Mandating Health Insurance: The Poor Have Too Much Money

I commend Hillary for the effort she has made with her new health care proposal. And I must give it to her that I have not had the opportunity to study it in great detail. I want to be able to read the original. But the fundamental premise of it is at some level offensive.

Mandating health insurance, how much sense does it make? The suggestion seems to be that the poor masses are sitting on piles of money, but instead of buying health insurance, they go ahead and spend it on beer and cigarettes. So the way to change that bad behavior would be make it illegal for them to not buy health insurance.

Granted she has talked of helping people with the money. What if you are given tax breaks? What if the government steps in and helps you out a little. Those good sounding suggestions sound like the voucher schemes the Republicans have for the schools in poor neighborhoods designed to pit the poor against the poor, and like Edwards' voucher scheme to help a few to vacate poor neighborhoods entirely. His cure for urban poverty is to help a few escape the neighborhood. See no evil is the cure to evil.

I get the impression Hillary has learned entirely the wrong lesson from her health care debacle in the early 1990s. She is reluctant to confront big pharma and the big dogs of the insurance industry.

Hillary's solution to the health care crisis seems to be give even more private and public money to the insurance companies. Make it the law of the land that the insurance companies must get richer.

She still does not understand that it is not particularl policy per se but the political style, the political methods used that will make positive change possible. Her proposal exhibits her lapse of judgment.

Edwards errs in the other direction. He makes it sound like he is going to nuke the insurance companies to get to universal insurance.

Barack has middle, sensible ground. With Hillary, the insurance companies get most of the chairs around the table. With Edwards, they get kicked out of the room. With Obama, the insurance companies get one of many chairs in the room.

That is one big reason Obama's health care plan is not too specific. It is evolving. He has a few basic benchmarks. But other than that he is open to listening to all parties concerned. He will take the stand, he will pick fights if he has to, but ultimately for him it is less about posturing or cowering, and more about actually getting the stuff done. He is serious about getting a solution.

Granted there are other positive details to what Hillary has put forth. But the central premise overclouds those good details. Go back to the drawing board, Hillary. Instead of surprising the people with a plan, she should make transparent the very process and the discussions that lead to her plan. She has repeated her 1993 mistake of doing seemingly big work in opaque ways.

The process is central to the possibility of a positive outcome. Hillary doesn't get it.

