Obama's HC Plan and Hillary Clinton's, a comparison of tactics
Many mistake Obama's methods for nice or naive. That's probably due to the Clinton machine and unfortunately many pundits have bought into it.
Pundits need to drop the superficial analysis of both candidates and get into real policy and tactical differences.
The way I see Obama's universal HC reform plan, it has nothing to do with being nice or naive. It could be described as checkmate in several moves while controlling the board. It's prosecuting a case where he knows the outcome and just needs to walk the jury there.
Obama does not plan to sit the insurance corporations down at a table and sweet talk them as for example Kevin Drum mistakenly asserts. His plan is to incrementally squeeze them through a series of popular legislative steps, while maintaining public support, and avoiding public backlash. It's not a love-in, it's a well orchestrated power play to get universal HC insurance.
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A critical issue to Health Care Reform is whether to use mandates to force voters to buy HC Insurance.
Mandates are currently the problem in Massachusetts, and a serious issue with Hillary's plan. Mass is a budding disaster on the level of "Leave No Child Behind." It's issued tens of thousands of waivers already due to popular pushback against the mandate. Some orthodox Dems don't want to discuss the problem. Many even bought into the strategy of mandates. But, it's a prime example of how mandating before people are ready, and without sufficient political clout to weather the backlash, is a foolish over reach, and jeopardizes the long term viability of the program.
Hillary's plan mandates from the start. It won't be able to build support or popularize the Gov Insurance program, or significantly fix the private sector, before mandating. In other words, it's a mandate before really establishing a popular option. That's a rather questionable strategy.
That plays to all the memes which get so much traction with moderates necessary to sustain HC reform, like "free market, big government, choice, and personal responsibility" memes. Basically all the high caliber Republican ammo.
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Obama's HC plan doesn't mandate.
He'll subsidize the poor and children from the start. That's a political winner with a Dem Congress, and will score popular support for the program. He'll offer voluntary buy-in to a Gov program, for those early adopters who are going to be the best sales people to the general public. Again, politically viable, and scoring points for the service to build momentum. He'll move to regulate the private sector to force them to end predatory practices and be more efficient. Again, a political winner. Importantly, he's avoiding political backlash which could unravel everything, by avoiding mandates which are politically radioactive. We don't need another failed program and status quo for another decade.
At every step he's building positive brand identity for his program, to expand it. At every step he's in a position of popular political strength, and the insurance companies in positions of political weakness. That's controlling the game and forcing the opponent into a corner.
He's left open the possibility for a mandate later, and has expressed commitment to universal care as the final outcome. But he would only mandate once it was actually viable politically.
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How will the Insurers respond to the Obama plan?
They'll lose customers to the HCI service Obama creates. They'll be under pressure. Their stock prices and profit margins will drop which will continually weaken them. They'll continually be forced to discuss issues of cost efficiency, bonuses, marketing, lobbying, profits, etc. which is a political loser for them. And when a GM, Google, or such buys into the Gov plan, it's be a nail in their coffin. They'll be forced simply by economic pressure to create new markets: i.e. supplemental insurance.
Which is the ultimate destination for them, to get them away from base coverage and into supplemental. They just have to be pushed, hard.
Will they fight? Sure, they'll fight any plan, Obama's or Hillary's.
But against Hillary's mandate they'll have far more ammo, and immediately counter attack against a fledgling program with it's own political problems. With Obama's plan they'll continually lose a battle of attrition against popular legislation.
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Obama's plan isn't naive or sweet. It's the surest way to win by controlling the political support and momentum.
It's Hillary's plan that's so questionable. Can she really just mandate now? Without the time to get the kinks out? Without building popular support for the Gov Program? Before seriously reforming the private insurance industry?
How will voters respond to being forced to either buy into private insurance they can't afford, or buy into a Gov Program they don't know?
Mandates only passed in Mass, and they're already in trouble there. Hillary wants to attempt that on a national scale.
Whose strategy is really superior, and whose is naive?
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Lastly, have the Clintons really learned from past failures? That's often presumed by them on the campaign trail, but where's the proof?
