Krugman's analysis of Obama's healthcare plan is in need of a checkup

[zulchzulu]

Krugman mentions in the NYT article "Mandate Muddle" how wonderful the healthcare system is in Switzerland and the Netherlands, where it is mandated.

He writes:

Other countries — notably Switzerland and the Netherlands — already have such mandates. And guess what? They work.

What Krugman fails to understand is that both of those healthcare systems mentioned are in no way similar to the way the healthcare mandated system would be in the United States any time soon. Add that both Hillary's and Edwards' mandated plans don't really offer an REALISTIC healthcare reform due to still being shackled to the healthcare insurance industry.

Here's an analysis from Physicians For A National Health Program say about the issue:

Switzerland’s universal-coverage health care system consumes a larger fraction of gross domestic product than most other countries, likely reflecting its citizens’ preferences and resources. Health care expenditures are closely linked to income.

(snip)

These results can be attributed primarily to the control exercised by Swiss consumers and the relatively high cost transparency of the system, requirement for universal coverage, and risk adjustment of insurers. Additional savings would likely be attained with liberalization of provider coverage and reimbursement policies.
http://jama.ama-assn.org/cgi/content/full/292/10/1213

What is most impressive about the Swiss health system is the role tight government regulation plays throughout the entire system. One can plausibly argue that this regulation is chiefly responsible for both the high quality and (relative to the United States) low cost of Swiss health care. Absent that regulation, the Swiss health system probably would metamorphose into something resembling the much less regulated, high-cost US system, which is both more inefficient and more inequitable than the Swiss system, as Herzlinger and Parsa-Parsi take pains to point out.
http://jama.ama-assn.org/cgi/content/full/292/10/1227

http://www.pnhp.org/news/2004/august/is_switzerlands_hea.php

Regina E. Herzlinger and Ramin Parsa-Parsi mention the contrast of the Swiss mandated system to what would be the American mandated system, proving it is apples vs. oranges:

Switzerland's consumer-driven health care system achieves universal insurance and high quality of care at significantly lower costs than the employer-based US system and without the constrained resources that can characterize government-controlled systems. Unlike other systems in which the choice and most of the funding for health insurance is provided by third parties, such as employers and governments, in the Swiss system, individuals are required to purchase their own health insurance.
http://jama.ama-assn.org/cgi/content/short/292/10/1213

Boiled down, prices for healthcare costs are regulated by the government. This is essentially the same with the healthcare system that the Netherlands enforces. There is also a minimum benefit that the consumer has no real control over unless they want to pay more for other services.

In glaring contrast, the American healthcare mandated system only deals with healthcare insurance and allows that industry to make it just as expensive as it is now. Any notion that the government will try to control healthcare insurance lobby is doomed to failure legislatively. The mandate just forces people to get healthcare insurance or get fined, get wages garnished, get tax refunds withheld and assign people to policies that they have no input or control over.

Clinton says that Obama's healthcare plan would leave out 15 million people. Her mandated enforcement policy would certainly leave out at least that many people, if not more.

This leads into the correct analysis by Obama that even mandated auto insurance does not cover all American drivers.
Krugman inaccurately tries to say that mandated auto insurance is practically covered by all Americans:

First is the claim that a mandate is unenforceable. Mr. Obama’s advisers have seized on the widely cited statistic that 15 percent of drivers are uninsured, even though insurance is legally required.

But this statistic is known to be seriously overstated — and some states have managed to get the number of uninsured drivers down to as little as 2 percent. Besides, while the enforcement of car insurance mandates isn’t perfect, it does greatly increase the number of insured drivers.

What Krugman fails to mention is that there are a lot of states that don't require the SR-22, which is car insurance proof of financial responsibility in case you get in an accident:

Delaware, Kentucky, Minnesota, New Mexico, Oklahoma and Pennsylvania do not require SR-22s, but if you have an SR-22 and then move to one of these states, you must continue to meet the requirements of the SR-22 state where the offense was committed.

New York and North Carolina do not require SR-22 filings, and most companies do not offer out-of-state SR-22 filings for policies in these states.

http://www.carinsurance.com/kb/content24186.aspx

Still more states don't require ANY car insurance at all:

New Hampshire, Tennessee, and Wisconsin are the only states that don't require drivers to provide proof of financial responsibility at any time.

http://www.insure.com/articles/carinsurancefaq/required-liability.html

Krugman gets it correctly that we need single-payer health coverage, as said in other articles he's written. But he knows that the chance of jumping from to disastrous healthcare crisis into single-payer healthcare in one jump is not going to happen anytime soon.

