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Health Care For All?

The stakes in Hillary Clinton and Barack Obama's current debate over health care are fairly straightforward: all or nothing. All, as in Clinton's description of her universal plan that offers coverage to everybody. Nothing, as in the lack of enforcement that Obama says Clinton has outlined to make sure that her universal plan actually works.

Clinton addressed her criticisms of Obama's plan, which does not require Americans to purchase health coverage and will result, she argues, in more than 15 million Americans left without insurance, at an event at the home of a supporter in Goffstown, New Hampshire on Monday. The New York Senator pointedly said "my plan is universal, meaning everybody is covered. Most of the Democrats have plans that cover everybody. Senator Obama does not." Earlier in the day, in talking to reporters, Obama said that until Clinton details how she would enforce the proposed mandate, her attack was "just a political talking point" and Obama advisers dispute the number of uninsured would be anywhere close to 15 million.

Experts say that without a mandate, many Americans would still not have health insurance, and the picture of who those millions are is an interesting one.

For people who want to get health insurance and make an effort to do so, Clinton and Obama have almost exactly the same plan: increasing the number of poor who can qualify for Medicaid, offering tax credits or subsidies for people who need help paying their health care bills and requiring insurance companies to offer everyone coverage, with the government subsidizing those who can't pay the full amount.

So the 15 million people without insurance under Obama's plan would be a combination of relatively well-off people who choose not to purchase health insurance and people who qualify for public programs like Medicaid who don't sign up. It could be a struggle for Clinton to find someone who wants health insurance but doesn't qualify under the Obama plan, because it's not clear such a person exists.

Most health care experts want those 15 million to get health insurance even if they aren't asking for it, a point Clinton nodded to when she said Medicare, the health program for the elderly, works in part because "everybody is required to be in."

People who are uninsured and can't afford it are effectively subsidized by the government when they show up without health insurance at hospitals with major illnesses or injuries. Having them covered might reduce that cost to taxpayers. And by requiring people to purchase insurance, Clinton would get the millions of relatively healthy people without insurance into the system. Insurance companies create what are called "pools" of people under their plans; a pool with a mix of young healthy people who don't spend much on health care and older, less healthy people would likely result in lower average prices than if healthy people chose not to enroll in health plans, as they have the option to under Obama's plan.

While Clinton has not detailed how she would mandate health insurance, Massachusetts has launched a new health care proposal along the lines of what Clinton is proposing. Next year, the state has suggested it will fine people who can afford insurance but don't buy it around $1,000, or about half the average cost of a year's worth of health insurance bills.

While $1,000 a year may not seem like a huge amount of money for the nine million Americans who make more than $60,000 a year and don't have health insurance, a mandate implemented in this way would require a segment of Americans to spend more than $1,000 either on health insurance or the fee for not getting insurance. This is unlikely to be a very popular position, which is perhaps why Clinton has avoided detailing how she would enforce the mandate. Based on the Massachusetts model, a less onerous mandate may not be effective; this year the state is simply denying people who don't get insurance a $218 tax exemption and so far more than a third of the state's uninsured have not signed up for coverage.

"Some of these people are saying now I don't want it," said Jonathan Gruber, an economist at the Massachusetts Institute of Technology who is a major advocate of the mandate idea. "That's where you get the political difficulty and you don't know how big that group is."

Clinton addressed this point at an event at the home of a supporter in Goffstown, New Hampshire on Monday, where she was joined at the dining room table with a handful of Granite State residents while more than two dozen reporters looked on. The New York Senator pointedly said "my plan is universal, meaning everybody is covered. Most of the Democrats have plans that cover everybody. Senator Obama does not." Earlier in the day, in talking to reporters, Obama said that until Clinton details how she would enforce the proposed mandate, her attack was "just a political talking point."

Experts say that without a mandate, millions of Americans would not have health insurance, and the picture of who those millions are is an interesting one.

For people who want to get health insurance and make an effort to do so, Clinton and Obama have almost exactly the same plan: increasing the number of poor who can qualify for Medicaid, offering tax credits or subsidies for people who need help paying their health care bills and requiring insurance companies to offer everyone coverage, with the government subsidizing those who can't pay the full amount.