My feeling was always that NAFTA, the failure of 90's HC Reform, and other policy decisions were fundamentally due to their politics and whose counsel they take. Third Way and such. Has that really changed?
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Rather than sound bites about "experience" and "change" I hope people look seriously into these policies, political ideology, counsel, and the different strategies they pursue.
Nicely laid out. My attention hiccupped at first when I thought HC was abbreviation for Hillary Clinton, not Health Care.
Even though I have vague imaginings of straight National-Health type systems, I acknowledge the exisence of (gasp) politics. When the UK established their health care system things were a bit in flux, it's fair to say. We forget how completely society was overturned in the war. Children being relocated to the country, class system in tatters, economy meaningless, etc.
To alter the business landscape as thoroughly as we feel is necessary will be a huge undertaking. I am therefore not put off by some caution in the policy process. There are other issues that do not need caution---war, torture, presidential power, civil liberties, etc. And there arer other commercial issues that can be attacked head-on, such as energy.
December 19, 2007 9:16 AM | Reply | Permalink
"My attention hiccupped at first when I thought HC was abbreviation for Hillary Clinton, not Health Care."
Good point.
Exactly. The same occurred throughout Europe and in Japan as well, and in the American Great Depression producing the New Deal. And to echo your point, those were drastic times which created a political climate which allowed for sweeping changes.
Things are getting bad now due to decades of Reaganomics and other factors. Change is definitly in the air.
But we don't want to blow it again as the Clintons already did once in the 90's, and are looking to over reach and blow it again for all the same reasons.
December 19, 2007 7:05 PM | Reply | Permalink
I have often felt that Clinton's achilles heel is the mandate. I'm a nursing student and I see people who want health care, but can't afford it. I don't see too many people that could have afforded it, but chose to get an Ipod and a cool car instead. So I think HC's plan would spend a lot of time and effort forcing a few people to get something they don't want at the expense of helping the vast majority to want something and cant get it. I have never understood the mindset of the HC camp that say because she has lost this fight already, she is the one with the experience to win it now. To me that is like saying if we ever go into another war we should call GWB back as commander in chief because he has all this experience loosing Iraq and Afgahnistan.
December 19, 2007 10:10 AM | Reply | Permalink
Yes, the Mandate is politically very foolish.
What you're imagining is already happening in Massachusets. It's a disaster, and is going to be the Democratic version of "No Child Left Behind" a mandate that hasn't been thought through and just creates turmoil.
Hillary want to expand that Nationally, which will have a hard time passing, and even if she can pull it off, will be a boondoogle around the Democrat's necks for decades. Which means, in 4 years or so when a Republican is elected, they'll be able to scuttle the HCI reform or turn it into something like Medicare-D.
Wrong wrong wrong idea.
December 19, 2007 7:10 PM | Reply | Permalink
Gotta disagree. Dead wrong. Krugman and Maggie have explained the basic economics, so let me just focus on the claim that this more than mandates threatens the insurers. If people do not have to buy, those who can afford to buy are more likely to do so, often the same people who are less price sensitive and/or more scared of big government. Also covered will be those already covered. Either way, there's less pressure to abandon private insurers for a Medicare clone.
Now throw into the pool a horde or people that private insurers make money by excluding, and now the private insurer has to compete with Medicare on an even footing. They're dead. So while I think you need to go back over the other reasons why only universal coverage leads to universal coverage, consider that universal is much more likely to drive out the private sector. That's one reason Krugman indeed gave for backing Edwards's plan.
Now, I'll qualify it. I should start another thread on this or plead for Maggie back to start one. But the lesson of the subprime scam is that it's not too hard to trick people into acting counter to their interest. So really only single payer can truly stop harm to the uninsured. One could argue that the result will be a meltdown like the present one, so again a disaster for private insurers, but still, it's a problem that fans of either approach, Obama's or Edwards's, might wish to discuss.
John
http://www.haberarts.com/
December 19, 2007 10:34 AM | Reply | Permalink
Krugman you should realize is wrong more often than not on big issues. Whenever the Dem party has really blundered, Krugman has been there cheerleading.
