Hillary Clinton, Pre-2016, Gingerly Addresses ObamaCare Debacle, Supports “Evidence-Based” Changes

By Lambert Strether of Corrente.

Hillary Clinton* gave two back-to-back speeches on health care in the 2016** swing state of Florida. The later one, at the University of Miami, was “visionary” (I think the word is) and a sales pitch to UM students to sign up for insurance. The earlier one, the keynote at the Healthcare Information and Management Systems Society (HIMSS) annual conference, is more interesting. Sadly, as of this writing an official transcript is not online, and reporters were not allowed in the hall (!). So I’ll have to cobble the Clinton* quotes together from multiple sources.

Here’s what I think is the key section (which is not the same as what the press thinks is the key section). From Health Populi’s live transcript in the hall:

“[CLINTON:] I am a believer in the idea that good data helps to make good decisions. It’s true in life.

It’s important to be guided by evidence about what works and what doesn’t…not ideology or personally held beliefs.

Unfortunately we’ve seen too often in Washington recently that many of our public debates take place in an evidence-free zone. (Applause) That is bad news for anyone who wants to get something done who would rather choose common ground over scorched earth. (Applause)

For example, the hyper politicized debate from the beginning has been often more about ideology than about data and what we can learn. The scare tactics have not necessarily helped us understand how best to improve care, lower costs, expand coverage…but to keep what works at the same time. That’s why we need what you’re doing so badly. To get back to evidence-based policy debates. And to use that when we need to fix things. 

OK, let’s talk about “evidence-based” just for one second. As I wrote:

The key point to remember in all discussions of ObamaCare is that neither it, nor indeed the entire private health insurance “industry,” should exist. They are rent-seeking parasites, economic tapeworms. One does not improve a tapeworm; one removes it.

To understand this simple point, all we need to do is look north to Canada, where we see a single payer system — they call it “Medicare” — delivering equal or better health outcomes at dramatically lower cost, without a health insurance industry, and without ObamaCare’s bizarre, mystifying, and above all unfair Rube Goldberg-esque complexity. In fact, if we’d passed HR 676 in 2009, we would have saved hundreds of billions of dollars by now (more than enough to cover everyone) and thousands of lives, though ObamaCare apologists don’t like to talk much about the excess deaths that ObamaCare’s achingly slow rollout caused and is still causing.

To put this another way, since the mid-70s, when Canada adopted its single payer system, we’ve conducted the largest controlled experiment in the history of the world. We’ve had two political systems spanning the same continent, both nations of immigrants and once part of the British empire, both mainly English-speaking but multicultural, both with Federal systems, and both with a free market system backed by social insurance. And the results of the experiment? The “evidence”? Canadian-style single payer wins hands-down.

So what, exactly, is the problem with the “evidence-based policy debate” as Clinton presents it? A debate that won’t even mention single payer? A debate that leaves billions of dollars in savings on the table? And thousands of lives? Could it be…. Ideology?

I’d say yes. Because look how Clinton takes single payer off the table without actually mentioning it:

[ClINTON:] I want to see us have a debate where our differences are fully aired. [No, you don’t, because if you did, you would do that yourself.] We don’t have one size fits all; our country is quite diverse. What works in New York City won’t work in Albuquerque. We have to have people looking for common ways of approaching problems using evidence, but leaving their gaming, blaming and shaming, and their point scoring, at the door.

(I’m perfectly happy to blame the political class for taking simple, rugged, and proven single payer system off the table. For which they in general and Clinton particular ought to be ashamed.) I’m reading “one size fits all” as a dog whistle for “single payer” and/or “gummint-run health care.” And if “one size fits all” doesn’t decode that way, what else can it mean? That different patients have different needs? A truism? Clinton’s statement is either vacuous, if not not a dog whistle, or disingenuous, if it is. Come on. Try this on for stupid: “What works in Toronto, Ontario doesn’t work in Saskatoon, Saskatchewan.” Yes it very does, because that’s what the evidence shows!

And I’d say yes because look what Clinton points to as an example of things to “fix.” Quoting Political Wire, since the transcriber Health Populi apparently doesn’t transcribe weak tea and small bear:

“Hillary Clinton offered a defense of Obamacare – but struck a note of concern for small business owners who’ve complained about mandates required by the law – in a twin set of speeches in Florida,” Politico reports.

