My Thoughts About Krugman’s thoughts on Clinton, Obama Insurance

Below is the letter I sent to Paul Krugman this morning in response to his column in the Times entitled Clinton, Obama Insurance.

Mr. Krugman:

At the beginning of your recent column, “Clinton, Obama, Insurance,” you wrote,

the difference between the plans could well be the difference between achieving *universal health coverage* — a key progressive goal — and falling far short.

You then discuss how Clinton’s plan with mandated health insurance will insure twice as many of the now uninsured as Obama’s plan will.
At the end, you say,

If Mrs. Clinton gets the Democratic nomination, there is some chance — nobody knows how big — that we’ll get *universal health care* in the next administration. If Mr. Obama gets the nomination, it just won’t happen.

My issue is with the two terms “universal health coverage” and “universal health care.”  In your article, you, much like Sen. Clinton, have equalized the two terms in question.  “Universal health coverage” is clearly about getting medical insurance to all American citizens.  However, anyone who has an HMO understands that just because you have insurance does not mean that you will get the health *care* that you need.  Somewhere between ’93 and now Mrs. Clinton has altered her fight but not her war cry.

Nobody is offering universal *care,* and it’s important that the American people understand this.  Maybe getting insurance to everyone is a step in the right direction or maybe it’s like replacing an area rug with wall-to-wall carpet on an old and rotted floor.  What we really need to do is replace the floor.  Making more people pay for inadequate insurance does not translate to adequate medical services for everyone.


~ by jaredran on February 4, 2008.

3 Responses to “My Thoughts About Krugman’s thoughts on Clinton, Obama Insurance”

  1. Dear “by jaredran on February 4, 2008”, I am not sure what you are trying to say. First of all my impression is that Universal Health Coverage/Care can take two forms. One, get private enterprise out of the picture and let people who work for the government do it; or let the private insurance companies facilitate a means for hospitals, doctors and other medical providers to get paid for the services they provide. Either way, for those who are not paying anything for health care now, they are going to have to start paying their way, either partially or fully. And that should have a nice premium lowering effect on those who are now buying health insurance – more people paying for the same health services means lower cost for a smaller group which is paying now. There are many people out there who can afford to pay for health insurance, but are electing not to, because they are healthy today. And they know that if they show up at the hospital sick or injured, the hospital has to take them in and treat them. As for cost reimbursement, that will be taken care of by those who buy health insurance paying inflated rates which cover the cost of services rendered to the uninsured.

    As for rules, nothing exists without rules. So the concept of “what is covered, what is not,” is not going away. Check out Medicare. That is a form of Universal Health Care for those who qualify. They have “not covered rules.” So the “glass is half empty” people will still have something to complain about.

    So Jaredran, let’s hear how you would design, fund and carry out a Universal Health Care Plan. Would you have rules, or will everything be paid for? Do we all get a money tree in our back yard, or will we all have to pay for the reimbursement of services? I look forward to reading you plan design.

  2. John, thanks for your response. This kind of disagreement can help us get somewhere.

    Let me clarify what I was trying to say, and hopefully that will help you see my point (and avail me of the responsibility of designing the next Universal Health Care Plan for our country).

    I think politicians and media outlets should be more clear about the definition of Universal Health Care. Does Universal Health Care mean that everyone has access to medical services when they need them regardless of how much they can afford to pay? Or does Universal Health Care mean that everyone has insurance and then whether or not you get the services depends upon how good your insurance is? I argue that the former is Universal Health *Care* while the latter is Universal Health *Coverage* and these are two very different things.

    Correct me if I’m wrong, but what you seem to be saying is that getting affordable health insurance for everyone (what I wold call Universal Coverage) provides the best road towards getting affordable health care for everyone (Universal Care). In order to display the crux of my position, I’ll concede this point, which I believe leads to the question “if universal coverage gets us to universal care, why does it matter if we conflate the two terms?”

    The road from coverage to care is likely to be very, very long, much longer than the road to universal coverage. Whoever is our next president needs to prepare the American people for this. Saying you’re going to bring Universal Care is skipping a major step and setting the wrong expectation. It hurts to hear Sen. Clinton say that she’s going to bring Health Care to all of America’s people, hear the people cheer for it, and then consider how many of those people aren’t going to be able to just go to a doctor and say, “Don’t we have Universal Health Care now?” They’re going to have to find a way to pay for insurance and educate themselves on how to use this insurance; how to follow these rules that you say are inevitable and that will always prevent insurance for covering everything. You may be right that they should have to spend this money and learn these things anyway and that these rules are necessary. But, they should also know what’s coming.

    So what do I want? I want Sen. Clinton to say, “We’re going to make you all spend some money on insurance or if you’re really, really poor get some kind of governmental insurance. We’re going to teach you how to use it, and we’re sorry that it won’t cover everything you want. We do hope, however, that it covers most of the things you need, but we can’t guarantee anything.” I want her to save the glory talk about Universal Care for later, when she can really offer it.

  3. Good info. and reading. I would definitely bookmark you to check for new updates.

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