Obama vs. Clinton

Gosh, there's so much to say about the election.

I want to talk about health care policies, but let me run through some preliminary items. I've not been shy about my preference for the black guy from Chicago's south side. I'll support Hillary Clinton if she wins the nomination, but I still dislike how she went negative on Obama and how Bill Clinton bashed Obama on invented grounds. Her campaign supported strong-arm tactics in Nevada, propagated unfounded assertions that Obama wanted a "trillion dollar tax increase on the middle class," and shamelessly distorted Obama's positions on Iraq and abortion. I also favor Obama because he spoke out on Iraq while Clinton was channeling Bush on the Senate floor (without even reading the National Intelligence Estimate). Obama current advisers opposed the war from the start. Clinton's current advisers did not, which says something about her foreign policy (not to mention her vote on Kyl-Lieberman). It's also odd that Clinton has been so unapologetic about her Iraq vote. Given this backdrop, I wonder what possessed her to stand and applaud Bush’s assertion during the State of the Union that there’s "no doubt" that "the surge is working."

As for the merely political, I think Obama is expanding the party base in ways Clinton simply can't. People who vote Democratic in one election are more likely to vote Democratic again. That matters. Obama is also a more effective campaigner and can help Democratic candidates in swing states. And the difference between 55 Democratic votes in the Senate and 51 Democratic votes is larger than any policy difference between Clinton and Obama. I also fear that the Clintons will unify the Republican base and hurt Democratic prospects. We have got to keep Congress blue.

On health care, there have been charges thrown about, especially on the question of mandates. Clinton requires that everyone purchase health insurance while Obama favors a mandate only for children. Clinton has charged repeatedly that Obama's plan would leave 15 million people uninsured. Obama has said that if there are indeed such a large number of uninsured people, he would consider imposing a mandate. Obama is weaker here. Would he require people who opted not to purchase health insurance to pay back-premiums when they eventually get sick? Neither has discussed how such a mandate would work, or how the state would penalize people who did not comply. Obama stresses that health coverage must be affordable before the government decides that it's mandatory. His campaign just released a mailer that says: "Hillary's health care plan forces everyone to buy insurance, even if you can't afford it." It concludes, "Is that the best we can do for people struggling with high health care costs?"

I'm not sure what to think about this whole debate. Hillary Clinton's plan makes intuitive sense. We don't want people gaming the system, betting that they won't get sick, while expecting public services if they ever do. But as Robert Reich says, the combination of purchasing pools, subsidies, easier enrollment, and mandatory coverage of children will cover all but 3% of the uninsured. Is it then better to "to require this 3% to buy insurance, or lure them into buying it with low rates and subsidies"? Meanwhile, 80 of the most respected public policy leaders have put forth the following statement which makes me think twice about the alleged deficiencies of Obama's plan:

"[W]ithout strong incentives to comply and harsh punishments for violation, [mandates] will have little impact on the number of uninsured Americans. Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions. There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible."

Return for a second to Obama's mailer. It asks: “Is that the best we can do?” Krugman attacks it as "Harry and Louise." But Obama asks a good question. Is it? Answer: No.

Neither Obama nor Clinton have had the guts to discuss the virtues of a single-payer, Medicare-for-all system. Clinton even had the audacity to criticize Obama for supporting one several years ago. And Obama's past statements, in my view, is why he lands on top. Anyone who's understood the genius of single-payer will ultimately return to it. Clinton is also financially beholden to the insurance industry (among other industries), which compromises her judgment. Obama, on the hand, refuses contributions from federal lobbyists. I'm convinced that Obama is a liberal at heart - see for example, his 2003 speech in support of single-payer. I frankly don't understand why any self-proclaimed progressive, Krugman included, would support a health care plan that forces (yes, forces is correct, even if it's supposedly a "right-wing talking point") citizens to purchase insurance from the private health insurance industry. Sure, the Clinton plan, like the Obama plan, would allow people to buy into a government plan, but there's no assurance right now that the government plan will be a cheaper alternative to big business.

In all of these discussions of health care policy, we haven't heard a peep from the insurance industry itself. Why aren't they criticizing such "bold" proposals for "reform"? They do after all prefer the status quo. The CEO of UnitedHealth made $124 million in 2004, while Coventry’s CEO made $25.4 million and Aetna’s CEO made $22.2 million. Not only are our health care dollars being diverted toward executives' yachts, but they're being diverted toward administrative costs, which now account for 31% of US health care spending. It doesn't have to be this way. Canada's national health program, which covers everyone, has an overhead of 1.3%. So why isn't the insurance industry concerned about the Democratic plans for reform?

Maybe because they know it's a whole lot better (for them) than it could be.