I’m reminded of an excellent roundtable discussion at TAPPED, outlining what a decent set of health care priorities would look like. There was some thought that the tie should be cut between employer and coverage. I have to agree with that, since it seems unfair to both employer and employee on any number of levels. So, I’m definitely not crazy about Donoghue wanting to mend, not end, that relationship: “Blending employer contributions with government tax incentives is the best way forward.” Seems to me the incentive is always for the employer to avoid making that contribution — QED. I’m also not convinced that it’s all that politically viable — witness how easy uninsuring employers got off in oh-so-liberal Massachusetts.
She would transfer the insurance tax break to an employee of an uninsuring employer, making it more affordable for that employee to buy it. Well, that’s a fine idea, but I don’t see tax breaks as being the total answer: For some folks, it doesn’t matter how much of a tax break they get — they still just can’t afford insurance.
And as a self-employed person, I’m always left with the feeling that employer-based plans treat us as an afterthought — although I’m pleased that her plan includes the creation of new insurance buying pools for small business, much like the Massachusetts plan. At this point, that’s just a no-brainer.
Other than these, Donoghue supports expansion of SCHIP — Medicare for kids. She also supports the feds negotiating drug prices; reimportation of drugs from other countries; electronic medical records; and an emphasis on preventative care. All fine, but not something that would distinguish her significantly from, say, Niki Tsongas.
With her sideways glance at the single-payer argument, Donoghue seems to acknowledge that we need a new vision, a new model for health care. But I’m not sure I actually get that from her plan: It seems like a solid bunch of incremental reforms that are fine in and of themselves, but will never catch the public’s imagination — which is what the reformers are going to need in 2009 going forward. The wonky stuff does matter — it’s a sign of good faith and having done one’s homework. But it should be in the service of a real vision: A, B, and C will lead to result D. This plan is a bit like asking how to get to Springfield, and having someone tell you, “Put gas in the car.”