That’s it? That’s really it? The mandate to buy junk insurance through the ObamaCare marketplace, already enforced for citizens, is too much for small businesses. Nothing about the crapified policies? Nothing about narrow networks? Nothing about balance billing? Nothing about over-55s being forced into Medicaid and then having their estates clawed back? Nothing about the random and capricious nature of who gets covered for what? Nothing about the millions left out, even when Obamacare is fully implemented? That’s it? Clinton’s suppression of ObamaCare’s issues — and her willful refusal of engage in an “evidence-based policy debate” — can only be ideological: “Because Markets,” as Neo-liberalism In Two Words™ puts it.***

To round matters out, Political Wire quotes the quote that everyone is quoting. Here’s what the press believes is the key section:

“[CLINTON:] I think we are on the right track in many respects [no, not in any respect whatever] but I would be [but, apparently, are not] the first to say if things aren’t working then we need people of good faith to come together and make evidence-based changes.”

There’s evidence! I swear! There’s evidence right on the same continent with us! Some of the evidence even speaks English! And I’d like to think that single payer advocates are “people of good faith” who want to make “evidenced-based changes.” But Clinton apparently doesn’t think that, or else she’s not saying what she thinks. Political Wire concludes:

First Read: “But do note: Hillary really didn’t say anything different than we’ve heard from President Obama on fixes.”

So there you have it. If the Democrat really want to run as “new populists,” they’ll have to do a lot better than this. “Fine words butter no parsnips” applied to Obama, and it applies, with equal force, to Clinton.

NOTE * For those who came in late, there are actually two Clintons; Bill Clinton, the former President of the United States, and Hillary Clinton, Secretary of State in Obama’s first term, and Bill Clinton’s wife. Hillary Clinton ran for President in 2008. Both are Democrats. In this piece, “Clinton” denotes Hillary Clinton.

NOTE ** Despite the headline, the Chthulu-like, soul-sucking horror of 2016 speculation makes me want to claw out my eyeballs. So I’ll just introduce the ever-useful qualification “barring health problems”.

NOTE *** To be fair, Clinton’s failing here could also be the result of the catastrophic lack of imagination and/or empathy common to our political class.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. impermanence

    I would imagine that Hillary and Bill have excellent health insurance. She couldn’t give a rat’s ass about anybody else.

    1. ScottS

      Darwin and his troops knew the lives of the hostages were valued highly by the Government. They didn’t know why, and I am not sure that I do, either. I think that the number of people with money and power had shrunk to the point where it felt like a family. For all the escaped convicts knew about them, they might as well have been aardvarks, or some other improbable animal they had never seen before.

      – Kurt Vonnegut, Hocus Pocus

      The Clintons seem like aarvarks to me, and certainly so do I to them.

    1. diptherio

      The most important word in the title of any bill is always the last one: Act. The Affordable Care Act is just that–an act. More are starting to see through it (though not quite enough for my tastes).

  2. TarheelDem

    Kinda early to be whipping on Ms. Inevitable. But the speech is predictable. Because it runs within the limits of “practical possibility”. That is, Ms. Hillary is not going to get burned again by the chair of the Senate Finance Committee exerting a veto on a health care plan and gee, Ms. Hillary would very much like not to have to deal with health care at all–didn’t President Obama go to the mat for that already?

    You want a different policy? Change the Congress. Get a Congress that votes a single-payer bill and puts in on Ms. Hillary’s Presidential desk (see how hypothetical this all is) and dares her to veto it. But most progressives right now don’t believe that it is possible to change the Congress to that degree. And that is because the electoral process is so wired against the 99%. So to change the Congress, one has to change the electoral process to allow “evidence-based” debate in each and every Congressional district, eh? And have districts up for grabs to candidates who can win those “evidence-based” debates instead of secure districts. Notgonnahappen, right?

    What moves things forward is demanding affordable premiums, no co-pays, and no deductibles. Is there evidence that high deductibles and co-pays actually reduce frivolous demand on health care facilities? There is no way to meet the requirements of affordable premiums (what percent of family income?), no co-pays, and no deductibles without moving to either straight-jacket regulation of private non-profit insurers or implementing single payer. Unless you play games with the word “affordable”.

    The danger of citing Canada are the ongoing efforts of the Harper government to undo Medicare-Canada on ideological grounds. Look at what Cameron has done to the UK NHS.

    And the defensive fight in the US is in response to GA Gov. Nathan Deal’s advocacy of letting people die at emergency room doors if they can’t afford a walletectomy. This is the upcoming distraction for the repeal advocates. End cost shifting by letting people die. Purely individualized private medicine. Brought to you by the same folks who are willing to let people starve.

    1. dearieme

      “Look at what Cameron has done to the UK NHS.” Very little: certainly not enough to address its problems.

    2. Banger

      No Congress is the last place to look at for positive change. We need radical cultural change from the bottom up. Clinton by introducing the notion that we ought to use reason to deal with matters of public policy is doing us a service and is, in fact, the most radical pronouncement any politician can utter without being pilloried by the propaganda organs. The fact is the American public aided by the entertainment/”news” media is driving at 150mph in the opposite direction.

