We must, as Mario Cuomo once said, look past the glitter and to the reality, the hard substance of things. There seems to be an inordinate focus on trivial issues such as haircuts, pickle vendors, and who has the best rhetoric. We need to focus more on what the candidates are proposing to do as president. Surprisingly, the second place candidate (who enjoys some of the trappings of being a front-runner as well) for the Democratic nomination proposed his health care plan this week and it did not include universal coverage. This did not generate much discussion, even among progressives.
This is a good article on Obama's health plan, his rationale, the policy--and political concerns behind it. It is a balanced article, although the part I excerpted is critical of Obama's plan. I encourage people to read the entire article and not be deterred by this critical portion of the article.
The excerpted portion, though, goes to the heart of the criticisms of Obama's plan. Even under a rosy scenario 15 million Americans would be left uninsured under his plan. People need to be aware of this when they enter the voting booth next year. Moreover, should our party stand for universal health care or adopt an incremental approach? Is there a health care crisis that demands universal coverage or is there not? You cannot decry the horrors of millions being uninsured and then turn around and propose a plan that will leave at least 15 million uninsured.
The Obama camp "promises" universal health care--after we turn the keys over to them for four years. We should simply have "faith" that they will deliver on this. Even if this is true, can we condemn 15+ million Americans to live without health insurance for two, three, or four more years? Three years is just a number to a Washington politician; it represents real pain and suffering for those who have to wait for three years. Universal health care is an idea whose time has come. As the blaring music on the promising day on which Obama announced his candidacy said, "Don't wanna wait 'til tomorrow. Why put it off another day?"
http://www.tnr.com/doc.mhtml?i=w070528&s=cohn053107==But there are some differences between what Obama and Edwards have proposed. And by far the biggest, most important one is the fact that Edwards has a "mandate" in his plan: He would require every single American to get insurance. That means his plan is truly "universal." Obama says he, too, is committed to covering everybody by 2012. And he has a mandate that all children get insurance. But there is no similar mandate on adults. There is, in other words, no requirement that every adult American have health insurance. And that means his plan is not universal--at least not in the same sense that Edwards and his advisers mean it.
Why does this matter? Obama's advisers, for what it's worth, think it doesn't. Not much, anyway. They believe that their initiative will help cover most Americans within two or three years. After that, they say, they can come back to the problem and, following through on Obama's promise, cover that relatively small portion of the population that still doesn't have coverage. If that requires passing some sort of mandate then, so be it. They're prepared to do so.
I think they mean it. But can they do it?
The best studies out there--by Urban Institute researchers, the RAND Corporation, and MIT economist Jonathan Gruber--suggest that, without a mandate, improving affordability will cover roughly one-third of the people who don't have coverage. Mandating that kids (but not adults) have coverage bumps that up to about a half. Obama's advisers think that, by really loading up on the subsidies--and making enrollment a lot easier by, for example, having an automatic enrollment with voluntary opt-out at your place of work--they can goose that up to two-thirds. But that's getting optimistic--and,
even then, you still have around 15 million people who are uninsured.In other words, the "mop-up" job at the end would quite likely be more than a mop-up. It'd be a substantial task, maybe even a huge one. That's why most health care experts believe you can't get that close to universal coverage without some sort of a mandate.==
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