Health Care As A Spectrum
Health Care Options

In The News

Ten lynched in Bihar weren't thieves: Report Sify
Obama Proposes Tax Cuts for Middle Class and Elderly New York Times at least $80 billion a year in tax cuts to middle-class workers, homeowners and retirees ..... “end the preferential treatment that’s built into our tax code.” ..... eliminate income taxes for older taxpayers who make less than $50,000 a year ...... raise capital gains taxes on the wealthy, close corporate loopholes and abolish tax breaks that have saved hedge fund and private equity managers billions of dollars. ..... some C.E.O.’s make more in 10 minutes than a worker makes in 10 months ..... the nation’s “social compact is starting to crumble.” .... proposed major simplifications to the tax system, with a goal of making basic tax filing a five-minute exercise. ........ For about 40 million Americans without complex taxes, he said, the government would essentially send a bill based on electronic information from employers and banks. ....... would “adjust the top dividends and capital gains rate to something closer to — but no greater than — the rates Ronald Reagan set in 1986. ...... by eliminating income taxes for older Americans earning less than $50,000 a year, Mr. Obama said 22 million people would no longer need to file an income tax return.
Obama Casts Voters As Agents of Change The Associated Press By suggesting that the power of change rests with voters, the ad offers a subtle shift on the ongoing debate within the Democratic field over which candidate best represents a shift in direction. .... they don't believe we can actually change politics and bring an end to decades of division and deadlock. They don't believe we can limit the power of lobbyists who block our progress, or that we can trust the American people with the truth ..... "I've taken on the drug and insurance companies and won ... "I defied the politics of the moment, and opposed the war in Iraq before it began," he says.
Obama's New Ad: Change is Possible, Forget 'Cynics' Washington Post Obama is launching his most aggressive advertising campaign in the state, with a direct, stylish spot in which he speaks directly to the camera ...... "And that's why we face the same problems and hear the same promises every four years." ..... his largest ad buy to date.
Clinton's Unhealthy Choices Plan CBS News Only two groups of Americans should worry about Hillary Clinton’s new health-care plan: the healthy and the sick. ..... expands every government health-care program in sight, including the ones that are already insolvent. ...... Senator Clinton is being treated as a political genius for leaving all the unpleasant parts of liberal health reform for later. Her plan features no explicit rationing, and she even claims that it would create no new bureaucracies. (Then who’s going to keep track of whether everyone has complied with the mandate to get health insurance?)
Clinton's health plan is good politics Newsday the increasing problems of cost and coverage. .... While her overly-big, bureaucratic Bad Idea as first lady ran a forest-killing 1,300 pages, the Hillary Care II of her front-running presidential campaign is only a sketchy 10 pages. It's impossible to assess the full impact of the plan without at least a few more dead trees of data. .... a country where bold, ground-breaking ideas get headlines but only pragmatically leavened proposals become law. ....... the lobbyist-pounded crucible of Congress .... not the government-run "single-payer" system loved by many liberals, not the "market-driven" status quo dominated by health insurers that is preferred by many conservatives. ...... get coverage through cost-shrinking insurance pools ...... the insurance industry that devoured Clinton's first plan with a $100- million ad campaign ..... That her plan is similar to those of rivals Barack Obama and John Edwards and of groups such as the American Medical Association suggests it has mainstream appeal. ..... Clinton has liked to say she matriculated in the "school of smaller steps." .... one of the most breathtaking political comebacks in U.S. history, Clinton has shown she understands not only the art of the possible but the value of the pragmatic. .... down moderate Main Street.
Clinton's Health Care Headstart Washington Post Now, she is promising to start health care reform right away, too. ..... she suggested that her requirement that all Americans buy health insurance would be enforced by employers who would check to ensure that prospective workers were insured .... said she could imagine a system in which "you have to show proof to your employer that you're insured as part of the job interview ? like when your kid goes to school and has to show proof of vaccination." ..... "In my two campaigns for the Senate, I did not leave any attack unanswered."
Clinton leads pack as GOP target Los Angeles Times her less enviable role as the No. 1 target for Republican attacks. ..... Romney said: "HillaryCare continues to be bad medicine." .... "Fundamentally, I think she takes her inspiration from European bureaucracies," he said. .... Clinton campaign spokesman Phil Singer said Republicans could "launch as many attacks as they like." ...... 78% of Republicans gave Clinton negative ratings. ..... "If you want to get Democrats going, say 'George Bush'; if you want to get Republicans going, say 'the Clintons ...... The Giuliani campaign now leads its website with an anti-Clinton video. ..... Sen. Sam Brownback of Kansas said in an interview last spring that Clinton was shocked but appreciative when he apologized to her for saying mean things about her during her husband's tumultuous White House tenure. ... "I hated them," Brownback said. "I did -- and it was wrong." ..... Mike Huckabee, a former governor of Arkansas, praised Clinton, saying she was a "brilliant woman -- brilliant intellectually, and she's brilliant politically."
Clinton Rejects Rival’s Attack on Luncheon New York Times her camp dismissed the broadside as signs of a “flagging campaign.” .... Mrs. Clinton’s campaign, however, did not let the attack pass quietly and responded. ..... “Increasingly negative attacks,” a spokesman, Phil Singer, said in a statement to Politico .com, “against other Democrats aren’t going to end the war, deliver universal health care or turn around John Edwards’s flagging campaign.” ....... Mr. Trippi used Mrs. Clinton’s efforts with big donors as a pitch for smaller donations. “You may not have $1,000,” he said, adding that donations of $25 to $100 would be welcome.
Trippi goes nuclear on Clinton Baltimore Sun Trippi, Howard Dean's 2004 E-genius, slammed HRC for holding a $25,000-per-bundler, homeland security-themed fundraiser in DC today. .... Tickets for the Clinton fundraiser are $1,000 a ticket and $25,000 per bundler. And for that money you get more than a meal — you get to attend one-hour breakout sessions in four different areas of homeland security that will include House Committee Chairs and members of Congress who sit on the very committees that will be voting on homeland security legislation.
Giuliani Says He's MoveOn's 'Worst Nightmare' Washington Post the former New York mayor calls MoveOn the "most powerful left wing group in the country" and designates himself their "worst nightmare."
Giuliani Hits MoveOn, MoveOn Whacks Back Washington Post John McCain says MoveOn should be "thrown out of the country."
Google Unwraps Presentations Washington Post does an extraordinary job of making a Web site look and work exactly like a disk-based application: You can move and resize images and text boxes by dragging them around with the cursor
Google Intros Gadget Ads Format InternetNews.com Google today announced Google Gadget Ads, non-traditional ad units with interactive, rich media capabilities. ..... The Gadget Ads can be Individual advertisers and agencies alike can develop the ads using Flash, HTML or both. They can incorporate real-time data feeds, images and video. ...... Advertisers will be able to choose between cost-per-click and cost-per-impression pricing models, as well as target their ads based on site context, domain, geography and demographics. ..... reaches 75 percent of unique Internet users. ..... Pepsi-Cola North America's Sierra Mist, Intel, Honda, Six Flags and Paramount Vantage. ... it bought ad-serving firm DoubleClick earlier this year and started offering video advertising last summer.
IBM, Google take aim at Microsoft's Office dominance Sify IBM announced the release of Lotus Symphony, a portfolio of free software tools for creating and sharing documents, spreadsheets and presentations. .... Lotus Symphony also supports multiple file formats including Microsoft Office and ODF (Open Document Format), and can also output content in the popular PDF format. ..... "IBM is committed to opening office desktop productivity applications just as we helped open enterprise computing with Linux," Steve Mills, senior vice president of IBM Software Group ....... "The lifeblood of any organisation is contained in thousands of documents. When those documents are based on proprietary software, only future versions of the same software will be able to access that intelligence," he said. ..... The presentation feature is available in 25 languages.
Amitabh and Abhishek at their jovial best ! India Target Father and son were shooting on adjacent sets, and unit members had a great time watching the two fool around. ....... the two kept paying each other mini-visits, sharing jokes and generally having fun. During one such break, Big B went to Abhishek's sets to see him perform when the director sent an assistant to call Big B for a shot. The poor assistant didn't realize that Abhishek's shot was on and he simply walked across to call Big B, coming in the way of Abhishek and the camera. ...... "Abhishek was at his jovial best, and declared in front of all that since the assistant had spoilt his shot, he too would go to the sets of Bhootnath to spoil their shot… and, he did actually go over to Big B's sets during his break. What followed next was hilarious. Abhishek got into Big B's costumes and got hold of the script. Next, he asked for the cameras to start rolling and started saying Big B's dialogues from the script. The entire crew was in splits as they watched Abhishek. Even Big B was amused. He turned to the director and said, 'Oh, You have got a new actor in my place, I should take your leave now.'" ..... the great rapport that the father and son share

