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Sen. Clinton's Health Plan: A First Look
Tuesday, 18 September 2007 15:46
by R.J. Eskow

Sen. Hillary Clinton has offered an initial look at her plan for health care reform. It's not likely to change anyone's mind about her candidacy, or about health care reform, but at the overview level it's well-designed and thorough. Her plan is solidly in the center of Democratic proposals. It emphasizes mandated coverage, cost reduction measures, and the elimination of predatory insurance underwriting. At first review, it reinforces the sense that she and her staff are knowledgeable, highly competent, and incrementalist in their approach.

We'll look at the plan's details, and then quickly touch on the Republicans' (predictable) responses.

Sen. Clinton has abandoned the regional health alliances that were a hallmark of her 1994 proposal. That makes the Edwards plan, with its regionally-based Health Markets, more traditionally 'Clintonian' than Sen. Clinton's new proposal.

Here are the highlights of the Clinton plan, based on an initial review:

Like the Edwards plan and Mitt Romney's Massachusetts plan, mandates are the centerpiece of the Clinton program. Every American will be required to have health insurance. To offset this new requirement, the Clinton plan promises future cost savings to ensure affordability.

I'm not a fan of mandates, for reasons discussed here, although I understand the thought process behind them. There are fundamental issues of fairness that are easy to address in theory, using subsidies — but most policymakers so far have failed handle premium and copayment structures in a way that does so effectively. I also suspect that Republicans will have a field day running against the mandate concept.

The Clinton plan — like those of Edwards and Obama — apparently offers a public insurance alternative, although details are sketchy at this point. The long-term impact of a public/private competitive model is potentially very significant: If private insurance companies can't compete on price and value, and if they're policed effectively enough to avoid their use of unfair underwriting advantages, they could potentially wither and die. That would leave the country with a de facto single-payer system — one created by market forces. Yet there are many potential hurdles between a mixed system and a fair outcome.

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Sen. Clinton's program is administered through the Federal Employee Health Benefit Program (FEHBP). She takes a page from John Kerry's playbook (and Ron Wyden's) by saying that this will provide "benefits at least as good as the typical plan offered to Members of Congress, which includes mental health parity and usually dental coverage." There will also apparently be also a public Medicare-like system, although details on that are sketchy at this point.

The problem is that, as Joe Paduda points out, many Americans can't afford the copayments and deductibles in the congressional health plan.

It will be difficult to light a fire under the political base with this plan, or for that matter with Edwards' or Obama's (although Edwards took the rhetorical lead today by promising to cancel coverage for the executive and legislative branches if health reform isn't enacted).

Sen. Clinton's plan appears to handle taxation issues in depth, and addresses the ongoing (and often neglected) issue of retiree health benefits. And Clinton has been ahead of the curve in addressing health IT issues.

Republican reaction was predictable:

"If you've seen the report this morning on the latest version of Hillarycare, you'll see that version 2.0 is not like to have any more success than 1.0," former Massachusetts Gov. Mitt Romney told reporters in New York. "Hillarycare continues to be bad medicine."
Yet, of all the candidates, Romney is the only one who has tried to enact health reform. As we've discussed before (here, here, here, and here), his record so far hasn't earned him any bragging rights. And Giuliani indulges in a typical attack of red-baiting, saying ""If you liked Michael Moore's Sicko, you're going to love HillaryCare 2.0. " That may not be a smart move, since a lot of people did like Sicko (a movie that condemned the "new Hillary").

As with any of the health proposals, the Clinton plan can't be fully assessed until more details are provided on knotty issues like premium calculations and benefit design. We'll be looking for more information, and will provide more details as we get them.

RJ Eskow is a writer, business person, and songwriter/musician. He has worked as a consultant in public policy, technology, and finance, domestically and in over 20 foreign countries. He also held senior-level positions at several major insurance carriers and has served as CEO of two companies. He is experienced in finance, strategic planning, marketing, data analysis, and IT. He specializes in health and medical issues, and has also worked in film and music.

Eskow currently provides consulting services and is developing a start-up company. As a performer, he has been signed to RCEG Records and his new album will be released in 2007. He's grateful he has rock music to fall back on if this business thing doesn't work out.

