Which Health Plan Is It, Sen. Obama? You're Poisoning The Well

"[The A.P.] reported that Sen. Obama could have 'a pretty good debate' with himself: "If he wanted, the Barack Obama of today could have a pretty good debate with the Barack Obama of yesterday." -- The Fact Hub

(The transcript of last night's debate is below the fold.)

Here's what Elizabeth Edwards had to say, via CBS News, on the highly misleading radio ad that Barack Obama ran before the January 3rd Iowa caucuses. The radio ad claimed "that Obama's health plan covered more people than either Edwards's or Hillary Clinton's plans":

"It's just complete untruth," [Elizabeth Edwards] said. "I'll speak on behalf of Senator Clinton as well. Both Senator Clinton's and John Edwards's health care plans cover one hundred percent of Americans and Senator Obama's does not."

That's from my story, "Elizabeth Edwards on Health Plans, Obama's Lobbyists, ..." Then there's what NYT columnist and eminent economist Paul Krugman had to say about Obama's health care plan and Obama's misleading, factually untruthful radio ad:

Obama goes Harry and Louise

A friend sends me this:

  Have you seen or heard about the radio ad that Obama is running in Iowa about health care?

  It has a man and a woman talking, with the man leading off saying that health care mandates "force those who cannot afford health care insurance to buy it, punishing those who don't fall in line."

This is what I've been complaining about. I was willing to cut Obama slack on the lack of mandates in his plan, even though the economics says they're necessary; I figured that in practice, if elected, he'd end up doing the right thing.*

I started ramping up the criticism when he started attacking his opponents from the right, making the lack of mandates a principle rather than a compromise -- because that was poisoning the well, making it much harder for any future Democratic president to implement a plan that will work.

-- From my article, "A Paucity of Hope (A 'Mendacity of Hope'?)."

Here's the segment from LAST NIGHT's CNN TRANSCRIPT OF THE DEBATE in South Carolina:

CLINTON: [I]f you don't start out trying to get universal health care, we know -- and our members of Congress know -- you'll never get there.

If a Democrat doesn't stand for universal health care that includes every single American, you can see the consequences of what that will mean. I think it is imperative that we have plans, as both John and I do, that from the very beginning say, "You know what? Everybody has got to be covered."

There's only three ways of doing it. You can have a single-payer system, you can require employers, or you can have individual responsibility. My plan combines employers and individual responsibility, while maintaining Medicare and Medicaid.

I think that the whole idea of universal health care is such a core Democratic principle that I am willing to go to the mat for it. I've been there before. I will be there again. I am not giving in; I am not giving up; and I'm not going to start out leaving 15 million Americans out of health care [AS DOES OBAMA'S PLAN].

Secondly, we have seen once again a kind of evolution here. When Senator Obama ran for the Senate, he was for single-payer and said he was for single-payer if we could get a Democratic president and Democratic Congress. As time went on, the last four or so years...

As time went on, the last four or so years, he said he was for single payer in principle, then he was for universal health care. And then his policy is not, it is not universal. And this is kind of like the present vote thing, because the Chicago Tribune, his hometown paper, said that all of those present votes was taking a pass. It was for political reasons.

Well, when you come up with a universal health care plan and you don't have any wiggle room left, you know that you're going to draw a lot of political heat. I am not running for president to put Band-Aids on our problems. I want to get to universal health care for every single American.


OBAMA: Right, exactly.

Here's the policy question: if, in fact, we are not making it affordable enough, which is what's happening right now, and you mandate on families to buy health insurance that they can't afford and if they don't buy it you fine them or in some other way take money for them -- this is what's happening...

EDWARDS: But, Barack, you're ignoring that we subsidize...

OBAMA: John, I haven't finished. John, let me finish.

EDWARDS: OK, all right, go ahead.

OBAMA: Now, what is happening in Massachusetts right now -- there are articles being written about it -- which is that folks are having to pay fines and they don't have health care. They'd rather go ahead and take the fine because they can't afford the coverage.

