Democratic Presidential Hopefuls Disagree on Health Care Policy

Published February 1, 2008

A heated debate is taking place in the Democratic presidential primary between U.S. Sens. Hillary Clinton (D-NY) and Barack Obama (D-IL) over whether the federal government should mandate health coverage for individual citizens.

The Democrats’ difficulty in agreeing on whether to impose a mandate requiring individuals to obtain health insurance strongly suggests it would be a very heavy lift for the next president. None of the Republican presidential candidates is advocating a mandate, so a bipartisan deal would be difficult indeed.

In arguing for her plan, Clinton told an Iowa audience, “If we don’t have universal health care, we will be betraying the Democratic Party’s principles.”

Tactical Disagreement

Obama shot back before a different Iowa audience: “Until she clarifies what exactly she intends to do to enforce this mandate … this is more of a political point that she’s trying to make than a real point.”

The Illinois senator would require children be insured but not adults. He says costs to consumers are the real issue.

“The reason Americans don’t have health insurance isn’t because they don’t want it, it’s because they can’t afford it,” Obama said.

Inside Fighting

Former Sen. John Edwards (D-NC) deserves credit for being up-front about his plan: He would require proof of insurance when income taxes are paid and/or when medical treatment is provided, and he would assign families that don’t have insurance to a coverage plan. The government would withhold tax refunds or use collection agencies and garnish wages to go after people who could afford to pay premiums but refused.

At least he is honest about the amount of government intrusion he is proposing.

You know this issue hits the jugular when liberal columnist Paul Krugman weighs in. He points out that under the Obama plan, “healthy people could choose not to buy insurance–then sign up for it if they developed health problems later. Insurance companies couldn’t turn them away, because Mr. Obama’s plan, like those of his rivals, requires that insurers offer the same policy to everyone.”

Krugman accuses Obama of “attacking his Democratic opponents from the right–and in so doing giving aid and comfort to the enemies of reform.”

Massachusetts Mandate

Those advocating health insurance mandates on a national level would do well to consider how Massachusetts’ experiment with an individual mandate has gone. The answer is, not so well.

Not surprisingly, the free or nearly free health insurance available to people making less than $30,000 a year ($60,000 for a family of four) is going like hotcakes. It is so popular, in fact, the program may exceed its budget by $150 million. The State of Massachusetts Web site shows 133,000 of the estimated 207,000 people eligible for the heavily subsidized coverage have already enrolled.

But it’s not going so well for those who aren’t eligible for the state subsidies. The great majority of them either remain uninsured or are asking for waivers that would exempt them from the mandate. So far, only about 10,000 of the more than 215,000 uninsured Massachusetts residents who aren’t eligible for subsidies have signed up for coverage with the Commonwealth Connector system.

Further, insurers expect to raise rates in Massachusetts 10 percent to 12 percent in 2008–twice the national average. And people who have signed up for coverage are complaining they are having trouble finding physicians who will see them.

“The state’s experience should be instructive to the presidential campaigns, and to officials in California, where Gov. Arnold Schwarzenegger, a Republican, has proposed a similar plan,” The New York Times reported in late November.

We couldn’t have said it better.

Grace-Marie Turner ([email protected]) is president of the Galen Institute, a think tank in Alexandria, Virginia.