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Obama and Clinton and Health Care

Paul Krugman at the New York Times on the differences between Barack's and Hillary's Health Care plans. In his view, Obama's plan is doomed to failure.

[...] as I've tried to explain in previous columns, there really is a big difference between the candidates' approaches. And new research, just released, confirms what I've been saying: the difference between the plans could well be the difference between achieving universal health coverage -- a key progressive goal -- and falling far short.

Specifically, new estimates say that a plan resembling Mrs. Clinton's would cover almost twice as many of those now uninsured as a plan resembling Mr. Obama's -- at only slightly higher cost.

Let's talk about how the plans compare.

Both plans require that private insurers offer policies to everyone, regardless of medical history. Both also allow people to buy into government-offered insurance instead.

And both plans seek to make insurance affordable to lower-income Americans. The Clinton plan is, however, more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies.

But the big difference is mandates: the Clinton plan requires that everyone have insurance; the Obama plan doesn't.

Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.

After all, we already have programs that make health insurance free or very cheap to many low-income Americans, without requiring that they sign up. And many of those eligible fail, for whatever reason, to enroll.

An Obama-type plan would also face the problem of healthy people who decide to take their chances or don't sign up until they develop medical problems, thereby raising premiums for everyone else. Mr. Obama, contradicting his earlier assertions that affordability is the only bar to coverage, is now talking about penalizing those who delay signing up -- but it's not clear how this would work.

So the Obama plan would leave more people uninsured than the Clinton plan. How big is the difference?

To answer this question you need to make a detailed analysis of health care decisions. That's what Jonathan Gruber of M.I.T., one of America's leading health care economists, does in a new paper.

Mr. Gruber finds that a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured -- essentially everyone -- at a taxpayer cost of $124 billion. Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.

That doesn't look like a trivial difference to me. One plan achieves more or less universal coverage; the other, although it costs more than 80 percent as much, covers only about half of those currently uninsured.[...]

And that's why many health care experts like Mr. Gruber strongly support mandates.

Now, some might argue that none of this matters, because the legislation presidents actually manage to get enacted often bears little resemblance to their campaign proposals. And there is, indeed, no guarantee that Mrs. Clinton would, if elected, be able to pass anything like her current health care plan.

But while it's easy to see how the Clinton plan could end up being eviscerated, it's hard to see how the hole in the Obama plan can be repaired. Why? Because Mr. Obama's campaigning on the health care issue has sabotaged his own prospects.

You see, the Obama campaign has demonized the idea of mandates -- most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the "Harry and Louise" ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care.

If Mr. Obama gets to the White House and tries to achieve universal coverage, he'll find that it can't be done without mandates -- but if he tries to institute mandates, the enemies of reform will use his own words against him.

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.

I would hope that Senator Obama, should he be elected president, would have the integrity to change his position on mandates if that's what it took. He claims to want universal coverage, and he states he believes he could accomplish that without mandates. If he's convinced he's incorrect he'd change his position, right?


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Comments (10)

Obama's speech (October, 2002):

Obama's speech (October, 2002):

Good afternoon. Let me begin by saying that although this has been billed as an anti-war rally, I stand before you as someone who is not opposed to war in all circumstances.

The Civil War was one of the bloodiest in history, and yet it was only through the crucible of the sword, the sacrifice of multitudes, that we could begin to perfect this union, and drive the scourge of slavery from our soil. I don't oppose all wars.

My grandfather signed up for a war the day after Pearl Harbor was bombed, fought in Patton's army. He saw the dead and dying across the fields of Europe; he heard the stories of fellow troops who first entered Auschwitz and Treblinka. He fought in the name of a larger freedom, part of that arsenal of democracy that triumphed over evil, and he did not fight in vain.

I don't oppose all wars.

After September 11th, after witnessing the carnage and destruction, the dust and the tears, I supported this Administration's pledge to hunt down and root out those who would slaughter innocents in the name of intolerance, and I would willingly take up arms myself to prevent such a tragedy from happening again.

I don't oppose all wars. And I know that in this crowd today, there is no shortage of patriots, or of patriotism. What I am opposed to is a dumb war. What I am opposed to is a rash war. What I am opposed to is the cynical attempt by Richard Perle and Paul Wolfowitz and other arm-chair, weekend warriors in this Administration to shove their own ideological agendas down our throats, irrespective of the costs in lives lost and in hardships borne.

