
In other words, Harry and Louise would support the Sanders plan now.
Enough said on that, I would think.
The two paragraphs in Urban Legend’s comment that precede the one I quoted read:
I agree that the Thorpe alleged take-down of Sanders’ single payer proposal is ridiculous. As you say, you can’t expect a candidate to dot every i and cross every t in a broad campaign proposal. The experience of other countries indicates almost certainty that in the long run, everyone would come out ahead with a “Medicare for All” system.
And:
I disagree completely that Clinton has no proposals for healthcare. She has quite specific proposals, including tax credits up to $5000 to reduce co-pays and deductibles (which she says are excessive), efforts to reach 16 million people who are eligible for Medicaid (a single payer plan) but haven’t signed up, and revival of the public option, the primary purpose of which was to make a genuine non-profit, efficient insurance offering available and force insurance costs further downward through direct competition. Whether they are adequate or not is a matter of opinion, but it should not be said that she has no proposals. They are there for everyone with a finger and two seconds to see.
The first of those paragraphs refers to the main point of my post: the sheer silliness of Emory University healthcare economist Kenneth Thorpe’s most recent attempt at a takedown of the Sanders proposal. The second of the paragraphs—well, it’s meaning needs no background.
But it does raise this question: Why has there been no study by mainstream progressive economists about the costs of these proposals of Clintons’, and an explanation of why this would be better than a plan that would, among other things, significantly reduce what are now the very high premiums that employers now pay to private insurers and that employees themselves pay in contributions to the premiums costs and also in copayments and deductibles?
Paul Krugman, maybe? Nah.
okay but it wasn’t me hand wringing over harry and louise. I hate those moronic stooges.
Yup. I caught that error and changed my comment to identify Urban Legend, not you, as the commenter. Sorry about that.
OK, Beverly, this is an improvement over your last post in which you falsely claimed that Hillary had not proposals about what to do with health care. You finally admit that Urban Legend’s second sentence is correct that she does have proposals, readily available on her website, even if these mostly amount to minor extensions or changes to ACA, with the only one possibly lowering costs, the appearance of the public option. Your reply is to complain that nobody has costed these out, which is not illegitmate, although it may be hard to do, especially the public option, something Obama initially proposed but gave up in order to get non-forthcoming support for the overall bill from GOP, which gave zero support at all.
This is a non-trivial point. He just barely scraped ACA through a Congress where the Dems controlled both houses of Congress (remember some GOP commentators hoping that Robert Byrd would drop dead they way Teddy Kennedy did so that the final cloture vote in the Senate would not pass?). And to get that, with zero GOP support, he had to buy off every special interest in the health care busines.. But then, as some here claim, maybe it would have been better if the health insurance companies were still able to deny coverage to people with preexisting conditions, as was the status quo ante changed by the passage of ACA. Anybody who wants to diss ACA needs to deal with that hard reality.
So I have found the whole debate over Sanders’ health care proposals to have been pretty ridiculous al the way around. if in fact he is able to fully do what he proposes, overall health care costs will go down as there should be zero private health insurance premia, although there will be some tax increases. That certainly looks better than the various ad hoc improvements (and they do look like improvements) to ACA being proposed by HRC, even as some commentators do not even recognize that she has made these and berate her over this.
But claiming that Harry and Louise would like this is a joke. H and L were spokespeople for the private health insurance industry, which was using them to oppose any changes that would reduce their profits. Of course H and L will reappear in ever more dramatic form to oppose a change that would reduce those profits to zero, you can count on it. If Obama could not get a public option through a Congress with Dems in control of both houses, the idea that one can completely elminate any role of the private health insurance companies in our health care system in a Congress with the House controlled by the GOP is fantasyland. Indeed, probablhy none of Clntono’s more modest proposals are going to get through either.
Without Dem control of both houses, both of their heath care platforms are basically pie in the sky, fantasy land discussions for some future better day.
As a matter of curiosity, what country or countries have a “medicare for all” system? Not Canada. As I understand it, their physicians and other healthcare providers are government employees.
I don’t think most people were as happy with their health insurance as you do. Experiences were already very bad. The problem was fear. I certainly don’t doubt that when large corporations and their Congress people say in effect, “If you try for anything better, we’ll make what you have a lot worse. We will punish you for attempting to reform our bad practices,” they can do it.
Fear of what the powerful will do to us has been very strong in America for three or four decades now.
Welcome to Angry Bear. First times we always approve to weed out the spammers.
JackD,
No, in Canada they are not government employees. You find that in UK, where there is full-blown socialized medicine. Medicare for all would probably resemble the Canadian system more than most others, although the devil is in the details, and administration and rules in the Canadian system are substantially managed by the provinces, so there are considerable variations across the provinces when it gets down to details, although in none of them are physicians state employees.