So the 15 million people without insurance under Obama's plan would be a combination of relatively well-off people who choose not to purchase health insurance and people who qualify for public programs like Medicaid who don't sign up. It could be a struggle for Clinton to find someone who wants health insurance but doesn't qualify under the Obama plan, because it's not clear such a person exists.

Most health care experts want those 15 million to get health insurance even if they aren't asking for it, a point Clinton nodded to when she said Medicare, the health program for the elderly, works in part because "everybody is required to be in."

People who are uninsured and can't afford it are effectively subsidized by the government when they show up without health insurance at hospitals with major illnesses or injuries. Having them covered might reduce that cost to taxpayers. And by requiring people to purchase insurance, Clinton would get the millions of relatively healthy people without insurance into the system. Insurance companies create what are called "pools" of people under their plans; a pool with a mix of young healthy people who don't spend much on health care and older, less healthy people would likely result in lower average prices than if healthy people chose not to enroll in health plans, as they have the option to under Obama's plan.

While Clinton has not detailed how she would mandate health insurance, Massachusetts has launched a new health care proposal along the lines of what Clinton is proposing. Next year, the state has suggested it will fine people who can afford insurance but don't buy it around $1,000, or about half the average cost of a year's worth of health insurance bills.

While $1,000 a year may not be a huge amount of money for the nine million Americans who make more than $60,000 a year and don't have health insurance, a mandate implemented in this way would require a segment of Americans to spend more than $1000 either on health insurance or the fee for not getting insurance. This is unlikely to be a very popular position, which is perhaps why Clinton has avoided detailing how she would enforce the mandate. Based on the Massachusetts model, a less onerous mandate may not be effective; this year the state is simply denying people who don't get insurance a $218 tax exemption and so far more than a third of the state's uninsured have not signed up for coverage.

"Some of these people are saying now I don't want it," said Jonathan Gruber, an economist at the Massachusetts Institute of Technology who is a major advocate of the mandate idea. "That's where you get the political difficulty and you don't know how big that group is."

--Perry Bacon Jr.

By Washington Post editors  |  November 28, 2007; 11:53 AM ET
 
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Comments

JADE7243-If you are not familiar with ME, know, I do not attack issues I do not have a recommended solution, or in this case several, For!

Only problem, I'm tired of giving away, what my account is screaming at me, I SHOULD BE SELLING!

Hint-Obasama only thinks he has a clue! His Clue was handed to him, by his Insurance Lobbyist!

He could use a better clue!

This Retort was NOT paid for by any Insurance companies!-BUT, I'd be willing to bet, They'd pay to shut me up!


Ohhhh, Bad News insurance companies-I own my soul!

Posted by: rat-the | November 28, 2007 10:10 PM | Report abuse

"People who are uninsured and can't afford it are effectively subsidized by the government when they show up without health insurance at hospitals with major illnesses or injuries."

Okay, just when was the last time you "showed up" at hospital with no insurance? When were you last in the emergency room at a city hospital with no insurance and a sick child? Got a couple of days to hang around waiting? And what about those same people who get billed exorbitant amounts for minimal service because they have no coverage, are required to make down payments before they receive treatment, are limited in the hospitals they can go to for treatment, and who end up bankrupt or near bankrupt because their current insurance stops covering them, limits coverage, refuses coverage for pre-existing conditions.

Having insurance is not the problem. It is having access to healthcare -- preventive and acute -- that is a problem. Obama's plan has been described as one whioh leads to universal access to care.

Obama's plan to me is the far better solution to a massive problem.

Posted by: jade7243 | November 28, 2007 9:05 PM | Report abuse

OK Folks! Being the RAT, occasionally I LOVE to PROVE it!

Who knows anyone who payed years for Insurance, then, BAM, got something like Cancer, AND STILL WOUND UP FINANCIALLY DESTROYED?!!!

What's that RAT? Health Insurance does not Magically cover all the exponentially Rising Costs of Treatments? That MANY Items are LIMITED, EXCLUDED, or just not COVERED?!!!