What I am opposed to is the attempt by political hacks like Karl Rove to distract us from a rise in the uninsured, a rise in the poverty rate, a drop in the median income - to distract us from corporate scandals and a stock market that has just gone through the worst month since the Great Depression.

That's what I'm opposed to. A dumb war. A rash war. A war based not on reason but on passion, not on principle but on politics.

Now let me be clear - I suffer no illusions about Saddam Hussein. He is a brutal man. A ruthless man. A man who butchers his own people to secure his own power. He has repeatedly defied UN resolutions, thwarted UN inspection teams, developed chemical and biological weapons, and coveted nuclear capacity.

He's a bad guy. The world, and the Iraqi people, would be better off without him.

But I also know that Saddam poses no imminent and direct threat to the United States, or to his neighbors, that the Iraqi economy is in shambles, that the Iraqi military a fraction of its former strength, and that in concert with the international community he can be contained until, in the way of all petty dictators, he falls away into the dustbin of history.

I know that even a successful war against Iraq will require a US occupation of undetermined length, at undetermined cost, with undetermined consequences. I know that an invasion of Iraq without a clear rationale and without strong international support will only fan the flames of the Middle East, and encourage the worst, rather than best, impulses of the Arab world, and strengthen the recruitment arm of al-Qaeda.

I am not opposed to all wars. I'm opposed to dumb wars.

So for those of us who seek a more just and secure world for our children, let us send a clear message to the president today. You want a fight, President Bush? Let's finish the fight with Bin Laden and al-Qaeda, through effective, coordinated intelligence, and a shutting down of the financial networks that support terrorism, and a homeland security program that involves more than color-coded warnings.

You want a fight, President Bush? Let's fight to make sure that the UN inspectors can do their work, and that we vigorously enforce a non-proliferation treaty, and that former enemies and current allies like Russia safeguard and ultimately eliminate their stores of nuclear material, and that nations like Pakistan and India never use the terrible weapons already in their possession, and that the arms merchants in our own country stop feeding the countless wars that rage across the globe.

You want a fight, President Bush? Let's fight to make sure our so-called allies in the Middle East, the Saudis and the Egyptians, stop oppressing their own people, and suppressing dissent, and tolerating corruption and inequality, and mismanaging their economies so that their youth grow up without education, without prospects, without hope, the ready recruits of terrorist cells.

You want a fight, President Bush? Let's fight to wean ourselves off Middle East oil, through an energy policy that doesn't simply serve the interests of Exxon and Mobil.

Those are the battles that we need to fight. Those are the battles that we willingly join. The battles against ignorance and intolerance. Corruption and greed. Poverty and despair.

The consequences of war are dire, the sacrifices immeasurable. We may have occasion in our lifetime to once again rise up in defense of our freedom, and pay the wages of war. But we ought not - we will not - travel down that hellish path blindly. Nor should we allow those who would march off and pay the ultimate sacrifice, who would prove the full measure of devotion with their blood, to make such an awful sacrifice in vain.

VOTE OBAMA FOR PRESIDENT!

Steve Crickmore:
Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions. There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible.

Sure Hillary's plan will provide much wider coverage than Obama's but at what cost.
The sticking point for Hillary's plans as Krugman says is mandates..It seems simple. It's all conjecture now. Let's see how well the mandated scheme works in Massachusettes before trying it in the other 49 states...

In the meantime, mandates seems to be an area where Hillary finds herself on some policy issues..She said yesterday she would consider garnishing a person's wages if they refuse to buy healthcare when they are mandated. I give her credit for pointing out the possible unpleasant but realistic down side of her plan, but this is where she will undoubtedly receive 'stick'.

ke_future:

the government has neither the right nor the authority to require that i get health insurance. on that rock, the ship of universal health care with mandates sinks.

this is the problem with leftist/statist solutions. you think that government knows best, when it's pretty obvious that it doesn't. you try to take away our freedom and liberty and try to disguise it as 'looking out for the little guy'.

thank you, but no thank you.

Lee Ward:

Yeah! And the government doesn't have the right and the authority to make me pay taxes either!

Oh, wait a minute -- they do.

And they can't force me to buy auto insurance!!!

