A belated opinion on Obama's and Clinton's heath care plans

A key point of contention between Sens. Barack Obama and Hillary Clinton has been on the issue of health care reform, often brought up in debates in the past (and likely again in future ones). Though about 95% of their plans are the same, Sen. Clinton has tried to make any issue of the fact that Obama's health plan does not include a mandate on adult individuals to have health care similar to the mandate states require for auto insurance (this is central to the health plan Gov. Mitt Romney and the Democratic legislature instituted in Massachusetts). The political point she makes is that without a mandate, Obama's plan would not achieve universality. Of course, a more intellectually honest point would be to say that while Obama's plan does not guarantee universality as Clinton's does by forcing a mandate on individuals, but universality could still be achieved if, as Obama believes, people are more likely to get or purchase health insurance under his plan (he and Clinton offer almost identical government subsidies and benefits). His political point is that people aren't uninsured because they aren't forced to be insured, but because they can't afford it. So simply making it more affordable will push Americans towards universal coverage.

In a nutshell, that has been the debate between the two candidates. Now, let me say that while I support Obama and his health plan over Clinton's, I personally favor a single-payer system (Obama has also stated in the past that he would favor this if he could start from scratch). But I recognize the political realities make the prospects of such big reform small in the near future (look at how difficult it has been to try and expand SCHIP, which has some 70% support among the American people), even with a Democratic president and expanded Democratic majorities in Congress. (As a side note, this is why I have cared more about the candidates' different foreign policy views which is truly the realm of a president, than their domestic plans that must have Congressional approval and more or less overlap anyway).

As a result, in distinguishing between the two candidates' health plans, my question is which is the one that approaches the goal of universal care but has the most likelihood of being passed into law? I've already said that there's little real difference between the two plans outside the individual mandate for adults, and Obama's clearly wins out to me on the latter point. Why? For one, I have my general faith in Obama's ability to unite partisans together and push through tough legislation, and specific to this issue, we have seen Hillary Clinton fail on this issue before in the early 90s. But more importantly, I believe the individual mandate would doom it to certain death in Congress. In order to enforce a mandate, you have to have some kind of enforcement mechanism in place, such as garnishing people's wages if they didn't get health care. This has caused problems in Massachusetts, and quite frankly, I think that is actually less politically palatable than simply having the government tax people and provide them health insurance directly.

While I hope Democrats achieve the 60-seat, filibuster proof Senate they are trying for this year, I think it is wise to factor in the need for a decent amount of Republican support at this time. I believe we have seen a bipartisan movement in the direction of something similar to Obama's plan. Last year, Sen. Ron Wyden, laid out a proposal that has drawn support from both sides of the aisle. The bill, still awaiting action in the Senate Finance Committee, has 14 co-sponsors that include many moderate Democrats and conservative Republicans. The Health Americans Act has several differences with Obama's plan, but is in the same general vein, as Sen. Wyden himself details here. Now I should point out Sen. Wyden is not planning on endorsing either candidate before the Oregon primary because he doesn't want his plan identified with either of the candidates' plans lest he risk the impressive bipartisan coalition that exists behind his bill.

But I do think this, in general, illustrates how a plan like Obama's might be better positioned to get passed. As Sen. Clinton says herself, we ought to be looking at who can actually bring about the "change" we seek, right? On the issue of health care, I believe Sen. Barack Obama again better meets that standard.