Making a little headway in understanding healthcare reform

If ever you've tried to untangle a knotted necklace, you've got a good sense of how I feel trying to make sense of the specifics of the healthcare reform debate. It's infinitely frustrating, and you start to rely on small victories to keep you going.

The New York Times interviewed Senator Clinton on camera about her plans for universal healthcare and then summarized the 45 minute conversation in print here. From what I can gather, the salient details are as follows:

1. You're going to be required to buy health insurance.
2. You'll spend somewhere between 5-10% of your income on health insurance premiums but no more than 10%.
3. It "might be appropriate" to make insurance companies spend your premium money on - gasp - healthcare versus, say, overhead and profit.
4. Raising tobacco taxes again may be a good way to help finance universal coverage.
5. Insurance companies won't be able to deny you coverage based on age or health status.
6. Tax credits and rolling back Bush's tax cuts would both help cover the estimated $110 billion cost of switching over to Clinton's proposed plan.

On first read, all of this seems relatively reasonable. Smokers and tobacco farmers are going to hate #4, but being a former social smoker who now detests the smell of smoke on her clothes after a night out with friends who still partake, I'm okay with encouraging people to stop. Where Clinton and I part ways is in this arena:

[Senator Obama] has suggested that affordability is the sole reason people do not buy health insurance.

Mrs. Clinton called that argument “just specious.” She maintains, and many health economists agree, that a share of the uninsured are “free riders,” typically young and healthy workers who can afford coverage but choose to spend on other priorities.

Yes, priorities like food and rent. I've been there. When you lose your job - and your benefits - and you have to make choices as to where the money goes, unaffordable health insurance premiums are not topping the list. I'm no health economist, but I'm backing Obama on this one. I don't think people avoid health insurance because they want a free ride. I think they avoid health insurance because it's too expensive and they've got other immediate pressing needs like keeping themselves and their families fed and clothed and with a roof over their heads.

The other missing link in this write is what happens to freelance or contract workers, the self-employed, or the suddenly unemployed. Capping premiums at 5-10% of your income is alright if you have a steady, predictable income, but when that's not the case, every penny counts. If you mandate people purchase health insurance, you've got to take into consideration how to accommodate those who don't fall into tidy little employment categories. The nature of our workforce is constantly changing. I've yet to see specifics on how that'll be addressed effectively.

This will be an easier topic to discuss come the general election because there are such distinctions between the Democratic and Republican plans for healthcare reform. But today's NYT article was a nice little knot to work through for the time being.