For the record: Clinton's and Obama's healthcare plans

I've been meaning to post my notes on a recent talk I attended with Prof. Jonathan Gruber, a healthcare economist at MIT who has consulted to Edwards, Clinton and Obama.  Gruber is the author of the research that supports Clinton's claim that Obama's healthcare plan will insure 15M fewer people than hers; several weeks ago, he hosted an informal Q&A on the elections and the economy with grad students in my department.  I don't have too much insight, but I do have some notes.  With Obama's false attack ads in PA running this weekend, what better time to post them? Healthcare wonks and advocates, take notice.  (Caveat: my notes are old now, so I hope I can translate them correctly.  All errors are my own.)

Gruber said that Clinton's healthcare plan is most similar to Massachusetts's new universal healthcare plan, which he explains has enrolled 400,000 new people, of whom 75% previously lacked insurance.

In Gruber's lifetime, the difference between the Dem candidates and McCain/GOP is the most distinct policy difference he's seen.  (McCain's plan: tax credits, no regulation, get insurance where you can, watch out for that moving bus! ...ok that last phrase was my own editorializing...)

He went on and on about the cost of healthcare, and how he considers it our most pressing national crisis, no question.  He said the average family plan in the U.S. costs $12,000, and that both Clinton and Obama agree that one-third to one-half of the income distribution will have to be heavily subsidized to make this affordable.

Both candidates want to reform the non-group market.  Gruber believes in mandates, and says Obama is disingenuous to say both plans will cover the same number of people. 

As for a single-payer model, Gruber says it is less innovative and offers less choice (others choose for us).  More importantly, he called it a political non-starter.  250M people are "happily insured" in the U.S., versus the 47M uninsured.  Also, the insurance industry earns $500-$700B per year.  Shifting to a single-payer model at the outset of reform efforts in this political economic landscape will not work.  He mused that a single-payer model could eventually evolve out of reform efforts.

He claimed that every major candidate has highly unrealistic positions given the national deficit.  He believes we have serious problems in the long-run, and that the major issue for the nation is rising healthcare costs.  He posed a rhetorical question, what's appropriate to spend on healthcare?  Gruber continued that two-thirds of healthcare spending is so productive that it compensates for the one-third that is wasteful, but to get rid of that chronic, wasteful one-third is to have to say no to treatments Americans want.  At this point Prof. Frank Levy, another economist studying technology and radiologists, interjected with his usual acerbic wit that when denied unnecessary x-rays and catscans patients act as if they're constitutional rights have been violated.  Good stuff.

Gruber said that we don't know how to control costs but that we do know how to cover the uninsured.  It seemed to me he clearly supported Clinton's plan, not least because she is quoting his research all over the place.  We academics like that kind of thing.

And a non-sequitur closing remark: Happy Passover!!