My core belief is that people desperately want coverage. They desperately want it, and my plan provides those same subsidies. And if they are provided those subsidies and they have good, quality care that's available, then they will purchase it. That is my belief. Now, it's fine for us to have a debate about how the best way to get there is, but to suggest somehow that I'm not interested in having anybody covered, or to suggest, as Hillary just did, that I was in favor of single payer -- I never said that we should try to go ahead and get single payer. What I said was that if I were starting from scratch, if we didn't have a system in which employers had typically provided health care, I would probably go with a single-payer system.

What's evolved, Hillary, is your presentation of my positions, which is what's happened frequently during the course of this campaign.

Blah, blah, blah.  Just like he always does, Obama explains and explains, but can't recover from his gaffes.

Here are two more key references:

Then there's the must-read column by Paul Krugman in December, "The Mandate Muddle":

Imagine this: It's the summer of 2009, and President Barack Obama is about to unveil his plan for universal health care. But his health policy experts have done the math, and they've concluded that the plan really needs to include a requirement that everyone have health insurance -- a so-called mandate.

Without a mandate, they find, the plan will fall far short of universal coverage. Worse yet, without a mandate health insurance will be much more expensive than it should be for those who do choose to buy it.

But Mr. Obama knows that if he tries to include a mandate in the plan, he'll face a barrage of misleading attacks from conservatives who oppose universal health care in any form. And he'll have trouble responding -- because he made the very same misleading attacks on Hillary Clinton and John Edwards during the race for the Democratic nomination.

O.K., before I go any further, let's be clear: there is a huge divide between Republicans and Democrats on health care, and the Obama plan -- although weaker than the Edwards or Clinton plans -- is very much on the Democratic side of that divide.

But lately Mr. Obama has been stressing his differences with his rivals by attacking their plans from the right -- which means that he has been giving credence to false talking points that will be used against any Democratic health care plan a couple of years from now. ... (Read all of "The Mandate Muddle.")

"Attacking from the right" ... "he has been giving credence to false talking points that will be used against any Democratic health care plan a couple of years from now. ..."

Just like Obama has also done on Social Security and any number of other issues.

As Krugman pointed out at his NYT blog, Barack Obama is "poisoning the well, making it much harder for any future Democratic president to implement a plan that will work."

Tags: Barack Obama, CNN Presidential Debate, Elizabeth Edwards, Harry & Louise, Health Care Plan, Hillary Clinton, John Edwards, Single Payer (all tags)



Re: Which Health Plan Is It, Sen. Obama?

Your tips and comments are always welcome.

What I do not understand is why Obama hasn't done the simplest thing, which would be to revise his campaign's health care plan.  Why hasn't he?  

by susanhu 2008-01-22 09:39AM | 0 recs
Because if he did...

It would be harder for the Obama Campaign to attack Clinton and Edwards from the right to win over center-right Independents. Sadly, it looks like Team Obama is willing to sacrifice good policy to play political games.

by atdleft 2008-01-22 09:44AM | 0 recs
Not sacrificing anything

Mandates for health insurance are not good public policy.


Government should ENABLE people to have access to health care, not PUNISH THE UNINSURED FOR BEING UNINSURED.

This is the most wrong-headed idea to come along in a long time.  14% of drivers do not buy mandated auto insurance. And 20% of the uninsured from MA had to be exempted from their mandate because there were no affordable policies.  And both Edwards and Clinton have hardship exemptions in their plans, which recognizes that there will be lots of people who won't be able to afford their plans.

Mandates to purchase insurance have never worked.  They will leave out about 15-20% of the uninsured.

This is NOT universal coverage.

by Helenann 2008-01-23 08:21AM | 0 recs
Re: Which Health Plan Is It, Sen. Obama?

Good diary.  Hardhitting, but not mean.

Elizabeth Edwards is right: The Edwards and Clinton plans are universal.  Obama's is not.

And his radio ad in Iowa was terrible.

Krugman is right on this.

It matters so much because universal heath care is the centerpiece of a New, New Deal.

It may be more important than whom is elected if we can create it.

by TomP 2008-01-22 09:49AM | 0 recs
Edwards and Clinton's plans are not universal

1. They have no monitoring or enforcement mechanism for the mandate rendering it meaningless.

2. Even with enforcement, they will leave out about 15-20% of the uninsured and will impose fines on those without insurance (who by the way are low income working people).

3. Their plans do not cover undocumented workers and their families who account for 12 million people living in the US.

So stop this nonsense claim that their plans are universal and Obama's is not.

