The 20% (Of All Of Us) Obama Can't Afford To Abandon or Lose
by architek, Sun Jun 08, 2008 at 03:53:55 PM EDT
Last night I was reading another story about how, EVEN now - when Hillary Clinton has bowed to pressure and endorsed Obama, still, approximately 20% of the likely Democratic voters
refuse to say they will vote for him.
Well, that 20% figure keeps coming up again and again, and I think that it represents the 20% of Americans who have chronic illnesses. As we know from Austan Goolsbee, Obama's healthcare plan, like Jim Cooper's 1994 plan, Tenncare, and the MA state healthcare plan, a consistent 20% of those currently uninsured are uninsured because chronic illnesses have rendered insurance very expensive for them.
That 20% are the chronically ill and many of them are also the so called 'uninsurables'. Basically, they are people with often common, but increasingly expensive illnesses. Their only common denominator is that as the price of drugs rises, and the political and economic clout of the American middle class declines, their often manageable conditions are increasingly seen as costing 'too much' to treat by insurers. Which means that people who were doing okay last year, find that this year, they get left out in the cold, abandoned.
And apparently, also abandoned by Obama. (Hillary would have covered them, and limited out of pocket, uncovered expenses too, which means the difference between bankruptcy and solvency for millions of people)
These illnesses can be common illnesses like athsma, hypertension, etc. but they typically require drugs to manage them. When people lose their jobs, if they dont find another job in a short period of time, and COBRA runs out, or they cant afford to pay the full cost of their insurance, which is often more than they realize it is, then they become forced to look for insurance on the so called open market. Everyone who shops for individual insurance pays a lot, but some find it almost impossible to get. basically, that group is everyone who has been using the healthcare benefits, sometimes even the perfectly healthy. People who have been to the doctor more than around once a year often find that they have to pay more for insurance. Obama basically classifies normal families as families without health issues.
What happens, though when you don't have a chronic illness, but you have seen the doctor for things that come up. Self employed or even employed people whose employers dont buy insurance for them, people who have had spider bites or people who have called the doctor over minor medical issues find themselves paying far more for insurance.
This is perfectly legal, just like charging people more for drivers insurance who have tickets is. It enables the insurance companies to charge 'normal families' less, they say.
They feel that this is not 'discrimination' it is how the insurance business works. (But it has the effect of making middle class people these days terrified of seeing the doctor. THAT IS NOT THE WAY THINGS SHOULD BE! But it is, and even if Obama can overcome the WTO rules and implement his plan in 2012, Obama proposes to keep it that way. Insurance is priced by risk, to the insurer. Or if he forces them to insure everyone who asks of the same age at the same price, insurance costs will go up a lot of everyone. Thats the obscene cost of not havig a mandate! Its unavoidable!)
That is the hard reality of risk-priced insurance.
But, what about the 20%? Again, that 20% isn't just the stubborn. Its the same percentage of us who know we are being abandoned. yes, we are expensive. But more and more people fall into the category every year. You may be well now, but its likely that even you, the reader, will be one of us soon. We are all in that 20%.
That includes both those who to insurance companies are 'uninsurable', and those who they might insure, if they paid what they consider to be a fair price. (The raw cost to treat them plus the profit margin, plus a buffer that is related to the likelihood of a flareup that could cost still more)
That is what Elizabeth Edwards was talking about when she mentioned that neither she nor Senator McCain would be able to buy insurance if they were not rich. Why? Because both she and Senator McCain are cancer survivors. Once somebody has had cancer, they find it hard to switch jobs, they cant do anything that risks a period in which they dont have insurance. If they get laid off, they often find it very hard - often impossible to find insurance because they are not a risk, they are a known loss.
Thats why Hillary's mandate was such a great idea because IT WOULD HAVE ENABLED A PLAN THAT WOULD COVER THAT ONE FIFTH OF US WHO HAVE CHRONIC ILLNESS.
Now, Obama's advisor Austan Goolsbee
said that neither Obama nor Hillary could afford to do it, but Hillary did the math and showed that she could, with her mandate. Nobody is arguing that it is possible any other way.
Not even presumptuous nominee Obama.
What I find is interesting, is that THAT 20% seems suspiciusly close to the 20% who refuse to vote against their own interests and vote for a small chance for adoption, eventually of a healthcare plan that probably will not help them! Can you blame them!? NO.
Would you put a loaded gun to your own head and pull the trigger?
Again and again, we see this 20% figure.. for example..
"On the campaign trail, Mrs. Clinton has attacked Mr. Obama for his plan, saying it betrays the Democratic principle of universal coverage. Her campaign has demanded that he take down an advertisement that claims his plan "covers everyone."
Mr. Obama has replied that her attacks are more about politics than substance; they didn't come, he noted, until she lost ground in the polls. But his advisers don't dispute her central charge. Rather, they claim Mrs. Clinton's plan would also"leave millions without coverage".
