As long as the insurance business is in the health-care business costs will continue to be astronomical. If the insurance business can convince the government to pick up the tab, costs will really sky-rocket.

Remember when big Pharma got the bartering-for-drug-prices removed from the recent give-away to them called Medicare Part D - or whatever? Drug prices have since hit the roof. It was when the insurance business got in the health-care business in the first place that health-care costs hit the roof.

McCain's 'solution' is to let the 'free-market' solve the problem - an obvious redundancy. (Hil and Ob? Their plans look like Ptolemy's geo-centric universe after 1200 years of tweaking it to death to make it 'work.')

Affordable? How about some realistic estimates of the cost of universal health care to the taxpayers? Published estimates are all over the place and most of them are just poorly disguised polemics.

There are some facts however.

a) we already spend more per capita on health care than any other country on earth - by a wide margin.

b) in the under 65 group, the sickest 3% consume 50% of monies spent on this group.

c) in the over 65 group, the dying and near dead consume an ungodly percentage of TOTAL monies spent on health care

d) every universal health care in the developed world has been forced to ration limited resources , especially to those in group c)

e) all over Europe universal health care is stressed by skyrocketing costs, with Sarkozy admitting that France can no longer afford it.

Anyone who doesn't get rid of the for profit insurance companies in the middle and push for single payer isn't really serious about universal health care.

What's wrong with this picture. This country is 35th world-wide in the quality of its health care AND that health care is number 1 in cost world-wide.

By the way 'offensivetoyou' your 'c' actually refers to people with incurable illnesses so one has to wonder just how much does it cost to administer pain medication, change the bed of, perhaps feed and bathe a person who is simply waiting to die. Anybody suspect some heavy-duty unnecessary 'doctoring', tests...padding that bill?

Maybe we can live up to that motto, of caring for those that can not care for themselves and those that live in unfortunate circumstance.

Do unto others as you would have others do unto you!

I get nervous when vague terms like affordability are used. Affordable by what standard? We need single payer and those people who truly have no level where premiums are affordable don't get gutted. Affordability varies by location. A person living in Oklahoma making $15/hour has a different level of affordability than one living in New York City and making $15/hour.

I wonder if any plan can truly create an equitable system of affordable premiums.

utahgirl

Both Obama and Clinton or clueless, cowardly or both for not talking about vouchers as part of a private-provider national heath plan. Countries like Germany and the Netherlands, where private insurers are a primary part of a national healthcare mix, all use a voucher system.

So, either stupidity/ignorance or cowardice gives us a "national healthcare" that isn't and won't be.

Krugman, is that YOU with your fingers in your ears and scales over your eyes???? PUHLEEZE, somebody send this man a copy of this report. But, then again, there are none so deaf and blind as those who will not listen or see.

Hillary is tricking America by framing her coverage as "universal health care." In fact, she's imposing mandatory payments to the insurance companies. As pointed out in this excellent thread, it'll CRUSH low income working people. This is the equivalent of the government telling you to send Xerox corporation a check for several hundred dollars each year or they will garnish your wages or send you to jail. It's facism. Giving control of your money to a corporate structure. But shame on me. I'm a registered Democrat and I'm criticizing another registered Democrat's health care policy.

Without mandates, you'll always have free riders. After all, zero costs a lot less than "affordable." And will U.S. society refuse medical care to those who don't buy insurance? How much of a political winner is that. (Someone should ask BO.)

Echoing all those above who reveal how stupid it is to have private insurance companies in the mix at all.

I'm unsurprised but still disappointed that no Presidential candidate has ever admitted the truth about matters like these: "I can't promise to deliver any particular piece of legislation. It's Congress who writes the laws. I can only encourage them to do what's right."

We saw what happened 15 years ago when Hillary popped her health-care surprise cake out of the oven. She didn't include Congress in its baking, so it was DOA at the Hill.

I'm sure both Hillary and Obama as President would be happy to sign whatever s/he got from Congress, providing that it was a real improvement over the status-quo. Right now, the differences between their approaches seem like they'll be of little consequence. --jzap

Let's start with a simple fact- most people who actually need any significant level of health care can't afford that health care. They can only get if they are lucky enough to have insurance where that cost is spread around and shared by a lot of people who don't need that same amount of health care but who are willing to share that cost to avoid the risks presented by a sudden or unexpected health care need. The way health insurance is kept affordable in the current system is to deny it to many of the people who need it most desperately. Both Obama and Clinton have plans to end that travesty. But the problem is ending that travesty is going to increase the costs of health care unless we can find some way to make other people who don't need or want health insurance share the cost of providing health care to those who do need and want it.

How do we make health insurance more affordable? We do so by making more people who don't desperately need it buy into the system so we can spread around the costs of giving it to those who do desperately need it. No one who actually needs health care can afford it. The question is can we as a society afford to share the cost of proividing it for them. If the answer is yes than we must accept that a system with mandates is the only way to do that except for having a single payer system. It is quite simple- any system that allows for everyone to get out of it all the health care they need can only work if everyone is required to share the costs and pay into it. People who claim they have a way to make health care affordable for all without requiring everyone in society to share that cost are living in a fantasy world.