      1. psychohistorian

        That entertainment/”news” media you write about is getting ”worse”. Thank gawd I don’t watch it anymore but I read today that the FLOTUS is going to appear on one of the shows where the Vice Pres and other political types have appeared as well…..just enough connection to “reality” to give it “street cred”….Salute the propaganda machine!

        The link: http://www.waynepost.com/article/20140227/NEWS/302279945/2054/ENTERTAINMENT

        Are we ENTERTAINED?

  3. steelhead23

    Isn’t Hillary merely solidifying her support from the medical insurance industry? Remember, that Hillary-care, Clinton’s bold move in 1993, also required U.S. citizens to purchase private insurance, rather than creating a federalized system. Because that plan sought to cap the costs of specific procedures, the insurance industry Harry and Louised her to death, and the legislation failed. I don’t quite know how Obamacare addressed cost inflation, but suspect it was more to the industry’s liking.

    By the way, the Ralph Nader article you linked http://nader.org/2013/11/01/silence-sponsors-superior-full-medicare/ is excellent and indicates where political pressure might be of some use. Thanks.

    1. TarheelDem

      Obamacare addressed cost-inflation through benchmarking against Medicare/Medicaid allowable costs. Which then can be finessed year-by-year with a Congressional “Doc-fix” bill.

  4. Eureka Springs

    If I were a democrat… and both Clintons and Obama are precisely why I am no longer. I would first look for a single issue (or more) where I agree with them. I can find not one single issue. And if I did find a single issue i would never trust them on it.

    These people, their party are monsters. Just like the otheR one.

    Thanks for the coverage lambert… use the lye soap when you shower this crap off.

  5. susan the other

    +100 million. Thank you again Lambert. (Give me single payer or give me death, ’cause I’m not paying for sick care.) So again, plus, plus, speak me more. I have come full circle-and-a-half more than once on Hillary. It’s not that I hate her, it’s just that I am completely disgusted with her and Buba and their quisling little hearts. If hearts really are the source of our intelligence, those two are morons.

  6. TarheelDem

    Nice timing. Just in time for the Clinton administration documents Friday document dump. Reputedly some Hillarycare documents included.

  7. Brooklin Bridge

    This “posture” smells of James Carville who worships at the alter of evidence based policy with almost as much fervor as Carl Rove.

  8. Barmitt O'Bamney

    OK, I got your empirical criteria right here, Hillary: Is our overall healthcare spending per capita still an outlier – is it basically 50% higher or more than good, well established systems elsewhere in the developed world, eg: Canada, France, Italy? Is our system still denying access to tens of millions of people absolutely, and making access prohibitively expensive to millions more, even though they’ve paid their premiums? Is it still delivering shockingly unequal benefits depending on social class? Are we still lagging behind in life expectancy vs. these other developed nations with their cheaper more inclusive health care systems? If you had to answer yes to any of these then the design of Obamacare is radically defective. If you answer yes to all of these, then it is an inhuman atrocity.

    Still, I can see where Hillary might doubt if it was really as crappy as all that. I mean Obamacare looks like shit, true enough, and it smells like shit, but until she actually tastes it – as in signs up for her own Bronze level product – then I imagine she will say the jury is still out, and claim that it’s a serious, viable reform for many people, and probably getting better all the time, or some such Democratic incrementalist gibberish.

  9. azcaclark

    If we were smart and practical we would push to lower Medicare eligibility to 60 or 65. In addition we would adopt a nationwide program like Vermont to cover all children under the age of 18.
    Both a politically feasible. Who’s against children having access to the doctor and many near retireds would vote for the proponent of such a system.

    1. ambrit

      “Who’s against children having access to the doctor..” Check out all those mainly R state governments that have refused to “upgrade” their states’ Medicade systems. (Many of whom are net recipients of Federal largess, and near the bottom of the heap anet incomes.)

  10. JaaaaayCeeeee

    Thank you for taking on the only thing that matters (which the press assiduously avoids): asking what is a potential candidate’s opinion on urgent policy needs.

    The press’s personality politics and polling, along with potential candidates’ efforts to stay amorphous, may seem crazy or stupid. It’s all really just foxily crowding out what matters: what is their policy position, how well they understand it, how well they articulate it, and how well they can sell it. At least Obama made promises, the failing of which we can track.

    Remember when Jared Bernstein coached Bill Clinton, to talk actual policy at the 2012 DNC, about R&R’s budget consequences?

    If we have to wait that long, for that little, from Hillary, she’s toast. I am not sure that she understands this. That won’t fly any more, no matter how much donors or press wishes it so.