Giuliani Says He's MoveOn's 'Worst Nightmare' Washington Post
Obama Economic Plan Includes Tax Breaks The Associated Press $80 billion annually in relief for workers, seniors and homeowners. ..... would give 150 million workers a $500 payroll tax credit, expand relief on mortgage interest, eliminate income taxes for seniors making less than $50,000 and simplify returns so millions can file in less than five minutes. ..... would pay for his proposals by closing corporate tax loopholes, cracking down on international tax havens and raising the top rate on capital gains and dividends ...... Obama's plan to eliminate taxes on seniors making less than $50,000 annually would mean 22 million elderly would no longer need to file an income tax return or hire a tax preparer. ...... the IRS would send prefilled tax forms to 40 million workers who take the standard deduction and have a bank account. They would simply have to sign and return it, which Obama estimates would save more than $2 billion in tax preparer fees, 200 million hours of work and "an incalculable amount of headache and heartburn."
Giuliani Hits MoveOn, MoveOn Whacks Back Washington Post
Gallup: Giuliani dips, McCain edges up, Romney slips; Clinton's ... USA Today
China says it opposes threatening Iran with war Reuters
Commonwealth chief to press Musharraf on army role AFP
Taiwan seeks attention but China steals spotlight Guardian Unlimited
Google Launches AdSense for Mobile InformationWeek
Amitabh gets best actor award for 'Black' Hindu
Big-name vendors lined up to offer WiMAX laptops Register Acer, Asus, Lenovo, Panasonic and Toshiba have all committed themselves to offering 'Montevina' Centrino laptops with on-board WiMAX wireless broadband support .... WiMAX, not HSUPA/HSDPA-augmented 3G, is the wireless technology that will bring mobile broadband to the masses. ..... By 2012, he forecast, some 1.3bn people worldwide will regularly find themselves within range of a WiMAX basestation, up from 750m in 2010 and 150m in 2008, though he conceded that the vast majority of the latter will be in the US.
Redline's RedMAX(TM) products chosen for first WiMAX network in Egypt Business Wire
OJ Simpson to face kidnapping, armed robbery charges AFP