Additionally, Krugman certainly needs to understand that mandated healthcare insurance is either never going to cover everyone realistically OR the policies are built to fail in the first place.

[jefferson_dem]

1. Thanks for the debunking of Krugman's screed.

One would think he would know better.

[Capn Sunshine]

2. It's imprtant to recognize Obama's plan is put forth as "workable"

IOW, it's part of an incremental step in the solution, not the end of the journey.

Like all of us, Obama recognizes pushback will be huge on this issue and this one might get one step down the road.

Frankly , I'm from the school of single payer and I think they underestimate how much support this concept has outside the beltway. But the beltway is where you have to start.

[cuke]

3. I don't see any debunking

I don't see where you demonstrate a significant difference between Switzerland's mandates and the ones being proposed. Switzerlands regulates it's medical care, and so do we. And you are flat out wrong to say that the proposals do nothing to limit the premiums insurers charge. ALL of the proposed plans do limit premiums

[cuke]

6. The SR22 issue is irrelevant

It doesn't matter if the state requires a certain piece of paper or not. The issue is whether they mandate insurance coverage. 47 states mandate coverage. Inflating the # because some don't require drivers to file a form proving they have insurance is dishonest.

[cuke]

7. One of your quotes contradicts your argument

"Switzerland's consumer-driven health care system achieves universal insurance and high quality of care at significantly lower costs than the employer-based US system and without the constrained resources that can characterize government-controlled systems. Unlike other systems in which the choice and most of the funding for health insurance is provided by third parties, such as employers and governments, in the Swiss system, individuals are required to purchase their own health insurance.
http://jama.ama-assn.org/cgi/content/short/292/10/1213 "

You seem to be using to point out a difference between us and the Swiss. What you don't sseem to realize is that the proposed plans move us closer to Swiss model by moving away from insurance provided by third parties and towards making individuals responsible for getting isurance, JUST LIKE THE SWISS!!!

[zulchzulu]

35. So a mandated document to prove coverage is not "relevant" to a mandate?

That's some bad acid you ate this morning.

[cuke]

44. And again, an Obama supporter fails to defend Obama

Just more attacks and denial.

No, filing a SR22 has no relevance to the health insurance mandates being discussed, which is why you can't explain how it is relevant. All you can do is deny that it's irrelevant (denial) and accuse me of doing drugs (attack)

All you have is denial and hate

[zulchzulu]

50. All you have is denial and stupidity

You really don't get it. The point of an SR22 is not about health insurance.

It's about Krugman being misinformed about how auto insurance that is mandated doesn't cover everyone....just like mandated healthcare insurance could not cover everyone, even if it's forced down our throats.

I'd put you on Ignore, but I'm fascinated that you can type on a computer. For that, it's amusing.

[wyldwolf]

8. there is none, really

[cuke]

10. I'm still waiting for someone to point out the differences

Z seems unwilling or unable to do so. Curious

[zulchzulu]

15. The main difference...

The Swiss program is strictly run as a mandated government program without all the complications that are entrenched in the American healthcare insurance system. Clinton's mandated plan simply is a great solution for the greedy healthcare insurance industry, who are fueling her campaign with lots of cash...wonder why?

Add that the entire Swiss population is about the same as the New York City metropolitan area.

[cuke]

17. All you have is blather

"The Swiss program is strictly run as a mandated government program"

And so are the Clinton and Edwards proposals JUST LIKE THE SWISS HAVE!!! So much for 'les differences'

"...without all the complications that are entrenched in the American healthcare insurance system. "

Funny how you don't many any of these "complications". You just claim they exist, as if you have any credibility

"Clinton's mandated plan simply is a great solution for the greedy healthcare insurance industry, who are fueling her campaign with lots of cash...wonder why?"

And again, I believe nothing on your say-so. How about some facts instead of your blather?


"Add that the entire Swiss population is about the same as the New York City metropolitan area."

And this argument is nowhere to be found in your OP. It's obvious you're reaching and grasping. If this were an important difference, you would have noted it in your OP

[frazzled]

20. Well, one difference between Switzerland and here is this

The population of Switzerland in 7,507,300 (less than the population of New York City). The population of the United States is 301,139,947 (July 2007 estsimate), about 40 times as great. Economies of scale do apply.

Switzerland has an estimated poverty rate of 3%; the US has an estimated poverty rate of 16%. Switzerland is indeed a wealthy county: it is a "modern economy with a GDP per capita 15%-20% above that of the big West European economies."