Oh, wait a minute, they can require it and I pay a penalty if caught without it.

Yeah -- but Social Security -- they can't MAKE me pay into social security!!

Oh, duh! Yes, they can.

Yeah - but I don't HAVE to pay property taxes, and sales tax and... and....

JLawson:

At what cost, indeed.

Think the deficit's high now?

Wait till we get 'universal health care' no matter who's plan you want. From other postings, I understand the Mass. experiment's running well over budget, and looking for the Feds to make up some of the excess. That's all well and good - but with all 50 states running the same, where's the Fed to get the money?

The deficit will balloon like crazy - and the $4tril National Debt we've got will look positively miniscule.

But it's what the 'people' wanted - so it's all good, right? Just look at how good things are in England, as they're faced with the hard cost of their programs...and how they're talking pretty seriously about severely rationing care.

I don't think that's what you envision when you imagine universal health care - but it sure seems the most likely outcome.

Whenever you want the government to 'give' you something, you'd be wise to make sure the long-term costs aren't going to be a lot more than you expect. Of course, neither Hil or Obama are likely to pay the political price for giving the voters what they've been told they want - the bill will come due well after they're out of office.

ke_future:

lee,

there is a specific constitutional amendment dealing with income taxes. states also have items in their constitutions dealing specifically with taxes.

and yes, i question the constitutionality of the social security scheme and taxes. the only way it got passed was because of FDR's threat to load the supreme court. most of the new deal programs were of questionable constitutionality.

the other isuue you brought up: auto insurance, is a state law, not federal law.

see, here's the thing, the constitution lays out specific areas of power for the 3 branches of the federal government. if it isn't enumerated it's supposed to devolve to the states and to the people.

but, as usual, leftists/progressives don't care what the constitution actually says, they just care about what they think should be done, without any concern of the consequences

Steve Crickmore:

JLawson..I think we could safely say that about Bush fudging the figures on fully funding the expected costs of the war on terror. I see how he has asked for another unrealistically low 70 billion for 'emergency funds' for the Iraq and Afghanistan wars in the new budget to Congress he presented on Monday.

With regards to healthcare his proposed budget cuts Medicaid by $18.2 billion over five years, essentially "shifting costs to the states".

.

JLawson:

All I'm saying, Steve, is that if you think the deficit is bad now - you ain't seen nothin' yet.

And is that budget cut for Medicaid the "decrease the annual program increase from 7% to 5%" cut, or are we talking about an actual CUT - from 100% to maybe 90% of the current budget? Because there IS a difference, you know. I don't see a 2% increase decrease as being a 'cut' - just not as fast an expansion.

Lee Ward:

"All I'm saying, Steve, is that if you think the deficit is bad now"

That's standard GOPer jabber. Bill Clinton reduced the deficit there's no reason to think the next Democratic president won't do the same. Democrats have become the 'responsible spending' party.

Steve Crickmore:

Lee, there are big differences in the candidates approaches to healthcare..Kevin Drum just had a thread about those differences focusing on the bugbear of Hillary's plan mandates....Here are two comments I liked from many..

And now all the policy wonks want to mandate (!) that everyone buy a policy from these same insurance companies that have been responsible for so much waste, red tape, and cost-shifting to other parties, basically creating a fee paid to private companies for simply being alive. And this is advocated by the supposedly more liberal party in the U.S. It's nuts

and

Actually, the defense is easy and the path is much easier from Obama's plan to real Federal health insurance than Hillary's.

Obama will introduce a Federal paid option for those who can't afford private insurance now. Probably by expanding Medicare to the non-retired or something like it. At the same time, this huge pool will offer insurance to anyone that wants to buy in. If, as I suspect and he must too, this single payer plan is more than competitive with private insurance, it will lure many people in who have private insurance or no insurance. Once much of the country is in this single payer plan, it will be that much easier to simply extend the plan to everyone. Here the free market works for progressive ideas.

Now, if you mandate everyone buys private insurance, how do you get people to single payer universal?

How do you garnish the wages of the self-employed or unemployed?

It is easy to see why Hillary has enormous finding from the private health insurance companies far more than any other Democrat or Republican candidate.


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Publisher: Kevin Aylward

Editors: Lee Ward, Larkin, Paul S Hooson, and Steve Crickmore

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