At SEIU, Obama "Rocked The House" Atlantic Online his argument that Hillary Clinton is too polarizing, too calculating and too change-averse to pursue transformative policies. ..... Obama seems more popular with SEIU members than he does with SEIU executives, many of whom are said to favor Edwards. ..... “But the real key in passing universal health care is the ability to bring people together in a process that is open and transparent and builds real consensus, and I’ve got a track record of doing that.”
Obama: Reappraise Wall Street Values The Associated Press a "what's good for me is good enough" mentality has crept into parts of the business world while working men and women toil longer hours and still struggle to pay for health care, tuition and taxes. ...... former Commerce secretary Bill Daley, former Fannie Mae CEO Jim Johnson and University of Chicago economist Austan D. Goolsbee helped Obama with the speech ...... win support for an agenda for change. ...... more than $1 trillion worth of corporate tax loopholes. ..... there is greater income inequality now than at any time since the Gilded Age ..... markets need to be more open and transparent to keep the trust of investors and the public. He said that trust can be restored by federal action like:_ New mortgage rules with tough penalties for lenders who trick homeowners into loans they can't afford;_ An investigation of the relationship and business practices of rating agencies and their clients;_ A five-star credit card rating system to inform consumers about the level of risk for their credit card, including how easily the company can change the interest rate;_ A request that lenders show some flexibility to people trying to sell or refinance their homes.
Clinton unveils health insurance plan Los Angeles Times a plan that would require every American to have health insurance, offer generous subsidies to help pay for the policies and gingerly seek to tamp down rapidly rising medical costs. ...... she had learned the lessons of her earlier failure, pledging to do less mandating and more negotiating. ..... left key elements open to bargaining..... would require sweeping changes to, among other things, the nation's drug and insurance industries ..... Half of the $110 billion-a-year cost of Clinton's "American Health Choices Plan" would come from savings that she says she can squeeze from the current health- care system. ........ Clinton's savings from modernizing the system and improving clinical practices are highly uncertain but little different than those cited by other candidates .... all Americans would face an "individual mandate," a requirement that they have health coverage, just as most drivers are now required to have auto insurance. ...... Because of her history with the issue and her status as a former first lady, Clinton dominated news coverage Monday with her release of the plan. ....... a candidate who has spent much of the presidential campaign seeking to build a softer, less-combative image .... She was particularly fierce about insurers. ..... "Right now, insurance companies have free reign to cherry pick the healthiest patients and shut out anyone who seems to them like a bad risk," she said. "Insurance companies spend $50 billion a year on elaborate calculations and schemes to figure out how not to insure people. Fifty billion dollars trying to shut out those who need care the most." ...... Clinton took in $146,000 from drug companies and health product companies ; $991,000 from various health professionals, including doctors and nurses; and $353,000 from insurers
Bolder Than Obama, More Pragmatic Than '93-'94 Plan ABC News the free-rider problem that occurs when emergency rooms
Hillary's Health Care Do-Over TIME Instead of forcing people into big buying cooperatives — back then, she called them "alliances" — her new proposal allows people who like their health insurance to keep it. Her earlier plan would have established a big new government bureaucracy to determine things like what specific benefits should be required for all Americans; her new one does not. And while it contains a version of her earlier plan's controversial "employer mandate," requiring businesses to provide coverage for their workers, it exempts small employers. ..... only 48% of companies that employ fewer than 10 people provide health benefits .... Clinton is still likely to cross swords with the industry by requiring insurance companies to sell policies to anyone who applies and by barring them from charging sick people more. ..... allow people to buy into a government-run plan, similar to Medicare, which would amount to a test of both the support and feasibility of a "single-payer" system similar to Canadian and European systems. ........ The real battle will be convincing Democratic primary voters which candidate can actually turn his or her plan into reality. ..... The mismanagement of the effort in 1993 and 1994 has set back our ability to move toward universal health care immeasurably. ...... premium costs have risen 78% in the last six years, to an annual cost of $12,106 per family ..... the Massachusetts program, which is proving costlier and more difficult to implement than advertised.
Black Sacramento For Obama Bay Area Indymedia, CA "the only candidate that can unite people to get things done." ...... The Obama campaign said it is looking to win all of the early voting states — Iowa, New Hampshire, South Carolina and Nevada —