Also::

"There is a mantra in Swiss healthcare politics, a phrase one hears again and again: healthcare in Switzerland is of
excellent quality, quite expensive”.

Indeed, according to OECD statistics, Switzerland operates the third most
expensive system in the world – behind only the USA and Germany. Though if calculated in US $ PPP, Switzerland
easily outspends all countries in the European region."

It's still a good plan, but direct comparisons to how something could work in the US are somewhat difficult. Some interesting facts (e.g., every individual must be insured separately--no family plans) can be found here (granted, it's from 2002):

http://64.233.167.104/search?q=cache:O6F8y8ZrAJgJ:www.civitas.org.uk/pdf/Switzerland.pdf+health+care+switzerland&hl=en&ct=clnk&cd=1&gl=us

[cuke]

23. I don't see the significance

and if it were so important a difference, why wasn't it mentioned in the OP?

Also, finding some difference is meaningless unless you can show that this difference will have a meaningful effect on the implementation.

[AtomicKitten]

4. Ferreting out the bias always helps in evaluating Op-Ed pieces.

Snark is the lifeblood of some here who swear by a pundit's POV as the gold standard (but only if one agrees with that POV, otherwise it's impugn the source, insult the OP). Rinse and repeat.

[BootinUp]

5. Shackled to private insurance my ass. Zulchula's analysis needs a checkup

Snips from the Summary of Clintons plan:

The Same Choice of Health Plan Options that Members of Congress Receive: Americans can keep their existing coverage or access the same menu of quality private insurance options that their Members of Congress receive through a new Health Choices Menu, established without any new bureaucracy as part of the Federal Employee Health Benefit Program (FEHBP). In addition to the broad array of private options that Americans can choose from, they will be offered the choice of a public plan option similar to Medicare.

# Insurance and Drug Companies: insurance companies will end discrimination based on pre-existing conditions or expectations of illness and ensure high value for every premium dollar; while drug companies will offer fair prices and accurate information.

# Individuals: will be required to get and keep insurance in a system where insurance is affordable and accessible.

# Providers: will work collaboratively with patients and businesses to deliver high-quality, affordable care.

# Employers: will help financing the system; large employers will be expected to provide health insurance or contribute to the cost of coverage: small businesses will receive a tax credit to continue or begin to offer coverage.

# Government: will ensure that health insurance is always affordable and never a crushing burden on any family and will implement reforms to improve quality and lower cost.



http://www.hillaryclinton.com/feature/healthcareplan/summary.aspx

[wyldwolf]

9. oh, now, you had to go and enter relevance and facts into the discussion. Bad Jim! Bad!

[cuke]

12. For some unknown reason, Z won't defend it's OP

Curious

[BootinUp]

14. I think all we are doing is insuring

a quick death to this thread.

[zulchzulu]

33. How would mandated healthcare be implemented?

Answer that. Let's see if you have a brain.

[BootinUp]

36. First we all sit around in a circle

and hold hands...



What a stupid question, lol.

[zulchzulu]

40. Of course you don't either know the answer or want to admit how stupid it is

Seriously...one more time for all the Hillary supporters.

How do you implement mandated healthcare insurance? Give me three steps and perhaps what happens if someone says they don't want to join in.

Got anything?

[BootinUp]

41. Try this, very educational.

http://www.school-house-rock.com/Bill.html

[zulchzulu]

42. The problem with that "example" is that the government forces people to get insurance

Nice try. I've seen that before. But, still no answer from you on the original question...

:shrug:

[BootinUp]

43. To be honest, I don't know what you are asking

[cuke]

45. Neither does Z, but it doesn't matter

Z shouldn't be asking about Clinton's plan. Z should be defending it's OP.

Z's questions are meant to be a distraction from Z's inability to defend it's OP

[zulchzulu]

18. The Pie In the Sky promises are hilarious!

I don't know what's funnier!

# Individuals: will be required to get and keep insurance in a system where insurance is affordable and accessible.

# Providers: will work collaboratively with patients and businesses to deliver high-quality, affordable care.

# Employers: will help financing the system; large employers will be expected to provide health insurance or contribute to the cost of coverage: small businesses will receive a tax credit to continue or begin to offer coverage.

# Government: will ensure that health insurance is always affordable and never a crushing burden on any family and will implement reforms to improve quality and lower cost.

Can't she add:

# The government and the healthcare insurance industries promise to be fair, honest and really neato!

# People who get their wages garnished and fined due to not getting mandated healthcare insurance will also get a nice letter from Bill talking about how he likes little puppies.

