Clinton or Obama -- On Health Care the Difference is Big

There has been extensive coverage in the mainstream media and blogosphere about the health care proposals of Senators Clinton and Obama. This issue is important to me because I am a passionate advocate of health care for all and because the way the candidates deal with it points to a major reason I'm supporting Hillary Clinton for President: She'll get results.

New York Times Op-Ed Columnist Paul Krugman closed his Monday column about the political and economic differences between the two Democratic candidate's health care plans by explaining that, "If you combine the economic analysis with these political realities, here's what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance -- nobody knows how big -- that we'll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won't happen."

Krugman makes a strong statement and it's based on two points: the first is that Clinton's plan provides universal coverage (through an individual mandate), and Obama's plan does not cover everyone and does not include an individual mandate (except he does have one for children, which suggests he understands its usefulness). On this the experts agree -- Obama's plan leaves 15 million people uninsured while Clinton's plan leaves no patients behind. According to the Wall Street Journal, "Outside experts agree that number is in the ballpark." Obama has acknowledged this fact, saying that "Fifteen million sounds like a lot ... I'll have 97 percent covered." The Washington Post notes that the "Obama plan could leave a third of those currently uninsured lacking coverage."

Krugman's second point is that Obama uses campaign rhetoric -- straight from the pages of the right-wing, anti-government playbook -- that demonizes mandates to the point where he would have a difficult time as president accepting a proposal that has one. The ideological intensity of Obama's critique is a serious problem because an individual mandate is an effective mechanism for covering everyone. It's far from the only way -- but it is one way and it has lots of political support. If you're trying to bring people together around a solution, ruling out something as big as this may well rule out your chance of success. In this way, says Krugman, "Mr. Obama's campaigning on the health care issue has sabotaged his own prospects" of winning reform as president.

The case in point is Obama's recent direct mail piece (PDF), which is misleading about Clinton's plan and his own. Ezra Klein of the American Prospect says that Obama is "fear-mongering" and "demagoguing universal health care." For example, Obama fails to mention that Clinton's plan guarantees coverage for all. And while he says that affordability is the key issue, he neglects to note that her affordability provisions are stronger and more specific than his. Obama also fails to note that his own plan has an individual mandate.

The nonpartisan factcheck.org has done a thorough analysis of Obama's mail piece that you can read on their site. Krugman and others note that Obama's mailer is also reminiscent of the infamous "Harry and Louise" ads that the insurance industry spent millions on to kill national health care reform in 1993.

Jonathan Cohn from the New Republic, commenting on Obama's mail piece, explains that "a presidential candidate who believes in a reform has to avoid making statements that could undermine that reform down the road. And that's precisely what Obama has done here. Even he has admitted, in some instances, that a mandate might be necessary in order to get everybody into a universal health care system. (And he already has one for kids.) But this mailer -- with all of its unmistakable echoes of Harry and Louise -- makes that task much harder."

"In the end," says Klein, Obama's "plan is not universal, does not attempt to be, and is probably less generous in its affordability provisions than Clinton's. And even so, I wouldn't really care, as it's still a pretty good plan, except that he's decided to respond to the inadequacies of his own policy by fear-mongering against not only a better policy, but the type of policy he's probably going to have to eventually adopt. It's very, very short-sighted."

The substantive difference between Clinton and Obama on health care is that Clinton will cover everyone and Obama will not. There's no reason to hope that every man, woman and child in our country will be covered under Obama's plan because that's not what he intends to do. When it comes to health care, the difference is clear: Obama's plan sets us back. Clinton's plan moves us forward.