Health Care As A Spectrum

Culture Shift Better eating, sleeping, exercise habits Shift primary focus from illness to wellness Incentivize good behavior

Bedrock Basic Care A national grid of medical clinics that provide basic care to anyone who walks in As the country gets richer you add number and quality of services offered

Basic Universal Insurance For the next level services not offered by bedrock basic care Private sector Managed competition Plenty of market forces so there is a constant push to bring down costs and enhance quality

Advanced Health Insurance For services not covered by Bedrock Basic Care and Basic Universal Insurance Purchased by those who can afford it and those who qualify for associated government programs Plenty of market forces so there is a constant push to bring down costs and enhance quality

Flight Into Space Kind Of Health Insurance If the super rich want super care at super expensive rates and can afford it, let them have it Over time services move from the right to left

When you say universal health insurance, that can sound like you are saying no matter who you are, no matter what disease you have, no matter how expensive an operation you need, you will get it. That would be utopia. And any such promise would be a lie, not humanly possible. There is no such thing called a blank check.

Take a look at the table above.

Left takes pressure off of right. As in Culture Shift takes pressure off of Bedrock Basic Care which takes pressure off of Basic Universal Insurance and so on. Right adds to the quality of left over time. So what was once only available to those with Advanced Health Insurance can end up being part of the Bedrock Basic Care package over time.

This way health care is universal. It is unnecessary for the vast majority of the people for vast stretches of time. It is there when it is needed. The market forces are at work. Innovation is not muffled. Money is made. Profit is made. There is competition. So costs don't go up when they don't have to.

Health Care Options
The Spectrum Concept: Wide Applications
The Spectrum On Gender
The Spectrum/Dialogue Concept Is Key To Power

Something similar should be thought of in terms of education. If you put all books and all journal articles online that are "free" and supported by ads, you are putting all that in the Bedrock Basic Care compartment. The technology is already there. I am working on my autobiography that way. I am not looking for a publisher. I am publishing it as I am writing it. Online. Ads are displayed. It is so easy to do. All it will take is for some college textbook writers to follow in my footsteps. And there will be a deluge. Money will still be made. But there will be no artificial profits.

