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Democrats’ health plans not much help to undecided voters

Senators Clinton’s and Obama’s split over mandating coverage distinguishes them from one another, but does that difference matter?

From the June ACP Internist, copyright © 2008 by the American College of Physicians.

Stacey ButterfieldBy Stacey Butterfield

In the seemingly endless Democratic primary, Sens. Hillary Clinton and Barack Obama have expended a lot of effort trying to distinguish themselves from one other. She stands for experience, he stands for change, and so on.

They both stand for health care reform and have acknowledged that they propose very similar plans for covering the uninsured. But their plans do have one difference—mandates for coverage—and there doesn’t seem to be any consensus on whether that is a big, important difference or a small, insignificant one.

Both plans require insurers to offer coverage to everyone, and use federal funds to make the coverage affordable for consumers. However, Mrs. Clinton’s plan will require all Americans to purchase coverage or face as-yet-unspecified penalties. Mr. Obama’s plan requires mandatory insurance only for children; for adults, coverage will be optional.

Proxies explained their candidates’ proposals at the 2008 World Health Care Congress (WHCC) in Washington, D.C., where one of the keynote addresses featured representatives of the three major presidential campaigns. Since my last column focused on Mr. McCain’s proposals, I’ll stick to the discussion between Mrs. Clinton’s and Mr. Obama’s campaigns.

Democrats’ health plans not much help to undecided votersU.S. Representative Jim Cooper of Tennessee, who represented Mr. Obama, said the mandate issue has been overplayed. “I think that’s much ado about a technical subject,” he told the audience of health care leaders in April. “The health care plans of Hillary Clinton and Barack Obama are almost identical. We are for universal coverage.”

He also offered an explanation for Mr. Obama’s policy decision. “An upfront, individual mandate will probably get zero Republican co-sponsors in Congress,” Mr. Cooper said.

That’s not true, argued Chris Jennings, the political strategist who represented Mrs. Clinton at the WHCC. “There already is [bipartisan support],” he said. He noted that mandatory coverage legislation has been proposed by Sen. Ron Wyden (D-OR) and Sen. Robert Bennett (R-UT), and two Republican governors, Mitt Romney and Arnold Schwarzenegger, have been the driving forces behind state efforts to mandate insurance.

“The reason why we want everyone to be in the system is to make it work rationally,” Mr. Jennings said. If consumers can wait until they are sick to purchase health insurance, it would raise the premiums of those who buy insurance as well as drawing intense protest from health insurers, he explained.

Obviously, the most likely to opt out under the non-mandatory plan would be the young and healthy whose premiums would typically subsidize the cost of covering the less healthy, more expensive patients. Mr. Obama’s advocates argue that if health insurance is made affordable, almost everyone would choose to buy it, but there’s no way to prove that without enacting a plan.

The Obama plan does have the advantage of being less expensive. Analysts have calculated that his plan would cost taxpayers 50%-80% of what the Clinton plan would. Since either plan would cost the government tens of billions of dollars a year, it’s somewhat difficult for laypeople to really grasp the price difference.

So what is the priority in creating a new health care coverage system? Gaining bipartisan support? Ensuring that everyone is within the system? Limiting cost?

Attendees at the WHCC, who were mostly health care industry executives, seemed to be thoroughly divided about the answers to these questions. After the representatives from the two Democratic campaigns and a spokesperson for Mr. McCain had presented their candidates’ proposals for health reform, the audience voted on their perceptions of feasibility and cost.

The votes were just about even. Mrs. Clinton’s plan got slightly positive ratings, with about 54% of the group finding it feasible and 51% saying it would help with costs. The voters were exactly split on the feasibility of Mr. Obama’s plan and slightly favorable (54%) on cost. The evaluation of Mr. McCain’s plan was slightly negative, with 45% voting yes on feasibility and 46% on cost.

With that mixed evaluation from the health care experts, it’s no wonder that the American voters are still undecided about who they want to lead health care reform.

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