He was a big proponent of NAFTA, said it was all going to be milk and honey. He bought into ENRON and deregulation, and totally missed how dangerous it was and the inherent danger of fraud and massive scale rent seeking activities. He was actually a paid consultant and speaker for ENRON, to the tune of $50K. I could go on.
The last big thing he got right was the housing bubble, when he actually stuck his neck out and showed some courage. Unfortunately, he's been back peddling ever since becasue he couldn't stand the heat. Now that his predictions are coming true, the irony is he distanced himself from them years ago. He's frankly rather a coward.
Keep in mind we're coming off decades of Reaganomics, the Chicago school, and generally pro-corporate, anti-regulation, market worship as religion. Keep in mind even much of the Dems bought into that, and now it's ingrained. The Clinton's "3rd Way" which includes people like Krugman, and Lieberman, is all about that.
So, just keep in mind, Krugman has some of the good qualities you'll find in the Clintons, and the bad. Hearing Krugman endorse the Clintons is like the Clintons endorse the Clintons. He made all their mistakes with them. You shouldn't put much weight in it.
December 19, 2007 7:28 PM | Reply | Permalink
On your assertions:
First of all, people who can afford to buy mostly already are, they're just getting ripped off. The fairly small number of people who can afford it but don't, are largely motivated by the ridiculous costs of present HCI. Give them an option to buy into Medicare and they will, voluntarily.
People who can't afford to buy, can't. Period.
Mandating people to buy won't help, it'll just create a political fiasco as we already see in Mass, with tens of thousands of exemptions and massive political pushback. People don't like being forced, and it's foolish when you don't need to but can just structure it so they buy in, with subsidies, and as it builds brand identity and reputation.
Later, when the system is established and the kinks worked out, when it's known and popular, and when it's only the goof balls and holdouts who still don't have HCI, THEN you mandate. That's the finale, not the opening act.
Which was the whole point of what I already wrote, if you read it. Cal it a virtous cycle.
The difference is, you don't need a mandate to do it, and a mandate is actually a liability.
Maggie Mahar is wrong about mandates, and wrong about Mass. Frankly, she has spent too much time with insurance companies. She's become an advocate of non-profit private insurers, ignoring their many other problems of inefficiency.
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To establish the virtuous cycle, all you need is to:
1) Allow voluntary buy in to excellent Gov HCI, which is going to be as good as any PPO or HMO, allow people to get the best hospitals and doctors, and will cost less becasue Medicare is far more efficient. Both Hillary and Obama offer than.
Large numbers of professional and working class, upper class and middle class, Dems and moderates, and even Republicans, will want to buy in to Medicare. Then those people will become your sales people.
2) Subsidize the poor and children. That's a political winner, and allows people who can't afford it to get HCI, which allows them preventative and child health care, which is in our national interest, and will actually drive down costs by freeing up emergency rooms and increasing economic productivity.
3) Avoid mandates! Nobody can complain becasue nobody was forced. there won;t be any snafus of mandating people buy, and failing to subsidize them if they're too poor, and such dangerous risks in Hillary's plan, which are already happening in Mass. Republicans can't complain it's forcing big government. People will voluntarily join the virtuous cycle. Just the other day I met a working class guy who was paying $350/month for HCI, and was dying to buy into Medicare.
No, Universal Coverage from day 1 requires mandates, which are politically disastrous, like "No Child Left Behind." The sureest way to sabotage Universal Care is to do it politically incompetently, just as the Clintons already did once. It should be mentioned the Clintons have been politically "successful" when they capitulated to Corporate America on issues like NAFATA, but have been lousy on actually progressive reform.
The surest way to get Universal Care, is to follow the incremental steps I outlined in the main post, which always maintain the political popularity of the program, and create a compelling virtuous cycle, while avoiding reckless moves like mandates and technical snafus that will alienate people from a Gov plan and give ammo to critics.
December 19, 2007 8:17 PM | Reply | Permalink