But, But, But, all these nice sold out Reps are telling us we need insurance, or their Lobbyists are going to get MAD!

WE'RE Sooooooo Confused!

Folks, the ONLY ones benefiting from this grand scam to get everyone Insurance, are the superfluous GREEDY, Un-Necessary, INSURANCE COMPANIES, THEIR LAWYERS, and Their Lobbyists-and a few Congressmen, or Billary!

Don't listen to me too much, but I'd say we could make the whole situation a lot better, if we got Illegals off the costs, and possibly more Workers covered by Worker's Comp-instead of dumped at Emergency Rooms...

You can lead them to the light, But you can't force them to THINK!

RAT-Has spoken!

Posted by: rat-the | November 28, 2007 4:55 PM | Report abuse

Even though many may like the policies that Senator Clinton proposes, they should also consider her record , just as Senator Clinton insists.
.
The last Clinton Administration, when faced with the fact that protection rackets where torturing people with poison and radiation, chose to avoid its responsibilities to incarcerate the criminals and protect the citizenry.
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Instead, they made a deal with the criminal gang stalker protection rackets to leave them alone and to consequently abandon the citizenry.
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Do we want a President who sells out the citizenry for votes?
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Do we want a President who sends a "crime does pay" message to society?
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Would you vote for a President who has signed nonagression deals with the KKK or the Nazi party? Gangs that torture with poison and radiation are much like the KKK and Nazi Party.
.
We do not need a sellout President. We need a principled leader President.
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If you are one of the few who do not know what the above refers to, do a web search for "gang stalking" to see the tip of the dirtberg. Please do it before you decide to reply to my post.
.

Posted by: avraamjack | November 28, 2007 4:25 PM | Report abuse

Anyone looking for some new Hillary video from an SC stop and an interesting commentary on how race is impacting that primary should try: http://goupstate.us/index.php/lanefiller/2007/11/27/hillary_and_the_black_men_of_god

Posted by: lanefiller | November 28, 2007 2:23 PM | Report abuse

zukermand is correct - the article needs a bit of cleaning up; it appears that some cut & pasting went awry.

Having said that, its an interesting insight into the competing proposals by HRC & BHO. Thanks, Mr Bacon, for offering an article with substance on policy issues, rather than the horserace drivel that is so much more popular.

Posted by: bsimon | November 28, 2007 1:43 PM | Report abuse

re: "...the more I read comments like ordgobaltc's above, the more I tend to support Sen Clinton. She seems to really tick off the type of people that I find repulsive, she must be doing something right." Posted by: zukermand | November 28, 2007 12:45 PM

BRAVO! I coudn't agree more.

Posted by: freespeak | November 28, 2007 1:32 PM | Report abuse

It's funny, I live in NC and have no say in the choice of Dem nominee, so I don't really takes sides at this point. I'll support whichever is nominated. But the more I read comments like ordgobaltc's above, the more I tend to support Sen Clinton. She seems to really tick off the type of people that I find repulsive, she must be doing something right.

Posted by: zukermand | November 28, 2007 12:45 PM | Report abuse

New Ad from the Republican party:
Hillary can get the job done.(period)

What happen to John Kerry?
He voted for the war in Iraq before he voted against it.
What will happen to Hillary?
She voted for the war in Iraq before she voted against it.
She voted for the Revolutionary Guards as a terrorist organization, and then said she was against it.
She accepted giving diver's License to ILLIGAL IMMIGRANTS before she was against it.
It's simple: You can eat you FAT Cake and have it back.
She is a FLIP FLOPPER and I can't wait for the Republicans to run this Ad.

DEMOCRATS: A word to a wise is sufficient. DUMP HER.


Posted by: ordgobaltc | November 28, 2007 12:39 PM | Report abuse

First of all, can someone proofread this mess?

Second,
"People who are uninsured and can't afford it are effectively subsidized by the government when they show up without health insurance at hospitals with major illnesses or injuries."

By the government? What the hell is Mr Bacon talking about?

Posted by: zukermand | November 28, 2007 12:17 PM | Report abuse

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