Of course we have state to state variations, as the current situation regarding the expansion of Medicaid mandated by ACA, but allowed for state to state control by SCOTUS is in force.
There is enormous variation in systems out there, although all among high income nations outside the US do manage to have universal coverage, unlike us. WHO rated the French system the best, which is a hard-to-describe-hybrid of public and private. But everybody is covered, and it is very efficient. I have personally experienced it, and even as a foreign visitor, service was excellent with physicians even visiting one’s residence. This still happens in many nations, even though it is unheard of in the US, and I suspect one reason they have better health outcomes. Having lots of sick people go sit next to each other in a doctor’s office for extended periods of time is a wise policy?
BTW, I voted for Bernie here in VA yesterday, but I am very frustrated with the ftothing at the mouth anti-Clinton hysteria that some Bernie supporters are exhibiting, including outright lying about her positions as exchibited here on this site on this health care issue. Just stop it with the outright lying, please?
Ah. Damn! I was just about to post a nasty, sarcastic response to part of your first comment here when I read … this comment of yours!
Wow. You voted for Bernie! You go, guy!
Seriously, also thanks for addressing the French system and mentioning that you yourself used it.
Barkley:
It would be great if you would expand on the public and private which most people do not realize this is what most other countries have. It certainly is not singles payer. And the insurance companies are nonprofit and controlled with rates being negotiated. France allows insurance companies to charge a fee of slightly greater than 5% of income, pays ~77% of healthcare expenditures, has a provision for long term care, has a copayment, and spends ~ 11% of GDP on healthcare
More of us should talk about the differences.
Good to see you here commenting.
Interesting. I met a retired lawyer from Ontario yesterday who told me they were government employees. Is there insurance in Canada, as here under medicare, to cover deductibles and other “holes” in the system’s coverage?
Jack, about five years ago someone I met from Winnipeg, and who had recently had cancer surgery there, told me that the hospitals are government-owned and that the reason for sometimes long waits for elective surgery and such (which hers was not; she was operated on very shortly after her cancer, stomach cancer, was discovered) was that there had been a failure by the government to realize that more hospitals were needed. She said that that was in the process of being addressed. But I think she also said that doctors there are not government employees—although their compensation is set by the government.
Maybe it’s different from one province to another. Or maybe the retired lawyer from Ontario you met meant that doctors are effectively contractual government employees.
But to my knowledge, only Britain and at least partially Canada have the system you’re talking about, although France, Italy and some other European countries might too. Most northern European countries do not, to my knowledge. Australia, I believe, does not. Nor Taiwan, I believe, which along with France has the best healthcare insurance system in the world, according to things I’ve read. Israel also, I believe, does not.
Unless you assume the D’s take the house and get 60 seats in the Senate Bernies health care proposal is dead on arrival at the congress. As indeed was the public option, as noted it could not get all 60 D votes in the Senate. One has to ask what is possible, and Bernies plan is not. The first chance for it is 2023 after the redistricting of 2020, assuming the Ds manage to take a number of state houses back, otherwise the house will remain as gerrymandered in favor of the Rs as it is today.
Lyle; as noted earlier, even when the Democrats had both houses, the ACA was the best they could do given certain blue dogs and Senator Lieberman (D, Insurance).
The best long-run chance for a Canadian-style system is through a public option. A broad-based public option is probably still politically non-viable, but a camel’s nose that would be hard for any Congressperson to oppose would be giving people between 50 and 65 who do not have employer-based insurance the right to buy into Medicare. The costs of policies for people in that age group who make just enough not to qualify for credits become pretty severe even with the 3:1 maximum ration built into ACA. This could be an option built right into the exchanges. Any politician D or R will pay a price for preventing people in that age group from being able to save hundreds of dollars by taking advantage of something so manifestly reasonable.
If you look at it just part A and B together run about 800 a month (part A is 465 for those who never paid in and full part b is above 360 a month). Then add the part D subsididy of 70. Of course in addition you have to add some form of medigap so your talking 1100 a month, per person. So its not obvious that because in general the 50 to 65 set would be the healhtyest part of the medicare cohort and they would want a discount to the rate.
Imagine what would be possible with changes in plan coverage and costs in market competition among insurance companies instead of the cozy oligopolies seen in so many states. Consumers should relish the opportunities for greater choice, especially given how so many despise the current system and players. The stifled competition aspect is one pre-existing condition that should be eliminated.
I can’t imagine relishing the opportunity to spend more time picking an insurance plan and subsequently dealing with coverage, co-pays, provider errors, and the many other features of our current system. Cars, computers, even toaster ovens, may be fun to pick out features. Insurance? Nah. I want health care as I need or would benefit from it, not the opportunity to guess about my illness and financial capabilities for the next year.