    If Hillary can’t talk domestic policy and budgeting, and make it news, our need for more women in politics shouldn’t get her a single vote. That would be like voting for Hillary because it’s her turn (the courtier press likes such playing fields, but na ga hap pen).

    I don’t care who helps her (Brad DeLong?). Hillary should lose viability, the longer she avoids taking positions on the actual, urgent economic policies, that DC has been avoiding since Bush.

    She’s got to have positions that convince voters:
    1. she must articulate what Dems would propose to fix healthcare
    2. she must educate voters enough, to force their reps to legislate the policies she can articulate, against donor status quo goals.

    She’s got to similarly have positions on transaction taxes, cross border financial regulation, full employment, labor policy, SS and Medicare funding, education, etc., that show she knows that they are more urgent than ever, that she’s got positions on them, and will educate voters enough, so they can force their reps to legislate; again, against donor status quo goals.

    Obama has made it harder (and Republican temporizing infinitely more so), but her positions on policies are all that matter, not her past, not her personality, not whether she’s a green lantern, etc.

    1. Banger

      No sane American politician who has Presidential asperations can afford to take definitive positions on much of anything. Being President involves the ability to make deals based on current conditions so bridges should not be burned. Taking a stand on using “good data” and reason to make public policy is actually radical if you think about it since we live at a time that if there’s is a reasonable solution to any problem that automatically disqualifies it as a solution since all decisions made in today’s political world are strictly about power-politics, i.e., who gets what share of the loot. Our society is becoming as deeply corrupt as any ex-Soviet republic.

      If Clinton can just make a case for reason, science and so on I’ll be happy. It could create a general return from the edges of sanity that we’ve experienced at least since 2001.

      1. Lambert Strether Post author

        It’s not my job to adjust my expectations to what politicians think they can deliver; the exit to Kos is that way. As a voter, I’m tired of negotiating with myself. It’s there job to adjust their expectations to me.

        1. Banger

          Of course that’s true. But we have to acknowledge that we live in a society where power is concentrated at the top and, despite that, the left is moribund. Yes, believing the DP is a source of change is foolish and none of us should support them if we are on the left because it is precisely because the left supported Obama that he and his bosses can ignore our concerns. We would have gotten something had we given him the finger and forced the DP to move in our direction.

          I believe that bringing the idea of reason as being the chief issue of our time ought to be our role and that would enable the left to have a winning issue for once.

          1. JTFaraday

            What I think what you’re not recognizing is the way in which “reason” has been (re)defined to mean conventional wisdom, and the conventional wisdom is, broadly, that “what’s good for business is good for the country.” Evidence based claims will proceed from that grounding assumption.

            Consequently, any policy revisions with reference to Obamacare will be those that are good for business, AKA the “job creators.” And, indeed, we already see this prefigured in the way HRC references the Republican example of the undue burden placed on small businesses by the mandate to provide insurance for their employees.

            The state supporting profits over people in a broadly “free market” frame of reference by not forcing businesses to do much more than they already want to do is not anything new.

            What is new is an intensification of the power deployed by the government in the service of profit. Now individuals are mandated by the government to buy insurance and they must buy it from a private sector business. The penalty for not doing so is not so high this year, but it escalates quickly.

            This is why I keep suggesting that the proper way to understand “neoliberalism” as an ideology is not to see it as being “anti-government,” but to see it as the proactive deployment of power by governments to generate profit in the private sector.

            In this case, we see the extent to which the neoliberal state will go to promote the fiction of the private sector profit generating model because so much of Obamacare runs not only on the deployment of governing power in the service of profits but outright government subsidies as well.

            This just suggests that retaining the fiction of private profit is more important to neoliberals than any concern with the government spending that the maintenance of that fiction requires.

            If you think the fact that HRC invokes “evidence based claims” means that she is going to challenge the conventional wisdom itself, then you need to remember how the Clintons operate politically, which is to triangulate in the direction that best serves their personal political fortunes. This modus operandi has nothing to do with evidence.

            And, as a point of historical interest, it was Hillary Clinton who urged her husband to bring in former Republican strategist Dick Morris, the Godfather of Clintonian triangulation, when Bill was facing re-election in 1996 after having been trounced in the mid-terms by the first generation right wing jihad. So, this is the way HRC operates.


            1. Alexa

              Thank you, thank you, thank you, JTFaraday!

              You nailed it when you said:

              What I think what you’re not recognizing is the way in which “reason” has been (re)defined to mean conventional wisdom, and the conventional wisdom is, broadly, that “what’s good for business is good for the country.” Evidence based claims will proceed from that grounding assumption.

              Consequently, any policy revisions with reference to Obamacare will be those that are good for business, AKA the “job creators.” And, indeed, we already see this prefigured in the way HRC references the Republican example of the undue burden placed on small businesses by the mandate to provide insurance for their employees.