:rofl:

[cuke]

19. You can't even defend your own OP

all you can do is attack and deny

[zulchzulu]

28. Team Clinton's little mice are all in a tizzy

Krugman's allegations got spanked. Game. Set. Match.

Debunk what I wrote...er...enjoy your swim.

[cuke]

46. And again, an Obama supporter fails to defend Obama

All they have is denial and attacks

[BootinUp]

21. Your critique is marvelously lacking in substance.

On the other hand feel free to browse the sixteen page document that explains the proposed regulations you apparently think weren't proposed.

http://www.hillaryclinton.com/feature/healthcareplan/americanhealthchoicesplan.pdf

[cuke]

22. The OP has mysteriously left the scene

Can't imagine why

[zulchzulu]

25. Sorry... I have a job

I don't live here on DU like you.

[cuke]

26. And still no defense of your OP

You said the main difference was that the Swiss use mandates, and somehow you think that's a reason to oppose plans that use mandates.

[zulchzulu]

29. I wrote the OP. You try to defend it honestly or shut your piehole

I stand by my OP. I don't have to defend it. It has links. It has facts. It has figures. It makes sense.

If you think forced healthcare insurance is something that will get passed, then tell us how that will happen.

[cuke]

30. Your OP doesn't identify any differences

except that the Swiss have madates that put the responsibility on the individual to buy insurance, JUST LIKE THE PROPOSED PLANS DO!!

So what's the difference. Before, you said "the main difference" was that the Swiss have mandates, but you've never explained why that's a reason to oppose mandates, nor have you explained why Obama's plan has mandates if they're so bad

[zulchzulu]

31. You can't read?

Here's a little request for you. Read the OP again and see the point difference. I'm not retyping it becuase you're too lazy (or whatever) to comprehend the message.

[cuke]

32. There is no difference. That's why you won't defend your OP

Even you said "the main difference" is that the Swiss have mandates. For some reason, you think that's a reason why we should not have mandates.

Yet. Obama's plan has mandates and you haven't said a word about that

[zulchzulu]

34. Here's a wittle hint for you...

Read the second excerpted block where the text is in bold. Can ya do that?

It's never too late to learn to read.

[cuke]

47. LOL! That excerpt contradicts your OP

"What is most impressive about the Swiss health system is the role tight government regulation plays throughout the entire system. One can plausibly argue that this regulation is chiefly responsible for both the high quality and (relative to the United States) low cost of Swiss health care."

And in the US, the health system is subject to tight govt regulations which plays a role throughout the entire system. One could plausibly argue that this regulation is chiefly responsible for the US's reputation for providing some of the best health care in the world and that the new proposals will reduce the cost of health care to the levels the Swiss pay

I can't believe your argument is that medicine in the US is unregulated

[killbotfactory]

11. Insurance companies will fight every reform except the mandate

And mandates would be horrible for people unless we can get the industry heavily regulated and/or have an option other than private health insurance.

[cuke]

13. So go hide under your bed

"And mandates would be horrible for people unless we can get the industry heavily regulated and/or have an option other than private health insurance"

You must be pretty ignorant to not understand that all the proposals allow individuals to buy insrance from the govt.

[zulchzulu]

24. It should be just as successful as in 1993 when it was tried...

Oh...wait...it...

FAILED!

[cuke]

27. So all you have is BS speculation

You can't defend your OP so now all you'll do is attack Clinton

[rinsd]

16. So mandates are bad except when Obama uses them.

Ok then...:eyes:

[killbotfactory]

37. Mandates for children

Children are cheaper to insure, to begin with.

[BootinUp]

38. I've been waiting

for someone to basically attack Hillary's and Edwards plan for helping too many, thanks, I think that suffices.

[killbotfactory]

48. It won't help too many

mandates probably won't help at all, they will just lock the people who bother to obey them into shitty expensive plans, unless fundamental reforms are made beforehand.

[rinsd]

39. That must be why we have so few uninsured children.

Single payer is the way to go.

The only guy with that plan is Kucinich though I am encouraged by the Clinton and Edwards plans in terms of their "bridges" to single payer.

[killbotfactory]

49. There are also much more government programs already available for children

which will be easy to expand.

I don't see mandates as being particularly that important if reforms are made to the current system, and only see them as a catastrophe waiting to happen if they are implemented before significant reforms. My suspicion is that if mandated healthcare is on the table from the beginning insurance companies will be able subvert significant reforms while embracing the mandate.

Single-payer is definately the way to go.