I'll respond to some of the specific points in a minute, but the overall politics of pissing on less-than-perfection gives me deja vu. Back in 1994 I worked around the Prop 186 "Single-Payer Health Care for All" initiative in California. My girlfriend was the statewide administrative director and I campaigned for and developed the Internet site for the campaign. It was a great plan, progressive and comprehensive. And it got 28% of the vote with millions spent by the campaign for its passage. There were a lot of problems with the campaign strategy but the bottom-line was that it was incredibly hard to sell such a comprehensive change all at once.
And I remember before its defeat most of the single-payer advocates attacking Clinton's plan as inadequate (and his plan was better than Bradley's). So between the insurance company full-out assault on the Clinton plan and the Left's failure to mobilize for passage of anything less than single-payer, no majority for any health care plan emerged. And all the single-payer advocates who said good riddance to the Clinton plan were shocked to see single-payer go down to defeat at the polls -- and the end result was a worsening health care crisis for the poor and uninsured.
Bradley is advocating increasing health care funding by $55-65 billion PER YEAR. We have not seen any serious social programs on that order of funding in decades and folks seem hell-bent on dismissing it out of hand. Paul Wellstone was the only sponsor of Single Payer health in the Senate and he has endorsed Bradley partly because of his support for universal health care. God knows, I wish it was Wellstone running on Single Payer, but we have Bradley arguing for $60 billion per year to subsidize health care for the poor and low-income workers.
Let's be clear what is included in Bradley's plan:
** Every family with incomes under $32,800 per year would receive $1200 per child to pay the premiums for their health care insurance. They could use it for their employer-based health care if available or automatically qualify for the Federal Employees Health Benefits Program (FEHBP) which all Congressman and other federal employees use for their health care. Note all children currently on Medicaid will be fully subsidized for their health care premiums.
** Families up to income $49,200 per year would receive subsidies for the purchase of insurance for their children.
** Adults in families with income up to $16,400 per year would receive $1800 per adult and up to $5000 per family for premiums. This is a higher income threshold than the basic federal Medicaid level- which is as low as 60% of the poverty level in many states.
** Adults in families with income up to $32,800 would receives partial subsidies for purchase of insurance. For all such families, prenatal care would be completely subsidized.
** Creates a prescription drug option for Medicare for $25 per month with a 25% copay
Now this is not the millenium but it is a solid improvement for a whole host of families in the country.
So now for the specific criticisms:
> [From the December Progressive Magazine]
> WRONG PRESCRIPTION
> Bill Bradley's Health Plan Is No Cure
> Bradley's plan has already been endorsed by Chip Kahn, president of
> the powerful lobbying group the Health Insurance Association of
> America. And little wonder: Insurance companies and HMOs stand to gain
> billions of tax dollars from the Bradley plan, while Americans would
> still have no right to health care.
Yep, as I believe the Prime Minister of England said in explaining how he silenced doctor's opposition to the National Health Service there, he answered, "We filled their mouths with gold." A percentage of the $60 billion per year for this proposal will go straight to the profits of the insurance companies, but if that gets health care for people dying without it, so be it. We can mount the next political campaign highlighting those profits to argue for a single-payer alternative, but for now this is the best chance for real health care for a lot of people.
> Meanwhile, Al Gore would not guarantee the right to health care
> either.
This is frankly false. As noted above, for low-income children, there is as real a guarantee as you get and probably a promise of far better care than they get on Medicaid (when they qualify) since they will have access to the federal system of health care funds.
> Bradley's plan relies on tax credits and a new federal bureaucracy to
> help poor families afford children's coverage. The subsidies would
> tempt employers to drop coverage of employees and their children but
> wouldn't be adequate to help many low- and middle-income families buy
> private coverage.
Most of those at the income level qualifying for the tax subsidies don't receive much employer-based coverage. And if some people are switched from employer-based to a government-subsidized plan, that is probably a strategic gain for moving to a single-payer plan since people's ties to their employer-plan was the big obstacle/fear of it. I just don't buy that too many employers will cut coverage more than the subsidies increase. The employers that do provide health coverage now will have the same incentives to provide at least similar levels of health care for their employees. Under the Bradley plan the subsidies are set up by income level, so employer shifts will just increase spending on the plan.
> As for the poor elderly who receive help from Medicaid with nursing
> home and long-term care costs, Bradley would simply end thirty years
> of joint state and federal responsibility for their care and turn this
> over to the states completely (just in time for the boomers'
> retirement). Bradley would do the same for the disabled, risking the
> loss of the safety net for this vulnerable community.
This statement implies that federal funding would end which is false. The funding (hardly great currently) would continue probably in the same Medicaid-style plans currently administered by the states. It is worth remembering that most states already largely run Medicaid programs in their states with wide variations between states. Bradley's plan includes an expansion of home health care services for the elderly under Medicare.
> With premiums rising at 8 percent per year, poor adults with Bradley's
> fixed tax subsidies or skimpy vouchers would be able to afford only
> the cheapest plans (mainly HMOs) in the Federal Employees Health
> Benefits Program, not the high-end coverage that members of Congress
> receive.
Probably true but no doubt better than the Medicaid care currently suffered by the minority of poor folks who qualify for Medicaid.
> While traditional Medicaid is a program of uneven quality, with large
> variations by state, the record of for-profit HMOs in treating
> Medicaid patients has clearly been worse.
Take the same money for Medicaid and put folks in an HMO and I'll be the first one to argue the result will be poorer care. But the Bradley plan is a significant expansion of the funds for low-income health care. $1200 per child and $1800 per adult -- $5000 per family -- is a very respectable amount for purchasing health care. The amounts could be cut but so can Medicaid funding. Note that the above comment is about cost-cutting happening now in Medicaid.
To repeat, Bradley is advocating increasing federal funding for low-income health care by $60 billion PER YEAR. We should be welcoming that with open arms and spend our time advocating for rules that lock-in the full premium cost for the future -- locked in medical inflation adjustments, whatever.
But at least the principle and some of the money is there that everyone should have health care coverage. That is a vast improvement on the status quo.
-- Nathan Newman