              I’ve often attempted to make the same points, but not with the same degree of clarity that you’ve demonstrated!

              [And think tank ‘White Papers’ are rife with the reasoning that you laid out.]

          2. Lambert Strether Post author

            Issues don’t win elections. Policies do, because they bring concrete material benefits. And if you show the benefit with reason, you don’t have to say “I’m for reason!” (Which isn’t going to work anyhow, at least for counter-suggestible people like me.)

            I’m all for the use of reason, as I think the post shows. I just think it’s a means, not an end. (If… Well, let’s just say if a committed Bible reader comes up with chapter and verse for single payer, then welcome to the Big Tent, say I.)

  11. JTFaraday

    “If the Democrat really want to run as “new populists,” they’ll have to do a lot better than this.”

    No one out there actually still believes that do they? Because I am 100% positive that this entire “populism” set up is so the Clinton era insiders (who also ran the Obama administration) can go back to calling the populists “retarded” after they win the election:


    And this is because they do think the people are retarded, and “populism” is pandering to the the retards. From D-Party house organ, The American Prospect:


    1. hunkerdown

      Populist *Democrats* are retarded, in that they don’t understand the function of the Democratic Party: it’s not a debate hall, it’s a jungle gym for the kids to burn their anger and energy off and come back inside as good docile economic units for dinner.

      Gresham’s Law, don’t you know. Bad ideology drives out good.

      1. JTFaraday

        “Economic units,” yes. I just now read Adolph Reed’s Harper’s article, “Nothing Left,” and while I think he makes good points about how “liberals” or “progressives” have a vaporous, unfocused politics, I think it equally damaging to be so narrowly focused on defining “the left” as a revived labor movement, as he does.

        Personally, I think one important task of the real left is to walk back that (re)definition of human being and citizen into mere labor fodder, (and if not labor fodder then human garbage).

        So, this is one reason why I am reluctant to dismiss the so-called “identity politics” movements, which at their best (and it’s true they’re frequently not at their best) were about allowing people to become more fully human.

        The stumbling block there, of course, is the culture within which they were attempting to do this. So, here we are.

  12. Johann Sebastian Schminson

    No doubt we are too proud to do a basic cost/benefit analysis of the systems other countries use. That would be unAmerican, if only for depriving us of an opportunity to participate in our national pastime — shooting ourselves in the nuts.
    That said, as a continuously productive member of society who has had pre-existing conditions since young adulthood, the ACA has removed a major obstacle in my ability to get coverage, at any cost.

    1. Carla

      Johann, it is always good when someone who couldn’t previously get coverage gets it, as long as it is good coverage, and the person can actually pay for it. So I am genuinely glad that the ACA is working for somebody, and in this case, for you.

      Many, many cost-benefit analyses have been done, comparing health care costs and results in the United States vs. other countries. We always rank way below other industrialized countries for results, and WAY above for costs.

      But don’t take my word for it. Here’s the New England Journal of Medicine article discussing our stellar ranking of 37th in the world:


      1. Johann Sebastian Schminson


        Either Single Payer or Public Option would have been better, no doubt. As I said, a cost/benefit analysis clearly shows how far off the track we were, and still are.

        Keep in mind that the ACA, as bad as it is, is better than the old system. It’s also a piece of crap of a law.

        I got a really good plan at a comparatively reasonable price.

        1. different clue

          If the critics, including those here at this blog, are correct; then Ocare will be worse and more dangerous for many people and will produce many adverse outcomes ranging up to and including utter destitution and/ or physical death for many . . . by virtue of features carefully designed into the law.

          1. Johann Sebastian Schminson

            Well, that is certainly reassuring. I’ll pay my premiums and see what I get.

        2. Lambert Strether Post author

          On the public option magic zombie sparkle pony, see here and here here.

          And for anybody considering the PO as some sort of compromise, try imagining Social Security as the “public option” in a “Retirement Marketplace” structured just like the ObamaCare Marketplace.

          Not that I’m foily.

  13. allcoppedout

    Actually, you might intentionally infect yourself with a tapeworm to lose weight or for other health benefits. Much less dangerous than having to swallow Obamacare and other private insurance.