Nihil, I agree completely with both of your comments. I didn’t mean to give the impression that back in 1993 most people were thrilled with their healthcare insurance, just that back then they were afraid of having to deal with the kinds of things that almost everyone who isn’t on Medicare now has to deal with but didn’t back then.
I remember well that a year before the 1992 election, there was a special election to fill the Pennsylvania Senate seat left vacant by John Heinz’s death in a helicopter crash, and that the Dem. Candidate, Harris something (I can’t remember his last name), beat Richard Thornburg, because Harris something had campaigned on making major changes to healthcare insurance. I remember that Bill Clinton then campaigned hard on the issue. I also still remember him saying, “We have to seize the moment” to change the healthcare insurance system; I remember the look on his face and the intensity in the tone of his voice when he said “seize the moment.”
The look and tone of voice showed truly deep empathy, something his wife can’t convey even on the very few things (women’s issues) that she actually has empathy about.
I remember presuming then that he would appoint someone like the dean of Harvard’s School of Public Health to chair a commission to propose legislation. (I knew then vaguely that there were healthcare economists, but didn’t yet know of, say, Uwe Reinhardt, but presumably Bill Clinton did.) Instead he appointed his wife, cuz she asked him to. She knew next-to-nothing about the intricacies of the issue, and enlisted people as her top assistants whose knowledge was about at the same level of hers. I remember being dumbfounded. Truly … I just couldn’t believe it.
Anyway, ditto what run said. Welcome indeed to AB. Appreciate your comments.
Bev:
What exactly did you know about healthcare in 1993?
nihil:
For a few hundred dollars, I will save you from having to learn about it and choose for you. Of course if I am wrong, it is still your problem. Why are you so lazy and not want to figure it out? Even with Medicare, you have to know. For example, Part B will only pay 80% of the total bill (surprise for all of you people who believe otherwise). You still need to pay for the other 20%.
Hmmmm, maybe supplemental insurance? Ok kool, now what type did you want? There is Plan F which will cover your toilet paper even or a lesser plan which may still leave you something to pay. You can choose a plan N which will cover most of everything; but what if you are the type who is always kept for observation in the hospital? Medicare will not cover all of that and you are left with a higher cost. Guess what? If you chose the wrong supplemental, they will not cover it either under Plan N and you should have chosen Plan G. Maybe a lesser plan than N is all you can afford? And it might be so. Then there is the issue of which insurer. I chose AARP as they discount from the beginning and for 10 years as a member. Every little bit helps.
My Retuxin chemo was $14,000 a pop and 4 times. This came after a load of platelets at a lesser cost. If I get it in the hospital while there I am home free. If I get it as an outpatient, Medicare “may” not pay it. Kind of like the admitted and observation dilemma. You have to know this stuff otherwise you will pay.
Moving along, I forgot plans for prescription drugs or D Coverage. What Tier are your drugs? If they are Tier 1, you can probably get by with Wellcare Classic which is $33 per month with no deductible. Some drugs you may have to pay for. Everything is not 100%. Once you get into the other tiers, there are deductibles and copays. The higher the Tier, the more you have to pay in premiums and copays. Then there is that pesky donut hole of $2500. Once past that your plan kicks in again. Here again, you have to know this stuff otherwise you pay even bigger than normal insurance.
But wait a minute, this is Medicare, right? I forgot, there are co pays when you go to the doctor and also a deductible for the hospital and a deductible for the ER. If you pick the right Supplemental Plan, much of this may disappear. Then too like the PPACA, the better the plan the less the copay and deductible (I am assuming you are beyond the 400% FPL as below such you may qualify for subsidies on plan premiums and deductibles [Silver plans only]). Again, you have to know this stuff.
Medicare is not free and you will pay monthly fees for it and other plans and be subject to deductibles and copays also. It is supported by Medicare taxes which I still pay and also by the GF. You do have to know this stuff so you can make wise decisions. No one is going to choose for you and your knowledge will make for more interesting discussions.
Implicit in your comment is the assumption that there would be no change in how companies attempt to win your business. Greater competition has helped bring more consumer-friendly user interfaces in other industries, lowering search costs and making the buying decisions less onerous. If they want your business, they will attempt to make it easier for you.
Hmmmm:
And you believe this?
“Why has there been no study by mainstream progressive economists about the costs of these proposals of Clintons’, and an explanation of why this would be better than a plan that would, among other things, significantly reduce what are now the very high premiums that employers now pay to private insurers and that employees themselves pay in contributions to the premiums costs and also in copayments and deductibles?”
one assumes Kevin Drum is already on the case no? given his aversion to fantastical numbers and whatnot…
Well, I give Kevin Drum a pass, partly because he’s not himself an economist and partly because he’s really a good guy and is going through a lot, as you probably know.