At least Obama recognizes that his plan may not work for about 5% of the population and wants to understand who they are and what can be done to make sure that they, too, have access to health care.  Health insurance may not be the answer for everyone.

by Helenann 2008-01-23 08:24AM | 0 recs
because he's reaching

he wants to bring on soft Republicans and libertarian leaning independents and both groups will be very upset if forced to buy something.  LIke medicare they'd get used to it, but initially there would be a price.  Obama wants to be loved like Reagan so that he can get through progressive policies without complaints like Reagan did with conservative stuff, but Reagan did it through hypnosis, that was a more innocent time, before the internet, for just one thing. He's trying to woo them with what they want, by giving it away free, and he's not doing what base Democrats want, so he's getting them but losing us.  This race isn't about making us feel good, so that we'll duck walk into anything with smiles on our faces, it's about competence, and the stamina to fix the Bush mess. In this case competence = change.  

by anna shane 2008-01-22 11:29AM | 0 recs
NO ONE has to buy Medicare

There seems to be a lot of confusion about this point.  Medicare does not have a mandate.

Medicare is an entitlement.  If you paid into the SS system, when you turn 65 you are entitled to enroll in Medicare.

While there is no premium required (it is free to join) uou have to pay a Part A deductible of over $1,000 for hospital and nursing home coverage and coinsurance when you use services.  

If you want coverage for physician services under Part B, you have to pay a premium and face another deductible and coinsurance when you use services.

And if you want prescription drug coverage, you have to pay another premium under Part D, and then face another deductible, donut hole and coinsurance.

And there ARE NO MANDATES to buy Medicare.

You are entitled to Part A and you can elect to buy Part B and D.

No one is force to buy anything under the Medicare program and it works just fine. 99% of the elderly have coverage.

This is EXACTLY the model Obama proposes.  Make it available and affordable and people will buy it. No need to force anyone to do anything.

by Helenann 2008-01-23 08:33AM | 0 recs
Obama has by far the best health care plan

While not perfect.

The insurance industry is trying their best to pass "individual mandates"--Orwellian laws that require every person to purchase expensive, wasteful, for-profit insurance products, no matter the cost or the quality.

There's a reason that the insurance industry is making these individual mandates their top priority across the country this year.  Some progressives support mandates, wrong-headedly, on the assumption that we can make insurance corporations do the right thing, somehow, once everybody has become their customers.

Kudos to Sen. Obama for standing up to this scary proposal.  Now if we can just beat back Arnold Schwarzenegger's version in California...

by California Nurses Shum 2008-01-22 01:21PM | 0 recs
All mandates are not created equal

Even though I think mandates are a really bad idea, some mandates are better than others.

The worst mandates would be those that would force people to buy coverage in the individual market, leaving people to the for-profit incentives of the insurance companies.

A better kind of mandate would be to force people to buy coverage in a huge pool, like large group coverage.  It is easier to set the rules in this kind of plan and keep premiums affordable and coverage comprehensive.

But mandates are unnecessary.  Medicare is our biggest insurance program and there is no mandate. The elderly want insurance and they buy it.

by Helenann 2008-01-23 08:36AM | 0 recs
It would be the wrong thing to do

If you start from the premise that health care is a right, which Senator Obama does, then you have to reject the idea of a mandate.

Governments are responsible for ensuring that people's rights are met, not to punish them if they are not.

Obama offers affordable coverage to every American who WANTS it.  No one who wants health insurance will be left out of Obama's plan.  His has also been scored the most affordable of the three candidates.

He is also the only one proposing to let the 20-somethings stay on their parents' policy until they are 15.  The group that Edwards and Clinton are worried about not buying insurance is this group.  They have the highest rates of uninsured.  Many of them lost family coverage when they turned 19 and now do not get it through their job or school and can't afford to buy it in the individual health plan market.  Rather than force them to buy something they can't afford, Obama will let them keep their family coverage.  New Jersey in fact has extended dependent coverage to the age of 30.

This is the kind of policy Obama will pursue.  Don't FORCE people to buy something they don't want or can't afford, try to understand why they don't want it and then address that problem.