  14. Paul Tioxon

    Will Hillary build upon the ACA? Make it more efficient? For a starter, Medicaid should be rolled into Medicare. It’s already managed by the same organization, the difference is you do not automatically qualify for it by age, but by some sort of means test. The origins of Social Security show the fight from the early days of the New Deal are the same fight as today. All professional social insurance experts know that the waste and redundancy of operating a 50 state system is beyond stupid. Medicare operates outside the ideology of the State rights crowd, but Medicaid did not, mainly because it was seen as charity given to the undeserving because they did not pay anything for it. Despite all of the whining rational experts who would like to simply roll out universal health care and pension and unemployment programs, the political opposition would chew it to pieces if it was not bought and paid for the back breaking sweat of our brow. FDR knew that and insisted it Social Security be paid for a wage based contribution. Medicaid is still held captive to the demeaning politics of means testing. With the current Medicaid expansion completely fouled up by the Supreme Court, Hillary could solidify her reputation as a Democrat that actually did something worthwhile other than to help impeach Nixon as a young staff attorney.

    Medicaid ACA expansion has not rolled out in almost half the country and people who could apply for it, can’t and are stuck in limbo with no health care all. The entire Medicaid program should be moved from the states, saving them whining about ticking time bombs of costs and having to balance their budget and let their Uncle Sam run the show. It would save a fortune in administrative cost and the lying crap about Pennsylvanians or New Yorkers knowing what’ s best for their citizens health care can be put to rest. Medicine is based on human biology not political state boundaries. Doctors, not governors practice medicine. The Federal government should run it, eliminating the 50 different patchwork quilt of waste and substandard practices from the smaller poorer states. Hint, they mostly down South ya’ll! I’m talkin to you ‘Bama. And Corbett, you are a one hit wonder.
    And yeah, it would one small step for single payer, and a giant leap for the sick, the poor and the financially overwhelmed working class, that would be people who cash checks in exchange for work.

    1. JerseyJeffersonian

      Very well said.

      Good luck with getting rid of Corbett. I watch the battle unfold from South Jersey, and am an auditor of all of the slick early Corbett ads appearing on the radio. Would that we had the chance to unload Christie, self-described “adult in the room”, but unfortunately the Guidos bought his bull shit, and now it’s a holding action against this dreadful, vindictive bully to the end of his second term. That is, failing some really damning stuff emerging from the current investigations of Bridgegate and the Sandy reconstruction programs. Oh, please, oh, please.

    2. Lafayette

      Medicaid ACA expansion has not rolled out in almost half the country and people who could apply for it, can’t and are stuck in limbo with no health care all.

      What’s this? You thought it would look like an iPhone app?

      It’s complex, whether national or state – namely because Universal Health Care is genuinely complicated as well. The EU has reduced that complexity – not by trying to get insurance companies to “compete” – but by providing a Single Payer and mandated fees for HealthCare practitioner services .

      Which results, abracadabra, in a total HC-cost (all included) that is half that of, say, France. (See this OECD study of comparative HC costs here.)

      ObamaCare, whilst much better than that which existed prior, remains nonetheless a palliative compared to full-fledged EU national health services. Which is the “public option” that both Hillary (once upon a time) and Barack proposed – but which was shot down by the Replicants in Congress.

      If America resembles more and more some Latin Banana Republic replete with vested interests and a plutocrat hierarchy that rules the land, it is due to the manipulations of die-hard conservatives who will simply not accept progress.

  15. allcoppedout

    Just to remind people of what we know – the UK, German and French health systems were formed when the countries were broken by war. Any idea the US can’t afford a decent NHS is rubbish. I would personally rather be subject to clinical decision I wasn’t paying for directly because I wouldn’t trust ‘the doctor as salesperson’.

    Hilary will bottle out, frightened that telling the truth will bring the red under the bed backlash.

  16. MikeNY

    I really, really, REALLY don’t think my nervous system can handle a Hillary 2016 run. I think it will either have to be i) moving to Bhutan, or ii) helium balloons, for me.

    1. JerseyJeffersonian

      Not helium, Mike, whippets. They don’t last long, but they do take you away for just a little bit.

    2. j gibbs

      There is really only one word that describes Hillary. It is very short but I can’t use it here. Every time I read something about her, my only reaction is “not that &*^% again!”

      Is that wrong?

    3. Lafayette

      Fine, move on.

      We’ll get along without you. Somehow.

      Progress is not for the weak-at-heart. It takes bold courage and one helluva lotta footwork (convincing the grassroots that they are being bilked royally) …

  17. MaroonBulldog

    My impression: HiIllary delivered a series of scripted, vague buzz-words to a conference of data processing technologists, affirming to them that she believes in data-driven decision making and “evidence-based policy debates” (whatever ….) in terms agreeable to her immediate audience, but calculated to resonate differently outside the conference room than in it.

  18. LAS

    The ACA represents some very important stealth accomplishments – which seem not yet fully appreciated because we are all upset about the insurance exchange part and how costs are being shifted. Indeed there are political forces trained on making us upset.

