cross-posted on dailykos

Hillary Clinton gets it.  Oddly, so many of us here don't.  It's the Medicare-like buy-in option.  Many people here were certain Hillary Clinton wouldn't offer them the Medicare buy-in option, and yet, I was sure she had said she would.  It's in the literture: "If you have a plan you like, you keep it. If you want to change plans or aren't currently covered, you can choose from dozens of the same plans available to members of Congress, or you can opt into a public plan option like Medicare. And working families will get tax credits to help pay their premiums." Still, there was a definite sense of uncertainty, so just to be sure I emailed Ann Lewis and asked her, can everyone buy in to the public plan?

And, here's what she told me, "Everyone will be able to buy into a Medicare-type program." 

That's significant because unlike the Massachusetts plan that does not have a provision for buying into the public plan(I know, I asked, I would have bought-in like I suspect most Massachusetts residents who didn't qualify for the subsidized insurance program), Hillary's plan ensures that private insurance companies will have to compete with one of the most successful government programs you've never had access to before.  

To me, the understated Medicare opt-in is all that really matters.  It's a path to single or quasi-single payer healthcare if ever there was one.  And, it's packaged so well that people on both sides of the political ailse seem relatively happy with it.  See, it's like the name of the plan "American Health Choices Plan".  You want government administered health coverage, choose it.  It's quite brilliant.

Now, we could still just end up passing Medicare for All with Hillary at the helm.  She hasn't ruled it out.  According to Ben Smith at Politico:
"Clinton was asked directly about the relative modesty of her approach in a revealing, unpublicized New York talk in April, in which a board member of the Community Service Society of New York, Jonathan Greenberg, asked her why she "continue[s] to see the solution" as private insurance, rather than a single-payer national system. "Well, I didn't say that," Clinton responded, to the audience's apparent surprise. But she added that "for the short term, it'll probably have to build on the employer-based system, but with a lot of changes in how it operates and what the insurance companies are expected to do." She also proposed providing "options to people to buy into government health care." A far broader program known as "Medicare for All," she said, "would be something to be considered" if Democrats can win at least 55 seats in the Senate.""

Andrew Cline at the American Prospect argues "If she had the votes in Congress to push single-payer health care, she'd do it before you could turn your head and cough." Sounds good to me.  Ultimately, it's up to Congress.  As "Laurie Rubiner, Clinton's top health-care policy adviser, told the Washington Post, Clinton would let Congress work out the details. "We're going to leave a lot of this to the congressional committees," she said." Mhmm.  So we either are going to have a regulated large insurance pool with a public option buy-in, or better yet, when this issue finally gets debated, and we have Hillary in place, and if we have enough of a bottom up movement to support it, we'll pass Medicare for All.

I'm often stunned by people who argue that it is Hillary who will cower to insurers.  She's the only one talking about eliminating subsidies to private insurers through Medicare.  She mentioned this in her webcast last night, and this according to AIS Health Care.com(a "health care managers" information website)"Perhaps most ominously, Clinton says that "we have to crack down on the overpayments in Medicare to private plans. Those plan payment rates are around 12% higher than Medicare traditionally pays to treat the same beneficiaries. Reducing those overpayments could save Medicare $10 billion to $20 billion.a year."" 

And, consider this recent exchange between Hillary and an audience member at the National Association of Black Journalists conference, according to the New York Times.:"The audience member - who later identified himself as Kiara Ashanti, a freelance writer and blogger and a Republican - asked Mrs. Clinton why she was "still insisting" on bringing British- and Canada-style "socialized medicine" to the United States, asserting that such forms of universal care would hurt the black community. "Oh man, I can't answer that in 30 seconds, that was a string ofmisrepresentations," Mrs. Clinton, a Democratic presidential candidate, told the gathering of more than 1,000 black reporters, editors, and other journalists.
"I have never advocated socialized medicine, and I hope all the journalists hear that," she said. "That has been a right-wing attack on me for 15 years." Mr. Ashanti interrupted her with persistent criticism of government-run health care; Mrs. Clinton challenged him at one, asking if he thought Medicare was socialized medicine, and he indicated that he did. "You are in a small minority of America, because Medicare has literally saved the lives and saved the resources of countless generations of Americans," she said. Mrs. Clinton praised the health systems in Canada, Britain, and elsewhere in Europe as having better outcomes and results on some performance measures than the United States. Then she offered to share her statistics with the if he wanted to introduce himself to her staff. That is, she added, "if you're interested in being educated instead of being rhetorical."" Does that sound like someone who highly values insurance companies?  

And, then, there's Hillary's recent SCHIP proposal, which Bob Novak labeled her "grand design".  Novak describes Hillary as a "principal sponsor" and calls her amendment a "massive expansion""furthering her promise of "step by step" advancement toward universal health care." Novak claims, "The overall effect would make three out of four American children accustomed to relying on government care no matter what course their parents take. In sum, SCHIP turns out to be socialized medicine for "kids" (and many adults)." So, Hillary is already working toward government funded healthcare.  In fact, the SCHIP amendment provided the perfect testing ground for the public's reaction to federally funded healthcare.  Bush took up the issue, waged war on it, arguing the expansion represented "a step "down the path to government-run health care for every American." And, like all of Bush's wars, he basically lost.  Most americans were unmoved by Bush's scare tactics.

So, when I see Hillary's health plan, I see a path toward single payer or some sort of quasi-system popular in Europe.  

Articles sited:
http://www.spectator.org/dsp_article.asp ?art_id=12035
http://thecaucus.blogs.nytimes.com/2007/ 08/09/a-testy-exchange-on-health-care/
http://www.realclearpolitics.com/article s/2007/06/socialized_medicine_for_kids.h tml
http://www.nytimes.com/2007/07/23/washin gton/23health.html?_r=2&hp&oref= slogin&oref=slogin