Elizabeth Edwards is one of the most amazing Democrats - amazing Americans - that I know of. If she ever ran for office I'd become a monthly $100 contributor. I wish her a long and healthy life not just because all human beings deserve it, but because she has more to offer this country than we've seen yet, and I want her to have the chance to do something really special.
But that doesn't mean everything she says is right.
There is a diary on the rec list tonight that gives a devastating personal account of why mandated health insurance has been proved a failure. I want to complement that diary by offering analytical points that lead me to - with great reluctance - say that Elizabeth Edwards is, on this issue, completely wrong.
I just saw Elizabeth on the repeat of Countdown and she said the following (a rough paraphrase):
Any health care plan has to be universal. It has to cover everybody. And the only way everyone will be covered is if everyone must buy insurance.
It is from that very statement that Elizabeth traveled down an errant path on health care. Because of that very assumption, she is espousing a failed health care plan that will hurt so many of the people she is sincerely trying to help. And thanks to that error, we have to set her right, before the progressive movement makes the same error as she has.
Care, not coverage
The error she makes is to assume the problem is coverage. It is NOT. The problem with health care in America is that Americans lack guaranteed access to affordable care. Notice there was nothing anywhere in that bolded phrase that mentioned "coverage." That is because we must put the emphasis where it exists - guaranteed access (which covers the universality issue Elizabeth rightly pointed to) and affordable care which Elizabeth, unfortunately, did not even mention.
Health insurance does nothing, nothing whatsoever, to produce affordable care. In a system based on insurance you must pay a premium before you can see a doctor - if you haven't paid up you're SOL. Since most insurers are for-profit companies, they have as a core business model the desire to make money. Cost containment is going to be extremely difficult in this system without telling people who need care that in fact they cannot get it.
Affordability
The defenders of mandates suggest that with everyone in the system, paying premiums, the cost to patients will fall. But as that recommended diary showed this is just not backed up by evidence. Remember folks, we live in a reality-based community, and evidence trumps your assumptions.
In Massachusetts, the Connector - the state agency in charge of helping people find affordable care - had to rebid the lowest minimum health insurance plan several times in early 2007 to produce an affordable plan. Most of those affordable plans came with high copays and deductibles. At the end of 2007 the insurers informed the Connector that they were unable to limit premium increase percentages to under double-digits - meaning Massachusetts residents faced a minimum of 10% increases.
Elizabeth Edwards, we hope, understands better than most Democrats just how hard it is to get by in today's economy. People are having a difficult time paying rent, paying bills, buying food, on their meager salaries. So why is Elizabeth suggesting that all Americans be saddled with another bill, one they will have a difficult time paying? Doesn't she understand that the LAST thing American families need is a whopping bill they must pay under penalty of law? Does she really believe people should be subject to fines simply because they are poor?
The subsidies won't work
To that charge many defenders of mandate plans say "but there are subsidies for those who can't afford a premium!" Yes, there are. And in Massachusetts they have proved woefully inadequate. Currently the Massachusetts subsidies are running a $145 million deficit - meaning there is not enough money available to pay for the subsidies of everyone who is entitled to it. This is in a Democratic state, mind you - a state with a Democratic governor and massive Democratic legislative majorities.
Why are the subsidies inadequate? Because more people needed to use them than were expected. The combination of a stagnant economy and high premiums meant that the public demand for subsidies rose. It is likely still rising. If a nationwide mandate plan were adopted, there would have to be many billions of dollars set aside for such subsidies.
And is that a wise and efficient use of taxpayer money? Why should we be subsidizing health insurers? Wouldn't it be simpler, cheaper, and more effective to use that money to pay for care directly? Subsidies are therefore a massive waste of money - one that cannot even be counted on by the people who would need it.
Insurance fails to provide universality
Elizabeth told Olbermann that universality is of central importance. Here I agree. So why is she backing a plan that has failed to provide universality? In Massachusetts, only 7% of uninsured residents had purchased insurance, despite possible financial penalties.
7%. That's an unusually bad number. If universality is the goal, why would we embrace mandated health insurance to provide it, when it has so obviously failed to do so? Why not guarantee that every American, as a condition of being alive, has access to health care whenever they need it, and that they don't have to pay for it at the point of delivery? Instead, taxation pays the bills. Why isn't Elizabeth backing that kind of plan?
Insurance often fails to provide actual care
Even more damning is the fact that having health insurance is by no means any guarantee whatsoever that the policyholder will actually get health care. We all remember the horrifying story of Nataline Sarkisyan, who died because CIGNA would not authorize a life-saving procedure. She was insured! So was Nick Colombo. The California Nurses Association has collected dozens of similar stories at their website, Guaranteed Healthcare.
This would be an especially serious problem in a mandated insurance environment. Insurers would not be able to refuse to write a policy to someone - this is considered a good thing, a positive aspect of mandates. But those insurers WILL find other ways to make their profit, by denying care and claims to the sick. If they can't refuse a policy, they can, they will, and they HAVE refused health care. And they have done so in the face of state law - California fined one insurer $3.5 million and is looking at fining another for "hundreds of thousands" of claims processing "problems."
Insurance isn't going to provide most people with access to the health care they need when they need it. Which makes you wonder why we would even want to mandate this at all.
Employer-provided health insurance is on the way out
Mandated insurance plans assume a sort of perpetual 1990s - where most Americans have decent insurance through their workplace, and we just have to figure out something for the rest.
But for several years now we have been witnessing the collapse of employer-based health insurance. As the costs have skyrocketed - 78% since 2001 - employers have been pushing the cost burden onto employees. And more and more employers simply no longer offer health benefits at all.
This is going to accelerate as the recession deepens. Unemployed workers won't have health benefits, and those companies that remain in business will be trying frantically to cut their health care costs.
That means we are going to need to provide a different solution. One that provides the guaranteed access to affordable care that all Americans deserve. Single-payer, anyone?!
Conclusion
This isn't the full list of arguments against mandated health insurance, but it is the key points delivered concisely. It is sad that Elizabeth Edwards needs to be schooled on this, but, here we are. Her error was to assume the problem was a lack of coverage when in fact it is a lack of affordability. If Elizabeth can reconfigure her thinking on health care, and come to see it as a problem primarily of affordability - and that we need to guarantee affordable access to health care to everyone - then she will be on the right path. And it won't be a path that involves mandated insurance.
This is going to be the fight of our lives. Health care is one of the most important reforms facing our society. Mandated insurance, however, will not be among the solutions. It's my hope that Elizabeth will recognize that and stand with uninsured Americans like myself, people whose real problem is a lack of affordability. With her on our side, we can accomplish wonders. Let's hope she comes to her senses.