    FIRST – It is a major civil rights accomplishment. Historically, the states and federal gov shared the cost of Medicaid. However, the states had full control over setting Medicaid eligibility rules. Now ACA shakes up this pattern by transferring control over eligibility from states to federal gov. This is a civil rights victory and a big part of the reason why Southern states resist the act.

    SECOND – ACA is going to make more opportunity for comparative info and research to come out about industries (pharma, AMA, hospitals, insurance, etc.) that have purposely obfuscated information for exploitation purposes and market making. It will allow for better comparisons in finance, not-for-profit tax avoidance by hospitals and health care comparative effectiveness. The USA is coming from a place of huge disadvantage because of concealment and misrepresentation by these various entities; this has been one of the reasons our health care has suffered compared to other industrialized countries over the past 25 years.

    It is interesting that Hillary chose to speak out in Florida. Despite being “gerry” capital of the country, it is reputed to be one of the worst states in terms of good, consistent health care information and delivery.

    There are many industrialized countries with better health care systems than the US. Only a few of them are single payer. Many of them are not single payer. Single payer is not a necessary condition to improve health care in the US. What is necessary is much more regulation and sunshine. We also need to shift the health care work force from so many specialists pushing expensive procedures to wider access to primary care and prevention. We need more salaried physicians and fewer physicians that own expensive equipment and/or patents.

    There’s still a lot of work ahead for public health to be improved, but getting exclusively focused on single payer finance versus nothing else is missing the succession of important battles to be fought (some of which are being won) and the next battle being prepared for. Hillary seems aware and that’s something in her favor by my reckoning.

    1. Lambert Strether Post author

      Er, I’m more upset because thousands of people are dying without health care when there is a rugged and proven system available to us that isn’t even being discussed. Why isn’t Hillary upset about that, and why aren’t you? Eyes on the prize!

      * * *

      Yes, I’m aware that there are many health care systems, most better than ours, and not all single payer. Please read the paragraph that includes the worlds “controlled experiment.” We can crap around doing another decade’s worth of studies, and trying to buff the turd of the insurance industry, or we can adopt a system we can be sure will work for us.

  19. Veri

    In other words, Clinton won’t say much because she’ll need FIRE to help fund her Presidential ambitions. Then, there are her paid speeches – welfare from corporations to individuals who support their policies – on Wall Street.

    The Democratic Party sold its soul.

  20. taunger

    The speech was written for information professionals and clearly starts out talking about electronic health care records. Clinton’s remarks could more easily be construed as pertaining to upcoming Meaningful Use 2 standards for electronic health care records, which will have significant impact on medical providers nationwide (lack of standard implementation will result in cuts to medicare and medicaid reimbursement). That’s a big deal in the healthcare right now too.

    I find this article to be as lacking in background as the student loan articles that fail to incorporate forgiveness and sliding scale payment into their analysis.

  21. Banger

    American politicians are power brokers not “leaders” and haven’t been for some time. All of them, search for consensus around powerful groups and issues that can galvanize people. Clinton, I believe, indicated a potential theme of her campaign which I believe is positive. She states that we should be using evidence and “good data” to make policy decisions. Although this appears to be just empty rhetoric I don’t believe it is. The main feature of the “debate” on health-care that resulted in the ACA was that it was from beginning to end a back room deal with the powerful interests within the medical industry–the mainstream media and politicians of both parties avoided data, avoided any facts and did not call for study, did not examine other health-care systems (most Americans still have not the remotest understanding of how most Euro systems work even those on the left) and never went through any real debate except the usual horse-race reporting. The American people today remain as ignorant of the facts about health-care as they did six years ago.

    I believe, at a time when politicians rank very low, that Lady Clinton believes that bringing the idea of reason, evidence and so on to the fore will cause people to think about those concepts. Reason is not something well-liked by the majority of Americans but I think most could be persuaded that it may have a real place in public policy discussions. I have written here before that I believe that if the left can make reason and science a core value that it could galvanize the population to be open to reasonable arguments. This would contrast sharply with the general trend towards tribalism, propaganda, and anti-intellectualism that is a feature of the right-wing.

    Mind you, I don’t believe reason, logic and science should be paramount values–I believe compassion (the heart) should always rule–but reason is a good highway to get to compassion and the connection our society needs.

    I know Clinton is a tool of the oligarchs but so what? Every politician reflects the real power that exists at this time. You can’t thumb your noses at the hoodlums and expect not to get your ass kicked–but she is uniquely positioned to leverage power. I favored her over Obama in 2008 because she was a real player–Obama is a pure tool–completely dependent on Wall Street and the National Security State for his power. Clinton has a chance at some independent actions and could be a force for reform. Change can only come from the inside and the top–from the oligarch class. I see her statements as being positive.

