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February 19, 2008

Candidates' health plans duck some key questions

Democratic presidential candidates Hillary Clinton and Barack Obama are sparring over which of them is more electable, whether change is better than experience, and how the party's "super delegates" should vote.

What they are not doing as much of is debating issues. That's because on most policy matters, beyond the backward-looking debate over invading Iraq, there's little daylight between them.

The notable exception is health care. Both candidates say they favor universal coverage, a worthy goal in a country where 44 million people are uninsured. Their big difference is whether uncovered individuals should be required to buy health insurance. Clinton says yes, that anything less is unsatisfactory. Obama would require only that all children be covered. Adults will buy health insurance, he says, if given incentives, a questionable assertion.

Clinton's broader mandate (with government subsidies for the poor) would get the nation closer to the goal of universal health care coverage and would spread the cost over a larger pool of individuals, both good objectives. Further, it would do more to reduce the hidden tax on insured people, estimated at more than $1,000 a family, to pay for the health care of those who don't have insurance and show up at hospital emergency rooms.

But for voters, this narrow policy difference provides little basis for a judgment. That is because both plans are sketchy and incomplete, making the mandate on individual coverage kind of like a loose piece on a giant puzzle. Without seeing how it would fit with all the other pieces, it is difficult to make an informed decision.

Both Democrats' health care plans are more ambitious than that of presumptive Republican presidential nominee John McCain, who proposes much more modest adjustments to the health care system, centered on tax changes to encourage consumers to take a more active role in choosing, and paying for, their health coverage. Even so, Clinton and Obama are heavy on promises about making insurance affordable and available, and light on the more painful details. Neither says, for example, how he or she would enforce the individual mandates (Clinton's for everyone, Obama's just for those 18 and under). Would they garnish people's wages? Deny them access to health care? Shrug and look the other way?

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Posted by healthinsurance at February 19, 2008 11:20 AM