Paul Krugman is wrong. I have a great deal of respect for him but he is just flat out wrong on this and is on a warpath to destroy Obama for reasons I don't understand unless he is supporting Hillary.  Please go to Robert Reich's blog.  He was Bill Clinton's Secretary of Labor and he boohoos this whole mandate debate and concludes that Senator Obama's plan is more affordable and will end up covering more people.

Obama is the only one who has it right.  The truth is that the homeless, seriously mentally ill, unemployed, drug addicts, people who are paid in cash, and the poorest of the poor who live in the shadows are going to be hard to find to enforce a mandate and are probably not going to buy health insurance -- mandate or no mandate.  They need a different model for access to care.

As Obama says, let's find out who they are, why they don't want it and adopt other solutions to make sure they have access to care.

by Helenann 2008-01-23 08:15AM | 0 recs

Hold on a minute!!

He offered his plan shortly after Edwards did.  Robert Reich, Bill Clinton's Labor Secretary, has concluded that Obama's plan will likely cover more than Senator Clintons.

It was Hillary Clinton who was the last to the table with a health care plan and she literally copied John Edwards' plan.  She has not offered ONE SINGLE ORIGINAL IDEA to this entire debate. She adopted Edwards plan.

And no, he will not adopt a mandate that forces people who can't afford coverage to buy it or which imposes financial penalties on the uninsured because they are uninsured.

Thank God , he is the only one who has gotten this right!

by Helenann 2008-01-23 08:26AM | 0 recs
I normally don't rec

hillary hits on Obama, but I think Obama's health care plan - should he lose will be what does it.

The only thing Hillary's done to earn my respect in this campaign is putting out a bold healthcare plan that she knew would get criticism.

the frame by Edwards of comparing UHC to Social security (which is also mandated ) is a wonderful progressive frame.

If Hillary is smart she'll use this analogy and edwards comparisons to opting out of healthcare to "bush's plan" to opt out and privatize SS.

by TarHeel 2008-01-22 09:52AM | 0 recs
Re: I normally don't rec

The only thing?  Well, I suggest you don't know enough about her.  Our economy is in the tank and just today she was out there telling Bush his plan sucks because it doesn't do anything to put money in the hands of the litle guy, regular working people.  

by masslib1 2008-01-22 10:00AM | 0 recs
Re: I normally don't rec

There is a large difference between the democratic UHC plans and social security.  Social Security doesn't force you to pay $2,000 a month to a private entity under penalty of law...  social Security contributions go to the government and eventually come back to you, not some Insurance company CEO's...

That's the big difference and that is why mandated private insurance will not only fail, it will completely sour the American public to the whole idea of universal care and set the idea of affordable health care back 50 years at least....

I am one of the biggest proponents of health care reform, but I will seriously resent it if the government forces me to pay big bucks to some private insurance company's overpaid CEO, especially if all I get is junk insurance.  A system like that would last for 2 years, until democrats would be drive out of office by angry taxpayers paying out the nose for crappy private care under penalty of jail or wage garnishment or whatever...

To that end, Obama has it right... If you aren't going to have real universal care, then it must be voluntary... If the prices get low enough, the uninsured problem will mostly go away.  Most people who don't have coverage want it, they just can't afford it.  Would it achieve 100% universal coverage?  No.  These always going to be some curmudgeons who will stubbornly risk their health.   But, there are old curmudgeons who won't sign up for medicare just to spite themselves (my late neighbor was one of them--she never signed up for medicare until she broke her leg at the age of 70--and then only under great duress!).  If you get 85-90% coverage, you've made real progress, and low cost, high availability plans would do that.

I don't know if Obama's plans would be able to achieve such cost and access savings.  I personally don't think they will... but government mandates would be disastrous both in the short and long run.  Republicans would have a field day with it, and rightly so.  It's neither right nor fair.



by lordmikethegreat 2008-01-22 10:11AM | 0 recs
Re: I normally don't rec

How many times do you have to be schooled on this?  Edwards and Hillary both allow you to purchase a completely public, Medicare type plan.

by masslib1 2008-01-22 10:20AM | 0 recs
Re: I normally don't rec

you can school me any way you want... I know that Edwards plan does this, if Hillary's does, this is the first time I've heard of it...  Considering that she has said she's willing to "compromise" with insurance companies, that part of the plan would be the first to receive the axe, I'm sure...  I doubt that Edwards' idea would even make it out of committee...

