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Corinne Ramey

Where Do the Candidates Stand on Health Care? Barack Obama

Hillary Clinton and Barack Obama have been sparring over health care during the past few days, throwing insults left and right and prompting plenty of controversy on their respective health care plans.

Even the famed Obamagirl music video has something to say about Obama's health care plan. "You're into border security, let's break this border between you and me," she sings in the video, which has now been viewed on YouTube over four million times and spawned various spoofs. "Universal health care reform, it makes me warm."

So Obamagirl likes Obama's health care plan, but how does the plan fare for the rest of us? First, a few details:

Obama's plan, similar to the Edwards plan that I wrote about recently, seeks to provide health insurance that is affordable, comprehensive and universal. Obama's website claims that "Through partnerships among federal and state governments, employers, providers and individuals, the Obama plan will save a typical American family up to $2,500 every year on medical expenditures." Despite the ambiguous language -- "a typical American family" and "up to" $2,500 -- there's a lot in Obama's plan that makes sense.

According to the Obama campaign website, the plan establishes a new public insurance program, which will be available to people who are not covered under Medicaid, SCHIP, or through their employers. The new public insurance program would also be available to the self-employed and for small businesses to provide health insurance to their employees. The program would offer comprehensive benefits similar to those offered by the Federal Employees Health Benefits Program -- the plan that currently insures members of Congress -- and nobody would be turned away from the plan based on pre-existing conditions.

Obama's plan would also create a National Health Insurance Exchange, which would "act as a watchdog and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible." The Exchange, based on Mitt Romney's Massachusetts plan, would insure that income-based subsidies are available and force insurers to justify premium increases. Insurers would also be forced to offer every applicant a policy, regardless of pre-existing health conditions. Although the Exchange is somewhat similar to the regional Health Care Markets in Edwards' plan --although it's national instead of regional -- it doesn't create competition between private and public plans in the way that Edwards' plan does.

The plan also contains a grab-bag of additional policies designed to improve efficiency and lower costs. A disease management program, better integrative care for people with chronic conditions and more preventative medicine will be included in the plan. There are also measures to improve data collection and transparency through adopting electronic health information systems. According to the plan,

"Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims. Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records."

According to the Rand Corporation, electronic health records could save an estimated $77 billion each year.

Sounds good so far, but what's the bill? Obama, similar to John Edwards, plans to roll back Bush's tax cuts on wealthy Americans, although Obama sets the bar at $250,000 instead of Edwards' $200,000 (Might Obama have wealthier campaign supporters?) When introducing his health care plan in Iowa, Obama said, "To help pay for all this, we will ask all but the smallest businesses who don't make a meaningful contribution today to the health care coverage of their employees to do so by supporting this new plan. And we'll also allow the temporary Bush tax cuts for the wealthiest Americans to expire." Obama puts the cost of his plan at $50-$65 billion annually.

Much of the argument among both the Democratic candidates themselves and within the progressive community has come down to universality and mandates. Just how "universal" is the Obama plan, and what does universality really mean, anyhow? Universal health care is commonly defined as a system where every American -- young, old, employed, unemployed -- has health insurance. In the end, this comes down to enforcing health insurance through individual mandates and forcing to people to buy insurance whether they want it or not. Enforcement can be carried out through a variety of different ways. Insurance coverage can be checked at schools, public agencies, doctors' offices, or even through the IRS. Americans are "forced" to have car insurance, so why not health insurance, too?

Obama, unlike other candidates, only forces all children to be covered in his plan. Clinton, whose plan does include individual mandates, charges that Obama's plan would leave about 15 million Americans without coverage. "Among the Democrats, all of us except Sen. Obama have universal health care," she said. Although Obama's plan makes universal coverage a possibility in the future, it certainly doesn't create one hundred percent coverage.

Perhaps the question of "to mandate or not to mandate" comes down to the actual measures in the plan that make insurance affordable. Mandates don't necessarily make a health care plan a good one -- after all, you can't just force people to buy overpriced insurance -- but if used in conjunction with low-cost, subsidized, or sliding scale public plans they have the potential for success. Mandates work if good, affordable plans are available to all, and the existence of mandates can actually force governments to create affordable plans because of increased consumer demand. Mandates, writes Paul Krugman in Friday's Times, could actually make insurance cheaper for everyone:

"And it’s not just a matter of principle. As a practical matter, letting people opt out if they don’t feel like buying insurance would make insurance substantially more expensive for everyone else. Here’s why: under the Obama plan, as it now stands, healthy people could choose not to buy insurance — then sign up for it if they developed health problems later. Insurance companies couldn’t turn them away, because Mr. Obama’s plan, like those of his rivals, requires that insurers offer the same policy to everyone."

So when it comes down to it, is Obama's plan good for the middle class? The basic answer is yes -- increased preventative care, the electronic health records system, and mandatory insurance for children are all a big step in improving the current health care system. The creation of the National Health Insurance Exchange sounds promising, as does expansion of current federal programs like Medicare and SCHIP. But as Ezra Klein writes in the American Prospect, Obama's plan is still a sort of baby step towards the health care system that the middle class really needs. As Klein says,

"Its failing, somewhat ironically, is a lack of audacity. It accepts the sectioning off of the market into the employed, the unemployed, the old, the young, and the poor. It does not consolidate the system into a coherent whole, preferring instead to preserve the patchwork quilt of programs and insurers that make health care so difficult to navigate. It does not sever the link between employment and health insurance, nor take a firm step towards single-payer, despite Obama's professed preference for such a system."

Is the middle class ready for a plan with the kind of "audacity" that Klein suggests? If carried out well, I'm inclined to say yes.

Corinne Ramey: Author Bio | Other Posts
Posted at 7:07 AM, Dec 01, 2007 in The Candidates on Health Care
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