Besides writing for the Atlantic Free Press, he maintains his own blogs: Future-While-U-Wait for technology and futurism, A Night Light for politics & music, and The Sentinel Effect for healthcare-related issues.
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a guest said:

For Immediate Release September 17, 2007
Contact: Deborah C. Peel, MD or 512.970.9007

Will Hillary’s New Health Care Plan Ensure That Americans Control Access to Their Health Records?

Will Senator Clinton display a newfound respect for every American’s right to health privacy? Or will Senator Hillary Clinton’s new health care plan violate patient privacy like her 1993 plan? 2,400 years ago, Hippocrates realized that patients would not seek medical treatment unless doctors swore never to share any information they disclosed without consent. Health systems that do not preserve the privacy of the patient-doctor relationship will fail, because patients will not be willing to participate in a system that allows employers and corporations to steal and use personal health information to harm them.

Dr. Deborah Peel, of the Coalition for Patient Privacy asserts, “HMOs, the insurance industry, employers, marketing firms, the drug industry, banks and financial institutions, and the data aggregating industry all view health care “reform” as a golden opportunity to strengthen and extend the authority HIPAA granted them to steal every American’s sensitive health data. The primary use of electronic health records today is for sale or use by corporation for purposes that do nothing improve health.”

Will the citizens of New Hampshire support Senator Clinton if she doesn’t end prescription data mining? In 2006, New Hampshire passed a law to stop prescription data mining. The state was sued by two data mining corporations and a judge blocked the new law. One of those corporations reported revenue of $1.75 billion in 2005. Not a dime was used to help a single sick person.

Consumers should beware of health plans advanced by Senator Clinton and the other presidential candidates if their plans do not adhere to the 2007 privacy principles developed by the Coalition for Patient Privacy:

Recognize that patients have the right to medical privacy*
Recognize that user interfaces must be accessible so that health consumers with disabilities can individually manage their health records to ensure their medical privacy.
The right to medical privacy applies to all health information regardless of the source, the form it is in, or who handles it
Give patients the right to opt-in and opt-out of electronic systems
Give patients the right to segment sensitive information
Give patients control over who can access their electronic health records
Health information disclosed for one purpose may not be used for another purpose before informed consent has been obtained
Require audit trails of every disclosure of patient information
Require that patients be notified promptly of suspected or actual privacy breaches
Ensure that consumers can not be compelled to share health information to obtain employment, insurance, credit, or admission to schools, unless required by statute
Deny employers access to employees’ medical records before informed consent has been obtained
Preserve stronger privacy protections in state laws
No secret health databases. Consumers need a clean slate. Require all existing holders of health information to disclose if they hold a patient’s health information
Provide meaningful penalties and enforcement mechanisms for privacy violations detected by patients, advocates, and government regulators

* Definition: Health information privacy is an individual’s right to control the acquisition, uses, or disclosures of his or her identifiable health data. (Report of the NCVHS to Sec Leavitt dated 6/22/06)

About Dr. Deborah Peel and the Coalition for Patient Privacy

Dr. Peel is known for her straightforward and fiery advocacy, ranking number #4 on Modern Healthcare magazine’s 2007 list of the 100 Most Powerful People in Healthcare.
Patient Privacy Rights and Dr. Peel earned the attention of Congress by working cooperatively to form the bi-partisan Coalition for Patient Privacy in 2006. The Coalition includes over 40 organizations from across the political spectrum, including the Family Research Council, the Christian Coalition, the Electronic Privacy Information Center , the California Medical Association and the ACLU. Collectively, the Coalition shares the vision that Americans should control all access to their health records.

Patient Privacy Rights and the Coalition continue to educate Congress about the need for ‘smart’ legislation to ensure the right to health privacy is guaranteed and protected in federal statute. Patient Privacy Rights also promotes the use of ‘smart’ technologies that ensure consumer control of personal health information such as consent management systems and health record banking or trusts.

Patient Privacy Rights is a national consumer watchdog organization based in Austin , TX. The mission of Patient Privacy Rights is to guarantee that all Americans
control access to their health records. Web site: www.patientprivacyrights.org

Interviews with Dr. Peel about the privacy implications of the health care plans advanced by the presidential candidates can be arranged by contacting Ashley Katz: akatz@patientprivacyrights.org

September 18, 2007
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