The problem is, even if such a plan were to pass, most Americans won't hear about it, either... or, they will not trust it since it's "government" care (don't think that the insurance companies won't be milking that angle), and many will end up paying through the nose to private insurers and building up resentment to both universal care and the democratic party.

A tax funding a clear program is easier to both implement and sell to the public than some murky mandate with a dizzying array of unsatisfactory choices.



by lordmikethegreat 2008-01-22 10:27AM | 0 recs
Re: I normally don't rec

It's right in her plan and she's talked about it several times.

by masslib1 2008-01-22 10:28AM | 0 recs
Re: I normally don't rec

This is the first I've heard of it... seriously...

But, it is good to hear!

by lordmikethegreat 2008-01-22 10:34AM | 0 recs
I'll buy the public

plan if I'm allowed to.

by TarHeel 2008-01-22 10:29AM | 0 recs
Re: I'll buy the public

Me too.

by masslib1 2008-01-22 10:32AM | 0 recs
Re: I'll buy the public

You'd have to be an idiot not to... Unfortunately, there are a lot of idiots out there...  They usually vote Republican.



by lordmikethegreat 2008-01-22 10:35AM | 0 recs
Re: I normally don't rec

Mike, look up what Medicare costs per month -- and how much of that goes to private insurance companies.

One person I know, who's on Social Security, pays the following for Medicare:

$95/month for Plan B (doctor's visits, lab tests, etc.)

$144/month for an AARP supplemental

$45-100/month for Plan D prescription insurance/co-pays, and annual deductible

Why the AARP supplemental?  If you have to go to the hospital, Medicare does NOT play the first $995 and you have to pony up $995 before the hospital will even admit you.  The supplemental covers that and a myriad of other items that basic Medicare Part A does not cover.

ALL of that comes out of that person's monthly Social Security check.

by susanhu 2008-01-22 10:26AM | 0 recs
Re: I normally don't rec

But, the core benefit... part A and B is publicly funded and paid for.  Supplementals and all that are icing on the cake, and I think a system that allows for private supplementals is actually a good idea.  The core benefit is low cost and publicly funded... any extras are the choice of the consumer.

I don't count Part D in the equation, 'cos that was a terrible hack to an otherwise good system.

The point is, the basic benefit... which provides a good coverage net for people, is still low cost, universal, and publicly funded...  No one is "mandated" to get supplemental coverage.  No one is mandated to get part D.  Heck, no one is mandated even to sign up for medicare Part A (which is free).  Some people don't...  My elderly neighbor didn't... absolutely refused to!

That's the point I'm trying to make...



by lordmikethegreat 2008-01-22 10:33AM | 0 recs
Great comment

About 20% of the Medicare population has signed up for a private plan.  Those plans are currently raking in about 12% more than they are paying out.  Talk about a giveaway to the for profit insurance industry.  

But this means 80% prefer the original single payer fee for service Medicare where they can go to any doctor of hospital.  Sure, we need to fix Medicare.  The drug benefit is draconian for those with chronic illness and primary care docs under Medicare don't get paid enough and we have to do something about long term care.  But overall, Medicare as it was originally envisioned is a very successful program.

This is the model that Obama uses. Everyone is entitled to it, but no one is forced to enroll.  You don't need to force people to buy coverage if you make it available and affordable.

Medicare never has had a mandate and never will.

by Helenann 2008-01-23 08:43AM | 0 recs
If he loses

because of health care, it will be because:

1. people bought the Clinton's fairy tail that their plan is universal (it will leave out about 10 million uninsured Americans and 12 million undocumented families for a total of 22 million)

2. people believed that mandates will get us to universal coverage, which they wont.  There is no evidence that any mandate reaches 100% compliance. They usually leaving out between 15-20% of the targeted population.

3. Because the American people didn't understand that his is actually the most affordable and promises every single American who wants health care will be able to afford it.

Obama's plan is most like Medicare, where you are entitled to it, but no one forces you to buy it.

by Helenann 2008-01-23 08:39AM | 0 recs
When will Hillary enact reform?

