Hillary Is Better Than Obama On Health Care

My opposition to High Deductible Health Plans is well known to readers. (See http://pediatrics.aappublications.org/content/133/5/e1461.full.pdf+html for the ineluctable conclusion that they suck on a multitude of levels.) I have also condemned the general heedlessness of Obama to the finer points of health care financing, and his administration's concern with only the poor, to the exclusion of the working class that they purport to be very concerned about. In this case, policy does not meet up with words. In general, I think the Obama health team's health approach has lacked, shall we say, fine tuning.

At the same time, if Obama's political approach has been marked by preemptive surrender, Hillary's 1990's approach erred on the other side. With disastrous results, the Clintons treated Washington policy makers as they would have treated the Arkansas legislature, as a bunch of rubes, which they weren't, especially the insurance lobby. But if Hillary lacked astuteness of political approach in those early years, she did know policy. She and Bill basically knew what they were talking about.

Hillary is a lot older and one can only hope, wiser, if not a better candidate. Hey, I wish she were, but one person can only do so much. She is married to Bill, but she isn't him – and that's OK. At least she is smart and good on policies. (I just wish she could stop being so reactive with her propensity for declarations. I wince when I hear “MY PLAN WOULD ….” She can't get away from a tone of preemptive hectoring, that I feel is yelling at me the audience, borne of criticisms I haven't leveled at her. But at this point, I'm just hoping the polls turn around for her.)

What she is saying now on health policy is needed and smart. Apparently her guru is Neera Tanden, who seems smart. See:

http://www.nytimes.com/2015/10/07/us/politics/hillary-clintons-proposed-changes-to-health-law-zero-in-on-affordability.html?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=22650728&_hsenc=p2ANqtz-87xbQPdWWOtHGFglk8vzI-XxqfcWQN5zqyiKPlSjYemkhIOwHRhj3jLK3wDC99qoEp3KEPu23AmkCpu7vmdlZzdiw6KA&_hsmi=22650728

Basically, she is attacking the HDHP program, and proposing to take on the drug industry. Good! Limit the out of pocket, and include three visits a year without a deductible. Excellent. Lower the advantages that accrue to pharma – they have enough, and lowering margins won't inhibit innovation.

I also think she's right to plump for rescinding the coming penalties on Cadillac plans, even though it might be a stance directed on gaining union support. I say, let people have as much insurance as they can get, and forget about their “having skin in the game.” You need other ways to reduce expenditures than making people feel pain when they are sick. She doesn't have a program to decrease the in-hospital and procedure costs yet, but no one does. I would think that that would come; it's the logical extension of less reliance on HDHPs. Maybe she has something in her back pocket, but you don't have to talk about that yet, unless in general terms when pressed to speak about cost.

So, I write this as a note of celebration. Good for her! Health is one area that a Clinton II administration would improve the Obama approach. Maybe we'll get to see how the rest of her agenda goes. However it goes, hers would certainly be better than a Rubio-Kasich approach. God, the risks we are running....

Budd Shenkin