A few weeks ago, a TMV reader suggested we evaluate and post on the health care reform strategies of the leading Democratic candidates.
By now, those strategies are semi-old news and others having already chimed in. But I was reminded of the request after reading an analysis of the Clinton, Obama, and Edwards plans in a recent edition of The Economist. The article offers a number of useful insights and summaries for those who have not yet had an opportunity to do their own analysis of these plans or read others’ analyses.
Leading off, the article notes that …
All three have eschewed radical change. Instead, they are jostling over the centre ground: how to tweak America’s predominantly private health-care system.
As a moderate, that strikes me as both smart and necessary. They’ve apparently learned from Hillary’s experience in 1993: radical proposals on a subject as emotionally charged as health care can quickly go down in flames. But don’t be fooled: With the exception of Hillary’s new plan, the other two are not shy about major reform.
With respect to Edwards’ plan, The Economist article notes that …
Mr. Edwards has long set the pace with an ambitious plan that nods at cost control but concentrates on insuring every American by 2012 … Mr. Edwards’s scheme promises an overhaul of insurance markets, subsidies to help poorer people pay their premiums and a legal requirement that everyone should buy health insurance.
In a sop to the party’s left, a government health scheme, such as Medicare, would compete with private insurers. Employers would have to provide their workers with health insurance or pay a tax. But the Edwards plan would still cost the federal government some $120 billion a year, money that would be raised by rolling back Mr. Bush’s tax cuts for the rich.
My take, which is obviously colored by my right-leaning perspective: Not only is Edwards’ plan perhaps the most ambitious, it smacks of big government getting bigger, of that old “tax and spend†label associated (fairly or not) with Democratic programs. Rather than pay for his program by eliminating tax cuts (for anyone, the rich or otherwise), I’d like to see proposals for cutting government spending elsewhere, and re-applying those funds to health care priorities.
The one nod I will give to Edwards’ plan: mandatory coverage, purchased or otherwise secured.
While conducting the annual review of a younger employee in the mid-1990’s, I reminded him that the company not only offered good pay but a very solid benefits program. He said he didn’t care about benefits, especially health benefits. He was young, ailment-free, and thus paid for rare medical expenses out of his own pocket. What about emergency care, I asked; wouldn’t he feel better having coverage, just in case? He shrugged it off, blinded by a young person’s stubborn sense of immortality.
What I now realize is that not only was that employee doing himself a disservice, he was affecting the rest of us, as well, especially people like me with a family at home, whose annual healthcare costs could be astronomical. Without the premiums of the younger employees, we “elders with families†were picking up more of the burden. You can label that “selfish,†if you like, but the reality is pretty simple: Eventually, this younger employee would become an older employee, possibly with a family of his own, and at that point, he would covet a good health plan as much as I did. But without spreading the cost among those younger than him, the burden would be even greater on his family.
Many states have moved to mandatory automotive insurance; the precedent is a smart one and Edwards is headed in the right direction with this proposal for health care. (Some might argue that mandatory health coverage is better left to the states, but as federalist as I am on many issues, I think healthcare is enough of a national/interstate commerce issue, that it warrants a heavier-than-normal dose of D.C. jurisdiction.)
Moving on to Hillary’s plan, The Economist article offers this synopsis:
Her preferred step-by-step approach has started with cost control; ideas for boosting coverage are promised in the coming weeks.
Mrs. Clinton offers a litany of well-known, but sensible, savings, such as shifting to electronic records, concentrating more on preventitive medicine, improving the management of chronic diseases, and creating a “best practices institute†to set guidelines for optimal care. In all, she claims, $120 billion a year could be wrung out of the health system, money that could be used to pay for broader coverage.
You go, girl. In my book, that’s a much better approach than Edwards’ tax-and-spend concept, although I find it remarkable that electronic records aren’t already standard procedure. My one concern with Hillary’s plan, as it’s summarized by The Economist, is the “best practices institute†which would “set guidelines for optimal care.†Again, that idea smacks of big-government intrusion into private choices, and would seem to run counter to Democrats’ historic insistence on keeping government out of doctor-patient relationships on issues like abortion and end-of-life matters.
Regarding Mr. Obama’s plan, The Economist article notes that it “borrows from both his rivals’.â€
Obama focuses on cost-control measures similar to Clinton’s. And like Edwards, he would tax companies that don’t provide coverage; infuse federal funds through a roll-back of the Bush tax cuts; and reform the insurance market, “including the creation of a National Health Insurance Exchange, to act as a clearing-house for people to buy coverage, as well as an industry watchdog.†Unlike Edwards, Obama would not force people to buy health insurance. Additionally, he thinks “the federal government should reimburse private insurers for a share of any catastrophic health costs.â€
I don’t think the federal government has any business reimbursing private sector companies, and the exclusion of mandatory coverage is baffling. As The Economist article concludes, that exclusion “makes [Obama’s] plan both less efficient and less effective†than Edwards’ plan.