The Disappearance of Hillary Clinton's Healthcare Platform
Published on
Wednesday, March 30, 2016
by
Common Dreams
The Disappearance of Hillary Clinton's Healthcare Platform
What would happen if the media lifted the curtain on Clinton's healthcare
platform and introduced any level of scrutiny to her proposed improvements
on the Affordable Care Act?
by
Benjamin Day
(Photo: Reuters/Corbis)
In an extraordinary magic trick, performed on a national scale, Hillary
Clinton's healthcare platform has been disappeared. While policy analysts,
news anchors, and columnists have been engaged in an intense debate over
Bernie Sanders's "Medicare for All" proposal, Clinton's incremental
alternative has escaped almost all scrutiny - even among those who say they
prefer it.
Combining the election-season writings of our most prolific, liberal-leaning
columnists at the New York Times, Huffington Post, Vox, Mother Jones,
Politico, The American Prospect, etc. you'll find dozens of articles
critiquing Sanders's single-payer plan. None have mentioned a single Clinton
healthcare proposal as a point of comparison - merely that she supports a
philosphy of incremental reform.
Take Paul Krugman, a high-profile advocate of Clinton's approach to
healthcare reform. Krugman has published two op-eds in the New York Times
and five additional blog posts arguing that "[progressives] should seek
incremental change on health care... and focus their main efforts on other
issues - that is... Bernie Sanders is wrong about this and Hillary Clinton
is right." In all seven pieces, Krugman focuses exclusively on Sanders's
single-payer proposal and fails to mention even a single Clinton policy.
The disappearance of the Clinton healthcare platform has even been carried
out by pollsters. The Kaiser Health Tracking Survey included a bizarre
question in its February 2016 poll, which was widely cited in the press.
Respondents were asked to pick one of four possible directions for the
future of U.S. healthcare. Among the choices were "The U.S. should establish
guaranteed universal coverage through a single government plan" and
"Lawmakers should build on the existing health care law to improve
affordability and access to care." Thirty-three percent of Democrats chose
the single-payer option, while fifty-four percent chose the incremental
option. The questions were clearly intended as stand-ins for the Sanders and
Clinton healthcare proposals, but note that the single-payer option is a
policy, whereas the incremental option mentions no actual policies, but asks
respondents whether they support the (universally desirable) outcomes of
improving affordability and access.
What would happen if the media lifted the curtain on Clinton's healthcare
platform and introduced any level of scrutiny to her proposed improvements
on the Affordable Care Act? They would find two categories of Clinton
proposals: some that are so vague they're difficult to evaluate, and other
more concrete plans that follow in the footsteps of one of Congress's most
practiced healthcare incrementalists: Senator Bernie Sanders.
For example, one of Clinton's clearest incremental proposals is to repeal
the Affordable Care Act's poorly named "cadillac tax" on health plans with
high premiums. She announced this proposal on September 29, drawing the ire
of White House spokespeople. The move, however, followed in the footsteps of
a Senate bill to repeal the Cadillac tax introduced by Bernie Sanders and
seven Democratic Senators just a few days previously on September 24.
Clinton's position was correctly seen by reporters as necessary if she
didn't want to lose labor union support to Sanders.
"Because Clinton's healthcare platform has received zero public scrutiny,
she has had the luxury of floating other policy ideas in broad outlines, too
vague to evaluate."Many of Clinton's well-defined healthcare proposals are
rolled into a package of prescription drug reforms, which she released on
September 22, 2015. They bear a striking resemblance to the Sanders
prescription drug plan announced on September 1, filed as legislation on
September 10. Both would legalize importation of prescription drugs from
Canada, where costs for identical drugs are much lower due to Canada's
single-payer healthcare system. Sanders was a pioneer of importation, and in
1999 started driving busloads of American patients who couldn't afford
breast cancer drugs across the Canadian border. Both candidates call for
empowering Medicare to negotiate drug prices - even Donald Trump jumped on
board in January. Both would ban "pay-for-delay" deals between brand-name
and generic drug makers, and increase prescription drug rebates for Medicaid
and/or Medicare.