Krugman? He IS an economist. And is healthy. (At least I hope so.) No pass for him.
Frank:
As one person who has written extensively on healthcare, there is nothing Bernie Sanders or Hillary has written on healthcare today which will reduce the cost of healthcare. Do you want to do is hide it in the backdoor payment of it rather than pay for it up front?
“significantly reduce what are now the very high premiums that employers now pay to private insurers and that employees themselves pay in contributions to the premiums costs and also in copayments and deductibles
Lets examine this statement for a moment as it is a deception. Healthcare Insurance premiums, deductibles, and copays are not the driving cost factor in the cost of healthcare. The cost driver is the Healthcare Industry. No universal, single payer, or European lookalike plan will solve the issue either unless cost controls are put in place controlling what is acceptable in cost coming out of the healthcare industry. Sanders and Clinton can bang out the drums they wish to and blow all the whistles they want to; but, it is not going to happen unless they attack the root cause.
Now the root cause has three folds to it:
– One is “you” who believe you are entitled to every type of medicine and procedure available to mankind regardless of benefit when more proven methods are available. There is a huge clamoring for the usage of procedures and meds that are less likely to work for you. Guess what, by 2020 there will be a step backwards as many of these questionable drugs and procedures will come under greater scrutiny at to effectiveness.
No one wants to understand what is driving the cost of their healthcare nor do they wish to have an idea of what type of healthcare plan they do need. For some of you here it may be less, for others here it may be more, and for those here who have nothing it may be everything; however, should any one group be driving the entire equation? People will pay more attention to the purchase of a car, a new computer, or a new couch than they will the most necessary part of their lives . . . healthcare.
You have to know and running around shouting single payer or universal healthcare means nothing unless you know what it entails. You can join Lee Arnold and Anne at Economists View to get that type of review for healthcare. Ask questions and get knowledge before either candidate gives you what you do not want or need. Remember too, the driver is the healthcare industry and not healthcare insurance which is a small, portion.
Be wary of people who claim someone said something when it turns out he merely reiterated something. I turned to Maggie Mahar about some of this. Here is what she said:
– The Healthcare industry which believes it is entitled to obscene profits mostly based around R&D and being the sole provider (Galiant?). An analysis of Pfizer showed it had little if any R&D expenditures and it has been buying its technology in other company buyouts. So why is it claiming it is entitled to large profits? Because they can still do it and no one will stop them. European countries such as France, Germany, etc. are negotiating these costs with pharma as well as doctors and hospitals. For “any” healthcare plan to work and be effective this has to happen.
One thing which is happening is the consolidation of hospitals and clinics which will give it greater bargaining power with insurance companies beyond name recognition such as John Hopkins. Once this happens, insurance companies will have a larger nut to crack and government should step in and take control of the costs. To see something similar, take a look at the meat packing industry where 4 companies control 82% of it and they drive pricing to ranchers and feedlots (the real issue to The Refuge standoff).
– Insurance companies have the MLR which controls the percent of the premium which “must” be applied to healthcare costs 85% for group and 80 percent for individual. For individuals, the premium is calculated according to the lowest cost individual and ratios are then assigned. 150% maximum for smokers and 300% for older people. If you think this is bad, it used to be far worst up to a denial of coverage. I believe they will still be around even “if” there is a change in how healthcare is delivered. There is more then which needs to be done.
There would have been a “Harry and Louise” campaign regardless of the technical details of any Clinton plan. The Republicans were following Newt Gingrich’s directive that under no circumstances could they allow a success of that magnitude by a Democratic President, because they would lose the Presidency for a generation. Look what they’ve done now with the equivalent (ACA) of the Republican alternative that I believe was the Heritage Foundation plan offered by Lincoln Chafee at the time to prove Republicans did have a plan. The details really didn’t matter. It might have mattered as far as the particular messages of particular commercials were concerned, but no matter how the plan worked it would have been painted, and probably successfully because the money to oppose the plan far outweighed what could have supported any Democratic counter-message, as an assault on our freedom.
There absolutely would have been a “Harry and Louise” ad campaign. My point concerns why it was so successful. The reason: HMO and PPO network requirements and limitations, at a time when these were not the norm.
They sure as hell are now.
My observation is that Hillary has a lot of empathy. I guess it all depends on what the individual sees. It sure seems like almost the entire black community across most of the country agrees with me.
And P.S. To say she has lots of empathy does not mean she has more than Bernie. To me, they both have, for politicians for whom a degree of narcissism is a feature instead of a bug, a high empathy quotient.