I personally would like to see the for profit health care insurance gone, and as long as it exists prices will be higher than they should be. But it is not going anywhere anytime soon. People are afraid of a non market system and that is just a fact of life. There is no doubt an individual mandate would not be needed if we just collected the money for health care through taxes directly, but the point is that would basically be the same idea as the mandate- everyone has to share the cost. If a mandate is politically unfeasible, then there is no way that people are going to accept having to basically pay the mandate anyway, being limited in their choices by a government program, and having to disregard their dogmatic reverence for the wonders of the free market. It is just not going to happen.

If you want the system to be able to afford to provide everyone the health care you need then you have to have a mechanism to ensure everyone shares the cost. That mechanism can be single payer, or it can be a mandate. Single payer is better in my mind, but a mandate is better than any system without one. If we have any system other than a single payer I believe we are going to be paying more than we should, but I would rather have an imperfect over priced system that at least covered everyone who needed it, than one that doesn't. If we reject a system with mandates then we are rejecting the very basic values that must be embraced before a single payer system can even get on the radar screen. As long as we have a system where not everyone has to pay in and share the cost, then we are going to have to keep some people from getting the care they need. We need to say look- EVERYONE is going to share the cost of providing health care to EVERYONE else. Once we have that settled if people want to spend their money padding the profits of the insurance companies they are free to make that choice, but I am confident once we all accept we are sharing the costs we will quickly decide that a private system of profit driven insurance is just no longer in our price range.

We will be able to afford health care for everyone when we require everyone share the costs of providing that health care. To frame the debate as a choice between affordability and mandates is a false choice that fails to grasp the most basic idea of how a system of health insurance works. It may be true we can't afford a system of private health insurance, but if we are stuck with that anyway; we certainly can better afford that system under the values of shared responsbility and inclusion of all people than under one that does not embrace those core values fully.

Possible compromise:

Obama has proposed that the first $500 of payroll taxes be refunded to employees. Instead, why not put a caveate on this refund that to be eligible you must have at a minimum some sort of healthcare coverage, even if it is bare-bones catastophic coverage plan that has like a $5,000 deductible. If the employee doesn't have such a plan, then that first $500 of payroll taxes would instead be applied to a government operated plan (or possibly to an employer selected private plan).

With this combination, no-one would be in the situation that Obama cites in MA having to pay a fine for not being covered, and still not getting covered. Not getting a tax rebate can't really be classified as a fine or penalty.

I agree, thomaspaine!

From the time I left college, upon which I lost coverage via my parents, I went nearly five years without insurance. It wasn't util the state of Mass. made me buy it, that I finally got covered. Now, I was more than thrilled because my premium was reduced to a mere $90. Before universal coverage was passed, I would have paid over $200 a month. I could have afforded it, but it would have put a big squeeze on my spending. However, I can't look anyone in the eye and honestly say that the reason I didn't have insurance was because I couldn't afford it.

I, like many others my age and others older and younger also, was simply a gambling idiot. I just didn't want to spend the money on it. Looking back, I can see that I was wrong to do that, because I thought all along that I could just show up at the hospital and be taken care of anyway. I was lucky that nothing happened to me then and the people of Mass. were lucky that they didn't have to foot the bill for an irresponsible fool.

Looking past all his glaring flaws, I really appreciated the way Mitt Romney ran in this primary season, framing Mass health reform in conservative terms. Really, why should everyone else pay higher costs because of the irresponsibility of others?

Also, I really do not know what the critics of Mass care are talking about. I think its fabulous and a great benefit for all the hardworking people of the state whose employers do not provide it.

Of course, any plan must define precisely and logically what affordability means. There is no argument there; its commonsense. However, Hillary Clinton and John Edwards were right to advocate for mandates, because that is the only way to cover everyone. They are both right also in comparing it to medicare and social security, which is also mandatory.

Everyone dies and it usually is not peacefully in sleep. Even the old person who is so lucky to go that way, there is no doubt he or she went a lifetime without the need of medical care. Everyone gets sick or hurt. Whether its a sprained ankle or cancer. The uninsured drive up costs for everyone, essentially causing a crisis, in conjunction with unchecked greed of corporate America.

Mandates are the only way to universal care. I love me some Obama, but if he does not support universal care, he should be a man and say it and stop engaging in false advertising. Hopefully, he will come around.

I know there is not a lot of referencing on this particular post but it has been brought up, the comment is FREERIDE. Is this some sort of socialist anti-american bogey word? Are we seriously going to come to the conclusion that we can somehow eliminate so called 'freeriders". Do we have some sort of system set up in this country which puts people in jail or ships them to another country if they don't work as hard as others? Can we really not accept that many in our society as well as every other society in the world has 'freeriders'. Bottom line is that some people work really hard, other not so much, so the issue really is what is the best system to minimize the cost associated with those that have high cost care, those that are left uncared for and regular joe and janes like the rest of us. Isn't it? I know I am oversimplifying but are we not supposed to care fore every American? Would it not be more cost effective to use preventative screening and care so that the healthcare costs can be minimized.