Because Clinton's healthcare platform has received zero public scrutiny, she
has had the luxury of floating other policy ideas in broad outlines, too
vague to evaluate. Take the proposal to expand the use of Accountable Care
Organizations. How? According to Clinton's December policy brief: "In the
coming months, [Clinton] will provide full detail on her plans for delivery
system reforms that drive down costs." With the primaries drawing to a
close, no such details have been released. The same could be said of another
proposal to "create a fallback process" to review insurance premium rate
hikes in states that don't already review rates. There has been no
explanation of how such a plan would work, or whether it would require new
legislation.
This is the double standard at work in almost all national coverage of
Clinton and Sanders on healthcare reform: Clinton has been taken at her word
that her incremental plans will be politically feasible, succeed in
improving affordability and access to care, and are not shared by her
opponent. Sanders on the other hand received intense public pressure to
release details of his single-payer healthcare proposal, and when he did the
proposal was subject to an avalanche of public analysis and scrutiny.
This double standard is all the more remarkable because single-payer
healthcare is an established policy, practiced in one form or another in
almost every developed nation in the world. Incremental reforms that work
within the market-based healthcare system of the U.S. are far more
uncertain, and deserve greater scrutiny. They are easier to enact but
dramatically more likely to fall short of their goals. This is because
incremental reforms in the United States usually focus on expanding access
to care, without significant cost controls, in order to avoid opposition
from the healthcare industry. The resulting policies are often
unsustainable; make little headway against national trends of rising costs
and eroding access; or simply move costs around (e.g. from premiums to
deductibles and co-payments, or vice versa).
Previous national trends in incremental healthcare reform - from managed
care through pharmacy benefit management, chronic disease management, narrow
networks, and beyond - have often created lucrative new industries, but had
dubious impacts on underlying healthcare costs or access to care. Most of
Clinton's healthcare platform falls exactly into these danger zones, and
should be received with a critical eye.
The national discussion of single-payer healthcare reform is long overdue.
However, when the full range of national media outlets force one candidate
to run on real policies, while allowing another to run on values and
aspirations, we aren't having a real discussion of systemic vs. incremental
reform, we are merely aiding the corrosion of informed democracy.
This work is licensed under a Creative Commons Attribution-Share Alike 3.0
License
Benjamin Day
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The Disappearance of Hillary Clinton's Healthcare Platform
Published on
Wednesday, March 30, 2016
by
Common Dreams
The Disappearance of Hillary Clinton's Healthcare Platform
What would happen if the media lifted the curtain on Clinton's healthcare
platform and introduced any level of scrutiny to her proposed improvements
on the Affordable Care Act?
by
Benjamin Day
. 21 Comments
.
. (Photo: Reuters/Corbis)
. In an extraordinary magic trick, performed on a national scale,
Hillary Clinton's healthcare platform has been disappeared. While policy
analysts, news anchors, and columnists have been engaged in an intense
debate over Bernie Sanders's "Medicare for All" proposal, Clinton's
incremental alternative has escaped almost all scrutiny - even among those
who say they prefer it.
Combining the election-season writings of our most prolific, liberal-leaning
columnists at the New York Times, Huffington Post, Vox, Mother Jones,
Politico, The American Prospect, etc. you'll find dozens of articles
critiquing Sanders's single-payer plan. None have mentioned a single Clinton
healthcare proposal as a point of comparison - merely that she supports a
philosphy of incremental reform.
Take Paul Krugman, a high-profile advocate of Clinton's approach to
healthcare reform. Krugman has published two op-eds in the New York Times
and five additional blog posts arguing that "[progressives] should seek
incremental change on health care... and focus their main efforts on other
issues - that is... Bernie Sanders is wrong about this and Hillary Clinton
is right." In all seven pieces, Krugman focuses exclusively on Sanders's
single-payer proposal and fails to mention even a single Clinton policy.
The disappearance of the Clinton healthcare platform has even been carried
out by pollsters. The Kaiser Health Tracking Survey included a bizarre
question in its February 2016 poll, which was widely cited in the press.
Respondents were asked to pick one of four possible directions for the
future of U.S. healthcare. Among the choices were "The U.S. should establish
guaranteed universal coverage through a single government plan" and
"Lawmakers should build on the existing health care law to improve
affordability and access to care." Thirty-three percent of Democrats chose
the single-payer option, while fifty-four percent chose the incremental
option. The questions were clearly intended as stand-ins for the Sanders and
Clinton healthcare proposals, but note that the single-payer option is a
policy, whereas the incremental option mentions no actual policies, but asks
respondents whether they support the (universally desirable) outcomes of
improving affordability and access.