Then, today, we see another 20% reference - "Obama's bounce is the result of growing unity among the Democratic Party. Eighty-one percent (81%) of Democrats say they will vote for Obama over McCain. That's the highest level of party support ever enjoyed by Obama. Still, three-out-of-ten voters are either uncommitted or could change their mind before Election Day. Fifty-six percent (56%) of those swayable voters are women and most earn less than $60,000 a year."
Obama adviser Austan Goolsbee argues that if Mrs. Clinton's health plan is enacted, she will have to waive the mandate for millions of people. That is because, he says, there isn't enough money for subsidies to make health insurance affordable enough for people to buy it.
"You can't put in a mandate until health care is affordable," he says. He predicted that a Hillary Clinton administration would wind up exempting 20% of the uninsured, or about 10 million people. That is the percentage of uninsured adults who were exempted in Massachusetts, the only state to try an individual mandate.
That view may not be true. Ken Thorpe, a health-policy expert at Emory University who has advised all three major Democrats, said he ran cost estimates for the Clinton plan at the Clinton campaign's request, and found there should be enough money to make insurance affordable for all. He said he ran three scenarios with varying levels of subsidies -- from $100 billion a year to $120 billion a year. The campaign chose one in the middle: $110 billion.
If it turns out that isn't enough money to make health premiums affordable, Mrs. Clinton would have to spend more on subsidies, one of her health-care advisers said.
But, the adviser said, it is wrong to assume that 20% of Americans will be exempted. It is impossible to say for certain, because the campaign has not explained how large the subsidies will be or who will qualify for them.
The Obama plan does some other things to get people insurance. It allows adults up to age 25 to stay on their parents' insurance even if they aren't in school. And it attempts to lower the cost of insurance overall through a reinsurance plan, whereby the federal government would cover some expenses of some of the most costly patients.
Outside experts note that the Clinton and Obama plans propose spending about the same amount of money, while Mr. Obama uses some of his to pay for the reinsurance plan -- an initiative that could cost tens of billions of dollars. That should help lower premiums across the board, but it means there would be less available for direct subsidies."
also read this from 1994, Episode 1 of the universal healthcare saga.. This is an election post-mortem by Columbia Journalism Review lamenting the lack of objective coverage on the two health plans, Clintons and Cooper's "Clinton-lite".
"But what was missing from the coverage of Cooper's bill was solid analysis of how the bill would affect ordinary people -- analysis the polls say the public wants. As of late December CJR found no stories that explained how the plan would affect those Americans who are not insured and who still might not be if Cooper's plan becomes law. There was not even agreement among news stories on the number of people the plan would leave without insurance. The Palm BeachPost reported that Cooper "predicted [his plan] would provide insurance to nearly as many of the 37 million uninsured Americans as Clinton's plan." (Clinton's plan covers 100 percent of the uninsured.) The Washington Post quoted Cooper as saying his plan would cover "60 percent of the uninsured" (leaving 40 percent uncovered), while the Los Angeles Times noted that, "by Cooper's own estimate, the bill would not cover about one-fifth (or 20 percent) of those currently lacking health insurance."
No one pinned Cooper down on the numbers or interpreted them through the pocketbooks of families who would be affected. The bill calls for subsidies to help some families buy insurance, but what would happen if a family was too rich for the subsidies but too poor to buy coverage on its own? How would the family get insurance? Plenty of stories, however, quoted Cooper's solution: come back in a few years and pass another law to help these people out.
"Where were the stories that examined whether the Cooper plan would actually reduce costs of the health care system? Health care purchasing cooperatives are the main instrument of cost containment, but in Cooper's plan only employers with fewer than 100 workers are required to obtain coverage through them, if they want to continue deducting the cost of health insurance for their workers. This arrangement would leave all other employers free to operate outside the mechanism for curtailing costs and to continue the status quo, if they wished. The Congressional Budget Office found that the earlier version of Cooper's bill would actually increase costs of the health care system, at least initially, a point reported by The New York times and The Washington Post in February 1993, but ignored in the latest wave of Cooper promotional pieces."
('Come back in a few years', eh?
We thought that is what we were doing this time around. We have waited since 1994, how long will the next wait be?
I think that persistant 20% represents the people who realize they may have to wait forever if we dont attack this problem now.
Wait a few years, eh?
Thats the same solution as the one Obama seems to be proposing by default, since he has not made any committment at all to the chronically ill. In fact, logic dictates that reductions in cost for the 'normal family' he mentions may come at the cost of INCREASING costs to the chronically ill. (Plus, he will have to overcome the hurdle of renegotiating WTO agreements that prohibit many cost cutting proposals like setting up an alternative healthcare system competing with private industry, which industries are going to say discriminates against them.)
I am looking for more info besides the Public Citizen report on the WTO agreement and how it regulates industries involved in foreign trade.
There isn't much on the net. I will post more as I find them.
see page 33 material on GATS Article VIII, Monopolies and Exclusive Service Suppliers
American Journal of Public Health.. Global Trade and Public Health -- Shaffer et al. 95 (1): 23 ...