Hillary sure does talk a good game about how concerned she is for the uninsured.

What may not be widely know is that she is the only candidate unwilling to pledge that she would get to work on universal coverage in her first year.  AND she is the only one not to pledge to enact universal coverage in her first term as President.

Both John Edwards and Barack Obama have promised to get to work with the Congress on comprehensive health care reform their first year in office and to have enacted legislation by the end of their first term.

Hillary Clinton has not.  The only thing she has promised is to sign the Children's Health Insurance bill her first year and to enact universal coverage by the END OF HER SECOND TERM.

So if you want a President to actually enact universal coverage in the next four years,  Hillary Clinton is simply not your candidate.    She was so burned on this issue that this s the last thing she wants to take on as her first act as President.

But scholars of the Congress will tell you, based on decades of research, that if a new President of the same party as the Congress does not get to work immediately on major social change, the likelihood of success drops with each passing month and each year.  

It is highly unlikely that any president could enact comprehensive health care reform in their second term.  Most of their political capital is spent, with not enough left to take on such a major new initiative.

So it is Hillary Clinton who is spinning the fairy tale about getting us to universal coverage. She has said and done nothing to indicate she will do anything (other than sign a bill Bush vetoed) her first term as President.  And that is the truth.

As someone who has worked on this issue for more than 30 years, it is painful to watch her misrepresent both what she is offering and what Obama is offering.

I feel like this next election will probably be the last chance in my career to help craft and enact a universal coverage plan for the United States of America.  And I think it is imperative that people understand that this is likely to happen if we elect John Edwards or Barack Obama as the next President of the United States.

by Helenann 2008-01-23 08:59AM | 0 recs
"Poisoning the Well"

Great phrase. That's exactly what Hillary Clinton did in 1993. And she'll do it again if we let her!

by mcdave 2008-01-22 11:45AM | 0 recs
Clinton's claim of Universality

Is the real fairy tale in this book.

Hillary Clinton is claiming her plan is universal.  It is not.

She says she will impose an individual mandate to buy insurance as a way of achieving universality.  

There are precisely three big problems with this claim.

1. She has no mechanism for either monitoring American's insurance coverage on an annual basis, she has no mechanism for enforcing the mandate (forcing people to buy it) and she has not defined any penalties if they do not.  

Despite her cries of protest in the last debate, she does have a hardship exclusion for people who can't afford her plan.  Why do you need a hardship exclusion if everyone is covered?  And MANDATES WILL NOT WORK without a rigorous monitoring and enforcement mechanism.  Her mandate is impotent.

2. Mandates to purchase insurance, even if they have a monitoring and enforcement mechanism, do get get 100% compliance. About 14% of drivers do not comply with auto insurance mandates and 20% of the uninsured population in MA had to be exempted from the mandate because there were no affordable plans.  THUS, even if Hillary were to add a monitoring and enforcement mechanism, it is estimated that 15-20% of the uninsured would not comply or would have to be exempted, leaving out about 10 million Americans.

3. NONE of the plans, including Hillary's, cover the 12 million people living and working and raising their families here without the proper immigration papers.  This came out in the last debate.  Under all the plans, 12 million people remain uninsured

So lets see.  Where does this put us?

Hillary will leave out 10 million Americans who won't be able to afford it and 12 million undocumented workers and their families.


Obama's plan may leave out as many as 27 million (15 million who don't want it and 12 million).  

But at least Obama has promised affordable coverage to every one who WANTS it.  Hillary will leave out many of those who don't want it AND  can't AFFORD it.


At least Senator Obama will not try to force people to buy something they can't afford.

He has promised affordable health insurance to every American who wants it. That is about 290 million people or coverage for 95% of the American people.  He says, lets find out why these people are uncovered before we start forcing them to buy anything. \

If they remaining uninsured are the homeless and the unemployed and the seriously mentally ill and drug addicts and alcoholics and the poorest of the poor, forcing them to buy insurance will simply not work.  

We will have to come up with other solutions to access to health care for these populations.  

Time to burst the bubble.  Clinton and Edwards are not offering universal coverage and the sooner the American people wake up to this reality. the sooner we can have a reasonable debate about what to do about it.

by Helenann 2008-01-23 08:01AM | 0 recs


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