What would happen if the media lifted the curtain on Clinton's healthcare
platform and introduced any level of scrutiny to her proposed improvements
on the Affordable Care Act? They would find two categories of Clinton
proposals: some that are so vague they're difficult to evaluate, and other
more concrete plans that follow in the footsteps of one of Congress's most
practiced healthcare incrementalists: Senator Bernie Sanders.
For example, one of Clinton's clearest incremental proposals is to repeal
the Affordable Care Act's poorly named "cadillac tax" on health plans with
high premiums. She announced this proposal on September 29, drawing the ire
of White House spokespeople. The move, however, followed in the footsteps of
a Senate bill to repeal the Cadillac tax introduced by Bernie Sanders and
seven Democratic Senators just a few days previously on September 24.
Clinton's position was correctly seen by reporters as necessary if she
didn't want to lose labor union support to Sanders.
. "Because Clinton's healthcare platform has received zero public
scrutiny, she has had the luxury of floating other policy ideas in broad
outlines, too vague to evaluate."Many of Clinton's well-defined healthcare
proposals are rolled into a package of prescription drug reforms, which she
released on September 22, 2015. They bear a striking resemblance to the
Sanders prescription drug plan announced on September 1, filed as
legislation on September 10. Both would legalize importation of prescription
drugs from Canada, where costs for identical drugs are much lower due to
Canada's single-payer healthcare system. Sanders was a pioneer of
importation, and in 1999 started driving busloads of American patients who
couldn't afford breast cancer drugs across the Canadian border. Both
candidates call for empowering Medicare to negotiate drug prices - even
Donald Trump jumped on board in January. Both would ban "pay-for-delay"
deals between brand-name and generic drug makers, and increase prescription
drug rebates for Medicaid and/or Medicare.
Because Clinton's healthcare platform has received zero public scrutiny, she
has had the luxury of floating other policy ideas in broad outlines, too
vague to evaluate. Take the proposal to expand the use of Accountable Care
Organizations. How? According to Clinton's December policy brief: "In the
coming months, [Clinton] will provide full detail on her plans for delivery
system reforms that drive down costs." With the primaries drawing to a
close, no such details have been released. The same could be said of another
proposal to "create a fallback process" to review insurance premium rate
hikes in states that don't already review rates. There has been no
explanation of how such a plan would work, or whether it would require new
legislation.
This is the double standard at work in almost all national coverage of
Clinton and Sanders on healthcare reform: Clinton has been taken at her word
that her incremental plans will be politically feasible, succeed in
improving affordability and access to care, and are not shared by her
opponent. Sanders on the other hand received intense public pressure to
release details of his single-payer healthcare proposal, and when he did the
proposal was subject to an avalanche of public analysis and scrutiny.
This double standard is all the more remarkable because single-payer
healthcare is an established policy, practiced in one form or another in
almost every developed nation in the world. Incremental reforms that work
within the market-based healthcare system of the U.S. are far more
uncertain, and deserve greater scrutiny. They are easier to enact but
dramatically more likely to fall short of their goals. This is because
incremental reforms in the United States usually focus on expanding access
to care, without significant cost controls, in order to avoid opposition
from the healthcare industry. The resulting policies are often
unsustainable; make little headway against national trends of rising costs
and eroding access; or simply move costs around (e.g. from premiums to
deductibles and co-payments, or vice versa).
Previous national trends in incremental healthcare reform - from managed
care through pharmacy benefit management, chronic disease management, narrow
networks, and beyond - have often created lucrative new industries, but had
dubious impacts on underlying healthcare costs or access to care. Most of
Clinton's healthcare platform falls exactly into these danger zones, and
should be received with a critical eye.
The national discussion of single-payer healthcare reform is long overdue.
However, when the full range of national media outlets force one candidate
to run on real policies, while allowing another to run on values and
aspirations, we aren't having a real discussion of systemic vs. incremental
reform, we are merely aiding the corrosion of informed democracy.
. This work is licensed under a Creative Commons Attribution-Share
Alike 3.0 License