Bill Clinton's Gore Offensive

Never underestimate Bill Clinton. He just might talk Gore into jumping into the fray to split up what he thinks is the male voting block. Well, Obama has the Spitzer option.

In The News

India marks 'wedding of century' CNN International
Bollywood couple's low-key wedding disappoints celebrity-mad India The Age A woman claiming to be the lover of Bachchan slashed her wrist in front of the actor's home. ..... Police later arrested the woman, who they said was a struggling fashion model. ..... the guests — much like Liz Hurley's guests at her nuptials with Arun Nayar — were sworn to secrecy. .... the union was a gathering of the who's who of India. Top industrialists, film stars and politicians attended. ...... The most conspicuous absence was that of the other big dynasty that dominates Indian life as much as the Bachchans — Congress Party leader Sonia Gandhi and her children. ...... The two families used to be inseparable. It was Amitabh's mother, Teji, who gave Sonia away at her wedding to Rajiv. ..... Their children grew up together. The family albums are full of shared picnics, dinners and holidays. But at some point after Rajiv's assassination, a rift occurred between Sonia and the Bachchans. They have been estranged since. ....... Speculation was rife that the Gandhis would be invited, but the Bachchans evidently decided to seal the estrangement. ........ The gold-embossed invitation cards were four-pages long and came in a box, accompanied by flowers and traditional Indian sweets. ...... The henna was brought in especially from Rajasthan, the brocade silk saris were from Benares and the white tents air-conditioned.
No PowerPoint? Google will offer a free alternative Indianapolis Star
New Star Sanjaya Malakar Plans On Hiring Bodyguard Playfuls.com He dropped out of high school after his sophomore year and later obtained a GED. ...... While most people believe it was the “American Idol” haters who kept Sanjaya on the show for so long, the 17-year-old Indian thinks it was his fans alone who voted for him. .... Speaking about the Idol contestants and the outside world, Sanjaya said they are kept busy and isolated. ...... "We're in a bubble . . . . I got inklings every once in a while of something different going on that I guess was a cultural phenomenon, but I don't think it really has hit me yet how big it is."
Barack Obama outlines energy policy MSNBC Obama seeks to cut greenhouse gas emissions from cars by five percent in 2015 and ten percent in 2020. The idea echoes California's approach.
Obama: Change gun laws for mentally ill MSNBC
A new era of black political leaders
Obama critical of McCain over Iraqi visit
Obama dismisses notion of VP spot
Obama: U.S. ready for health care reform Obama said his fundraising success was proof that the nation's political mood was shifting and that Americans were eager to embrace new ideas. ..... take our country back...... Obama noted that in previous campaigns, presidential candidates have offered detailed proposals without building that political support
Sculpture of Obama as Jesus causes stir the plan he'll eventually support will offer universal coverage and will squeeze efficiencies out of the health care system. It also will stress preventive programs, such as weight control. .... "Standing pat is not an option." ..... Obama said if he was starting from zero, he would likely support a single-payer system, similar to the government-run program in Canada. But he's leery of taking such a step because the United States already has a complex and established system of employer-based health coverage. ....... "The government is already covering half the people," said Obama ...... Medicare, Medicaid and veterans health systems ..... Obama cited his mother's struggle with health care as she dealt with ovarian cancer. She died at age 53. ..... Obama said he was surprised that few at the meeting were willing to scrap the system. ..... "There are no simple answers," Kirsch said.

Dems and former President Clinton reach out to black leaders Staten Island Advance
To Bill Clinton, Obama's just one of the pack Chicago Tribune
Bill Clinton: Hillary would be best; Gore might run; Dems have ... USA Today "you have got the prospect that vice president Gore might run." ..... Sen. Hillary Rodham Clinton, "would be the best president by a good long stretch, for all kinds of obvious reasons -- or at least they are obvious to me. ... But she also genuinely loves her job in the Senate. ... So for her personally, she is going to (be) fine regardless. "