A Healthy Disagreement
ANKENY, Iowa -- She was two hours late after her campaign plane blew a tire. But when Sen. Hillary Rodham Clinton finally arrived here this afternoon, she offered her harshest critique yet of Sen. Barack Obama's approach to health care reform.
Meanwhile, in the ongoing debate over which Democratic candidate offers the best plan, Obama and John Edwards outlined ways in which they would force people to purchase coverage.
In an effort to provide insurance to the estimated 47 million Americans who don't have it, both Clinton and Edwards have called for mandating health coverage. But yesterday for the first time, Edwards outlined the consequences for people who don't want to buy insurance, proposing to garnish their wages. Obama, who would require all parents to provide coverage for their children, said he would fine parents who failed to do so, although he did not detail how much this would cost.
In her Ankeny speech, delivered in the gym of a community college, Clinton rebuked Obama for imposing a coverage requirement on children, but not their parents or other adults.
"If we don't have universal health care, then we will be betraying the Democratic Party's principles," said Clinton. "Imagine if President Roosevelt had said, well let's have Social Security, but let's start by leaving out millions of our seniors. Or suppose President Johnson, figthing the fight over Medicare, said you know, let's just cover some of our seniors with Medicare, eventually the others will catch up. That is not the way it works. They knew what it took to make big important changes in our country. They also knew if you aim too low, if you give up before the fight is started, then you have no chance of making it to the finish line."
Obama has criticized Clinton for not detailing how she would enforce such a mandate, and she largely sidestepped the issue today, saying she would automatically enroll some people if they came to hospitals and qualified for subsidized insurance. Obama has proposed this as well. The question remains as to what she would do for people who have high incomes and don't qualify for subsidized health insurance, but choose not to purchase it.
Edwards also entered the fray by announcing he would send collection agencies after people who don't sign up health insurance and require proof of health insurance on their tax returns.
"Barack Obama's plan leaves out 15 million people," Edwards 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 advisers dispute this estimate, arguing that people choose not to purchase insurance because of its high costs, not because they don't want it. His staff estimates up to 99% of the uninsured will gain coverage under his plan, leaving about three million uninsured in a country of 300 million.
In a conference call with reporters, Obama criticized Clinton for not taking the step Edwards has in declaring how her mandate would work in practice.
"Until she clarifies what exactly she intends to do to enforce this mandate -- is she going to fine people, is she going to take other steps to enforce it -- this is more of a political point that she's trying to make than a real point," he said.
That a wonkish subject like health-care mandates has become a political flashpoint reflects the closeness of the campaign, particularly in Iowa. In recent weeks, Clinton has relentlessly blasted Obama's health care proposal, as she courts Democratic voters who rank health care as one of their most important issues.
What's not clear is whether the attacks are effective. Obama, Clinton and Edwards share the basic goals of insuring more people, getting more low-income people on Medicaid, offering subsidies for people who can't afford private coverage, and making it easier for them to buy health insurance in the private market.
Clinton and Edwards are essentially attacking Obama for not requiring people who don't want insurance from being forced to get it. Clinton argued Obama's plan imposes a "hidden tax" on Americans because health care prices will remain high as long as every person is not in the health care system. Obama aides say they will bring more people into the system through voluntary means.
--Shailagh Murray and Perry Bacon Jr.
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