Democratic Frontrunners go Head-to-Head on Health Care

On March 27th, the Center for American Progress and the Service Employees International Union sponsored a forum on health care at the University of Nevada Las Vegas. All presidential candidates were invited to speak; Senators Hillary Clinton, John Edwards, Mike Gravel, Barack Obama, Representative Dennis Kucinich, and Governor Bill Richardson were in attendance. Candidates spoke briefly about their plans for health care, then fielded questions from moderator Karen Tumulty (TIME Magazine) and from the audience.

Hillary Clinton

Health care veteran Hillary Clinton didn't shy away from her rocky past with universal health insurance. In reference to the unsuccessful attempts of the Clinton Administration to reform health care in 1993, Clinton said the following,

Now, I am proud we tried. We may not have succeeded, but we set the groundwork in place so that now people are saying, boy, we wish we had done that back then because costs have continued to increase...I know probably better than anybody how hard this will be. Yeah, I know. I've got the scars to show for it and I've been through it, but that just makes me more determined. But it also makes me understand what we're up against...

On the issue of financing, Clinton didn't make a commitment to either employer mandates or individual mandates, but did mention the need for a complementary government-sponsored program to accompany any employer- or individual- based programs. She emphasized controlling costs by ending insurance discrimination (known more objectively amongst economists as adverse selection*) through risk pooling, by transitioning to electronic medical records, and by emphasizing preventative treatment. Clinton also mentioned increasing compatibility between record-keeping technologies around the country as well as the potential of "cafeteria" style insurance in which individuals are able to purchase only the coverage they choose.

In order to implement reform, Clinton also acknowledged the need for public and legislative political support.

We're all going to have plans, that's not in doubt. We need a movement. We need people to make this the number one voting issue in the '08 election to send a message to the Congress and the special interests, we're serious and we're going to get it done this time... But if we don't have the support to get a bill through the Congress, we can keep talking about universal health care coverage, and the number of the uninsured and the underinsured will keep going up, and we'll keeping spending more money and we won't have very much to show for it. So we don't only need candidates to talk about it, and we don't just need candidates to have a plan.

John Edwards

John Edwards' plans featured more specifics. He proposed an employer mandate "play or pay" system with government-regulated "health care markets" in which consumers can choose between government or privately provided health care. Such markets are meant to foster increased competition and thus help to lower overall costs of insurance provision. Much like Senator Clinton, Senator Edwards' other plans for cost control include mandatory preventative care as well as electronic record keeping. Although cost control is a main feature, Edwards is upfront about what it will take to fund reform. He proposes rolling back Bush Administration tax cuts in order to fund these health care markets as well as to support subsidized insurance for low and middle income families that make less than $80,000 a year.

We don't get universal health care for free. You have to cover 47 million people who don't have coverage. There's going to be a cost associated with the transition from the health care system we have today to a truly universal and more efficient health care system. So, no, I do not believe it can be achieved without finding an additional source of revenue. And the joke I always make about it is that American people have heard so many politicians for so long say, Oh, we're going to have universal health care, we're going to transform the way we use energy in America, we're going to end poverty in America, and in the process we're going to eliminate the federal deficit. They probably got a bridge in Brooklyn they want to sell you too. I don't think it could be done.

Barack Obama

Wunderkind Barack Obama offered the fewest concrete details. He explained that the relative newness of his presidential campaign at the time meant that his position on the issue was still in development.

Well, keep in mind that our campaign now is I think a little over eight weeks old. And so we will be putting a very detailed plan on our website... we have a plan that we are in the process of unveiling. What we want to do is try to set up a series of round table discussions before we actually announce it. Not just with experts, which we've already done, but rather with frontline workers, with nurses, with doctors, with consumers, which we're going to be scheduling over the next couple of months in terms of rolling it out.

The Senator assured listeners that he would carry out health care reform within his first term with some mixture of financing from employers, government, and individuals. Like Clinton, Obama did not yet have a stance on the employer or individual mandate systems but mentioned support for a complementary government system. He also spoke generally about the need for risk pooling, "front end" funding to reduce costs in the long-run, increased quality and efficiency of care, preventative care, and the "application of medical technology". Obama was a little more emphatic on the topic of political support,

...what I think is most important is we recognize that every four years we hear somebody has got a health care plan. Every four years somebody trots out a white paper, they post it on the web. But the question we have to challenge ourselves is do we have the political will and the sense of urgency to actually get it done...Now, I just have to repeat something I said earlier. And I'm absolutely convinced of this. The most important challenge for us is to build a political consensus around the need to solve this problem.

*For some economic background on adverse selection, see Akerlof, George A. "The Market for "Lemons": Quality Uncertainty and the Market Mechanism." The Quarterly Journal of Economics 84 (1970): 488-500.