I don't think the debate is moot. I think it's important. And I think that Clinton wins this debate on the merits hands-down because I just don't see that everyone will buy insurance if it's "affordable". As I believe several have posted above, this is about feasibility first and foremost. Is a universal plan feasible without a mandate on all? I think not.

Ocean Kat;

Health care is not manna from heaven. It's represents the time, effort, and money of thousands of very highly trained professionals - doctors who spent 10 unpaid years learning their craft, nurses who have to spend their lives around other peoples' shit, inventors and technicians who invent, build and run the enormously complex diagnostic tools which are at the heart of modern medicine, scientists and businessmen who invent, test, and market the drugs which are equally central, administrators who make sure hospitals run well, janitors, painters, and other craftsmen who do the nuts and bolts maintenance work. They all went to get paid - and paid well. They deserve the money.

Unfortunately, money isn't manna from heaven either. There's only a limited amount of it...so we have no ration services...which means lots of people don't get everything they want and some get thrown out of the boat.

If you're one of the latter - tough. It's always been that way and there's no sign that anyone's figured out a way to change that.

Ellen's Universal Health Plan

1. Anyone who wants health services goes and gets them.

2. Out of general tax revenues or borrowings the federal government pays the provider whatever the federal government feels like paying and bills the patient for 20% of the government's cost. Provider has no claim against the patient.

3. The bill to the patient is a lien on real and business assets and any government payments the patient is due. There's a 10% service charge tacked on if not paid within 6 months. When the balance reaches some amount, the government attaches wages (if the amount is big enough, might even execute on assets), and of course, on any sale or mortgaging of property the lien must be paid off.

4. The lien is not dischargable in bankruptcy (want to avoid paying it? die a pauper).

Worried about the 20% liability? Buy gap insurance.

If enough of us continue to believe in and operate from 'I've got mine and I don't care about anybody else,' the prevalent attitude that began, developed and was nurtured during the Reagan years, our health-care system will stay as it is. Only when and if we care that affordable health care should be available to all will the system change.

Reform isn't going to come out of D.C. - they need the big buck financial support of those profiteering from the present system. We, however, are who have the power to keep them in office or not. It's really up to us.

Using an abstract "Affordibility Schedule" is an inherently flawed construct. There are just too many unique variables that might exist for any one person's or family's situation. So let's face it, any health care reform plan that attemts to use an individual mandate is a fatally flawed approach, both policy-wise and politically (especially the latter).

Attempting to force people to buy an individual insurance policy in a health care landscape dominated by a profit-driven insurance market within the larger dysfunctional health care system is a terrible idea that will not work. Improved Medicare-for-all funded with a progressive tax, on the other hand, makes a lot of sense.

I'm a nurse and health reform activist in Massachusetts and I'm basing these comments on a large amount of data and lived experience; I have in my possession reams of state documents and testimonials that reveal how badly the plan is going here in Massachusetts. If you're interested in teh MA experience, read on, and if not, stop here.

Yes, it's true that in MA >300k people have new insurance coverage under our law but they mostly have FULLY SUBSIDIZED or heavily subsidized coverage. Only 4.14% of the newly insured after this law was implemented starting in Oct 2006 have purchased insurance paying the entire cost themselves.

Most of the uninsured in Mass. CANNOT AFFORD the insurance and are being threatened and intimidated by the state to buy these expensive crappy products. The low income residents are being forced to sign application forms for subsidized insurance that include an "Estate Recovery" clause. State-sponsored extortion, anyone?

It gets worse. For residents with moderate incomes (3x federal poverty level; FPL=10,400 for an individual) the "more affordable" policies have high deductables and big co-pays, and some have 20-30% "co-insurance" meaning after you pay the $2,000-$4,000 deductible you still have to pay 20%-30% of any bills!!

The theoretical model being used for our MA experiment that was created by MIT economist Jon Gruber (who, unfortunately for us, is on the Connector Board that's implementing the law) predicts that 20% of the state's uninsured will fall into the individual mandate "donut hole" where their incomes put them between being eligible for the subsidized plans but earning too little to "afford" to pay the full price for an individual policy, so they will escape the tax fine penalties for being uninsured thru the generous granting of a state waiver to the mandate (official permission to remain uninsured).

The state will be taking money from approximately 300,000 residents using the state dept. of revenue to levy tax fines of up to $912.00 a year simply because these moderate income residents cannot afford to comply with the mandate and purchase full price insurance on their own yet they are not eligible for a waiver.

Thank god Obama gets it and is calling attention to the harmful policy of the individual mandate that's being wrought on the people of Massachusetts.

We are very grateful for Senator Obama's help in getting the truth out and can only hope that his friend Deval Patrick, who happens to be the Governor of Massachusetts, will do the right thing and stop the unfair tax fines against the uninsured in our state.

http://www.HealthCare-Now.org for more info and to get involved in building the movement for single payer Medicare-for-all.

Madison believed that we should have separation of church and state throughout the land, federal and local. There was a fascinating moment during the congressional debate over what became the First Amendment. How could the beloved First Amendment be harmful to religion? Huntington feared that it would overturn or interfere with Connecticut’s approach, which was to have state-supported religion.
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