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Tuesday, April 29, 2008

Democrats and Health Care

Jacob Hacker on the Clinton and Obama health plans:

Are You Confused Yet?, by Jacob S. Hacker, Commentary, NY Times: Polls show that health care ranks near the top of voters’ concerns, especially among Democrats. ... And yet, voters must be awfully confused about where the Democrats stand on health care. ...

So what’s the main story: (1) a basic Democratic consensus about what should be done, or (2) a widening policy divide fueled by presidential ambitions? The answer is (1), but unfortunately, the reality of (2) is increasingly upstaging this welcome development. And, unfortunately, this unnecessary and self-defeating conflict could ultimately derail efforts at reform, confusing and turning off the very voters Democrats need to woo.

To see the basic consensus, we need to go back to its immediate source: John Edwards’s campaign proposal. Mr. Edwards’s plan, released in early 2008, had ... a requirement that employers either cover their workers or help pay to cover those workers through a public framework (an approach known as “play-or-pay”). The second core element ... would give workers whose employers didn’t provide secure coverage a choice of public or private insurance. The third core element was a requirement that everyone have coverage (a so-called “individual mandate”). ...

.The cornerstone of both candidates’ plans ... is the play-or-pay requirement: employers cover their workers, or their workers are automatically enrolled in a single insurance pool to which employers are required to make contributions. (Both candidates have said they would exempt small businesses from this requirement, which could pose a big hurdle to universal coverage, since most of the uninsured work for small firms.)

Done correctly ... a play-or-pay requirement makes covering people much less complicated. The more than 90 percent of non-elderly Americans (and more than 80 percent of the uninsured) who live in a family in which someone works would be enrolled automatically... Many of those missed are already covered through public programs, and aggressive outreach could reach those who still remain without coverage. Thus, Mr. Obama’s plan could well cover almost everyone even without the individual mandate.

But, of course, that hasn’t stopped the individual coverage requirement from becoming a flashpoint of disagreement. Hillary Clinton has savaged Barack Obama for leaving out an alleged 15 million Americans — an oft-repeated estimate, the precision of which belies the huge uncertainty about how an individual mandate would be enforced and how many people it would actually cover. ...

For his part, Mr. Obama has repeatedly charged that Mrs. Clinton will force some people to buy unaffordable coverage, an incendiary charge. ... But Senators Obama and Clinton’s proposals are so similar it’s hard to see how Mr. Obama can suggest that everyone will voluntarily sign up under his plan while Mrs. Clinton’s will impose unbearable costs on middle-income folks.

The truth is that the overall costs of the two plans, their essential structure, and their overarching logic are all but identical. Neither would force people to give up employment-based plans they’re happy with. Both would give people without coverage from their employer a menu of different plans, including a predictable, simple and attractive public plan modeled after Medicare. And both could cover all or virtually all Americans for a relatively modest cost. ...

But unfortunately, the fierce debate has pushed both candidates toward rigid positions and extreme pronouncements, elevating a modest disagreement into a confusing melee. .... Meanwhile, John McCain ... has gotten a free ride.

The overheated attacks serve neither Democratic candidate. Rather than impugning each other, they should be saying how they would ensure affordability and enrollment. Mrs. Clinton took an important step in this direction by committing to a limit on how much Americans will have to pay for insurance. Mr. Obama should make a similar commitment, and make clear he will automatically enroll employees and their dependents through the workforce...

Most important, Senators Clinton and Obama should be talking less about how they would cover the uninsured as an isolated group and more about how they would provide health security to all Americans, ensuring that everyone has affordable coverage that doesn’t disappear if they are laid off or change jobs. That’s, after all, what matters to most voters... Senators Obama and Clinton have a health care prescription for these folks that’s much more attractive than John McCain’s skimpy tax credits for coverage — if only they would speak about it in clear, simple and attractive terms.

While their plans may be very close overall, there may be a key difference - their willingness to make implementation of a health care plan a top priority after taking office.

    Posted by on Tuesday, April 29, 2008 at 12:33 AM in Economics, Health Care | Permalink  TrackBack (0)  Comments (62)

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