Friday, December 28, 2007

Democratic Candidate Healthcare Proposals

I was recently discussing politics with a friend who is interested in health policy (and is also a med student). I realized that while I knew the general ideas that the candidates had, I wasn't too familiar with the specifics. I had tried previously to go to candidate websites, but I found myself getting bogged down, as each one had a different way of presenting their proposals. I asked my friend if there were any sites that simply compared the different policies. He directed me to health08.org, a website run the Kaiser Family Foundation. The site was easy to use, and let me compare any candidate's plan against any other candidate's plan.

As I tend to be liberal-leaning, I compared Senator Clinton's plan with Senator Obama's and Senator Edwards'. The comparison was fairly helpful, as it went through the plans and compared them on a point-by-point basis. Here's a summary of each plan, and my opinion of them:

Clinton: Every American is required to have coverage. To make this affordable, the plan will provide income-related tax subsidies. Plan options, both public and private, will be available through a "Health Choices Menu," which would be operated by the Federal Employee Health Benefits Program. Coverage through employers and public programs would continue. Employers of small businesses would receive a tax subsidy to offset their costs. Cost estimate: ~$100 billion, partly financed by rolling back tax cuts on those making over $250,000.

Obama: Every child will be required to have coverage. Employers will either have to extend benefits or contribute to a new public plan. A new "National Health Insurance Exchange" would facilitate enrollment in the new public plan. Employers would receive tax benefits to offset catastrophic costs. Cost estimate: ~$60 billion, partly financed by rolling back tax cuts on those making over $250,000.

Edwards: Every American is required to have coverage, with a goal of universal coverage by 2012. The plan would create nonprofit "Health Markets" in which public and private options would compete with each other. Expanded public funding for coverage of low income adults would also be provided for. There is no provision for employers. Cost estimate: ~$100 billion, partly financed by rolling back tax cuts on those making over $200,000.

So basically, the three candidates are providing the same healthcare plan with minor tweaks. I think Obama's would benefit from mandating coverage, but on the other hand, the plans with mandates do not technically guarantee coverage. Simply by saying you must be covered doesn't necessarily make it so. And what are we going to do if people choose not to buy? Fine them? Put them in jail? Maybe I am not understanding the mandate, but if they really want universal coverage, they should just expand the Medicare payroll tax deduction and call it the "National Healthcare" payroll deduction. Of course, that will never happen, but I'm jus' sayin'... Anyway, given what I've read, I think Clinton's and Edwards' plans sounds the best and have more detail. Obama's is good, but not as broad as theirs; however, his plan might be the one that is most realistically implementable. It is interesting to see his views on policy. I think Obama would be in support of mandates if crafting a system from scratch, but in this climate, perhaps he believes that a more incremental change is more feasible. I suppose I should admit a bias towards Obama, but I think any one of the candidates I mentioned above would be more than competent.

To be fair, here is what I understand of some of the other candidates' plans (in no particular order):

Giuliani: Healthcare reform 9/11. Now.

Paul: Ban healthcare as it was not mentioned in the Constitution.

Huckabee: Plan members will ask themselves, "What would Jesus do to heal himself?" instead of making claims.

Kucinich: Mars has healthcare for all, so why can't we? I was the first to propose the Martian plan.

Thompson: Healthcare reform in U.S. America... [yawns]... is something.... umm, line?

=) Anyway, hopefully whoever is elected president in 2008 will bring about meaningful change to our system, which is clearly in need of reform.

1 comment:

  1. Hey Ajit,

    Great heads up on health08.org and a pretty good distillation of the major Democratic candidates' health care proposals. I agree that Obama's plan, as the most realistic "incremental" option, suffers by comparison to the expansive plans of Clinton and Edwards.

    Originally, I was very big on the mandate option, back when the Massachusetts plan was being pushed through by Gov. Romney. When Romney started assailing the Clinton health care plan many months ago, I was incredulous that he would be attacking a plan that was a near facsimile of his own Massachusetts plan. Regardless, I'm not so sure about mandates anymore, but I'm still constantly revising my opinion. Here is a great article from NY Times that provides some perspective on the effectiveness of a health care mandate, playing off some of the very issues you raise in your blog post:
    http://www.nytimes.com/2007/11/25/us/politics/25mass.html?ref=us

    Like you, I support Obama. In addition to the New Yorker profile you linked to, I suggest this exquisite argument for Obama, written by libertarian/conservative blogger Andrew Sullivan:
    http://www.theatlantic.com/doc/200712/obama

    It's a must read, and I wish all caucusing Iowans could hear or read the arguments Sullivan provides for an Obama nomination.

    You might want to post these links in a future blog post if you end up liking them.

    Happy holidays!
    Sriram

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