On Health Care, Dems More Alike Than Apart

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With less than a month before the crucial Jan. 3 Iowa caucuses, the three leading Democratic presidential hopefuls - Sen. Hillary Clinton, John Edwards, and Sen. Barack Obama - are each trying to convince voters that they have the superior health care plan, often by stressing the ways in which their opponents' plans are lacking.

"There's a big difference between Sen. Obama and me on health care," Clinton said. "I have a health care plan that covers every single American. He does not." The Clinton campaign has called on Obama to remove a television ad in New Hampshire in which Obama says he has "a plan to cut costs and cover everyone."

Edwards has also criticized Obama's plan.

"Barack Obama's plan leaves out 15 million people," he said in a statement. "The truth is that some people will choose not to buy insurance even though it's affordable, knowing that the rest of us will pay for their emergency room visits." (Obama's campaign says that only 3 million people would be left uninsured under his plan.)

There are significant similarities between the Democratic hopefuls' plans: All three would create public insurance plans (separate from, but similar to, Medicare) that would compete with private plans. All three would be financed, according to the candidates, in part by rolling the Bush tax cut on people with incomes over $250,000.

Candidates' Health Care Proposals

Clinton estimates the cost of her plan, which also allows people to keep their present plans or opt into a plan similar to what Congress has, at $110 billion. Edwards, whose populist platform includes vows to take on drug and insurance companies, says his will cost between $90-$120 billion. Obama estimates the cost of his plan at $50-$65 billion per year, and notes that it will include provisions that "undesirable" Americans - say, those with a preexisting condition - could not be refused coverage.

The difference Clinton and Edwards are trying to spotlight has to do with which of the plans truly constitute "universal" health care. While Clinton and Edwards would mandate that all Americans have insurance, Obama would only have such a mandate for children.

Obama, who says that health care costs are presently too high to justify forcing people to buy coverage, argues that Clinton has not explained how she would make people pay for their health care.

"Senator Clinton says 'I'm gonna make universal health care by mandating that everybody buy it.' But if people can't afford it, it doesn't matter what the mandate is, they're not gonna buy it," he said.

“Without an enforcement mechanism, there is no mandate," added Obama.

Edwards has explained how he would force people to opt-in: By making them prove that they have health insurance when they file their taxes and, if necessary, sending collections agencies after them if they don't pay. He is also running an ad saying he would take health insurance away from members of Congress who don't support universal health care by 2009.

Broadly, the health care plans of all three candidates are less different than the candidates might want voters to believe. Obama seeks to create a national health care "exchange" of private insurers, for example, while Edwards wants similar, regional "health markets." And even though Obama, unlike Clinton and Edwards, would not try to force everyone in America to purchase health insurance, it remains unclear how close to truly "universal" any plan could get without harsh enforcement levels that could result in backlash.

Health care expert Henry Aaron of the Brookings Institution argues that the specific differences in the plans may ultimately not make much of a difference.

"The plans differ in detail, but I don't think those details are critical, because in the end everybody's going to have to negotiate with Congress," he said. Aaron stressed that the real difference is between Democrats, who want to significantly reform to the health care system and insure more people, and Republicans, who want more minor reforms.

"This is not a primary campaign issue - it's a general election issue," said Aaron. "And I think the diversion into trying to determine whether my health care plan is bigger than yours is a complete waste of time."

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