      1. Banger

        No I think that what Lady Clinton says makes a difference. I have come to the conclusion that we no longer live in a republic with democratic institutions. We live in an Empire governed by an oligarchy with a number of factions. Hilary Clinton is a very smart politician who has managed to be the only potential candidate of either party to have her own national and international power-base based on a realpolitik view of the world and thus has the ability play factions against each other. What her ultimate goals are for good or ill I don’t know.

  22. Jason Boxman

    Oh, I wish I’d gone to her HIMSS speech now. If I’d known, I would have taped it. Oops. But the line went around the corner and down the hall, so to speak, and I didn’t want to wait in line to see Hilary Clinton denigrate my intelligence.

    I can fire off a tweet to #HIMSS14 and see if anyone still listening has a transcript or a recording, though.

      1. Jason Boxman

        Oops, should have reloaded my page first! See comment below. Someone linked to it in my #HIMSS14 twitter stream.

    1. psychohistorian

      Go for it Lambert!!!!!

      Color codes and all. After all, what would the Dem leadership (global plutocrats) do for a candidate/puppet if not Ms. Clinton of the great house of Clinton, similar to the great house of Bush, but not so old money yet.

    2. Lambert Strether Post author

      I cite to that in the post. But I’d really like a complete, official transcript (or the audio). There are quotes in the press that aren’t in that transcript, probably because the material wasn’t of interest to the transcriber.

  23. optimader

    Her best strategy would be to STFU.
    I’m guess’in whomever will vote for her has already made that decision. At this point she can only alienate those potential voters.

  24. Hugh

    What a great take-down. “Evidence-based policy” is a take off on “evidence-based medicine” and since we’re talking healthcare you can see the tie-in. Evidence-based medicine is really study and meta-study driven medicine. There are three major problems with this approach as it currently operates. The first is that these studies are often funded by the medical and drug interests who would primarily benefit from their results, and those who conduct and evaluate them have ties to these same interested parties. The second is that the conclusions of these studies are often over-stated, that is the methodology does not support them. The third is the efficacy of the approaches based on them is often debunked by further studies. We have seen this recently with blood pressure guidelines, statins and cholesterol, stents, mammograms, colonoscopies, and knee orthoscopies, to name a few. Then we see those physicians who have built up their practices around the old evidence-based medical guidelines resisting the new.

    I was thinking about this reading the post. I don’t think we should reject evidence in medicine, or policy, but medicine despite all the technology and politics are arts not science. Evidence-based often translates into a false objectivity hiding other agendas. And that’s what’s going on here with Hillary Clinton and Obamacare. As lambert says, you don’t make a tapeworm better. You get rid of it. Hillary Clinton gets money and support from those in the tapeworm industry. Most of those she knows, the members of her class, are in it or other parasitic industries. So when she says, “Evidence-based” we need to keep this mind.

    1. Lafayette

      It isn’t ideology; it’s blatant, bare-faced, open corruption.

      One makes for the other. You don’t get elected on a Corruption Political Agenda. You do get elected in America on an Ideological Agenda, however. The T-Party proved that factually in the 2010 midterms.

      When the American electorate, of which only 38% bothered to turn out at the polls, voted the T-Party into control of the HofR – meaning that they “bought the T-Party agenda. So, 62% of Americans apparently could not have given a damn.

      So, why all the complaining? You (plural) got what you voted for … and in 2012, you (plural) voted Obama back into the Oval Office, but did not vote the T-Party into oblivion. They still rule the roost in the HofR …

      Did you (plural) think that “democracy” is a parlor game that you can play on any Sunday you fancy? Evidently.

      But it isn’t just a “game”. It is something that directly affects your lives in crucial ways. Democracy is debating public policy and implementing it. That is, carefully consider all options and rationally decide which your prefer given good reason for implementing it as a policy.

      You (plural) then elect those who will most likely implement policies that you (plural) decide you want.

      For instance, if you (plural) get a party so ineptly blind as to seek scuttling a law of the land (ObamaCare) passed by Congress just because it smells of socialism (that dirty-word in the American language), then you deserve what you get – that is, lots of televised polemic and diatribe on the BoobTube.

      But certainly, not a HealthCare Insurance system that other countries perceive as a birthright and have adopted as a fundamental precept of Social Justice. But Americans think is just another Free Market Enterprise with which the government should not meddle.

      THAT, as an example, is the single-most important difference between ideology and progressive thought.

        1. Lafayette

          Yes, I know. It took consummate courage to do so.

          But living far away in France helped a lot. No gunmen at the door. No menace of a machine-gunning drive-by … ;^)

    2. Lambert Strether Post author

      “Because markets” means that corruption and ideology are identical. In a neat illustration of reflexivity, neo-liberalism implies that governmental functions are, and of right ought to be, for sale.

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