Health Care Smackdown

First, if you haven’t already, read Paul Krugman.

I was on a media conference call with the Clinton campaign on health care earlier
this morning. It was mainly about an ad Obama is running, but questions were
also asked. Oddly enough, Ron Brownstein, formerly of the LA Times,
asked what share of income should be devoted to health care from someone’s salary?
Clinton answered this some time ago. Unlike other candidate she has proposed
a premium cap so that health care never becomes more than a certain percentage
of anyone’s income. Jake Tapper took off down a different road: Since Clinton
has been talking about Democrats attacking Democrats, why is she now attacking
Obama? Is it because, as the Obama team suggests, she’s sinking in the polls?
Howard Wolfson chimed up to take that question. He said that Senators Obama
and Edwards have been attacking Clinton for some time. It was not the way their
camp wanted the race to go and it was not their choice for it to head down this
path. But since Senator Obama decided “the politics of hope weren’t
working,” with Edwards joining in on the attacks, Clinton had to respond.
You can’t let opponents attack you relentlessly without responding, Wolfson
added. Then he continued by talking about Clinton’s long-term commitment to
health care and the experience she’s accumulated over the years on the issue,
adding people are tired of “all talk no action politicians.” The
main point today is about health care, which Clinton has been talking about
all week, particularly mandates.

Krugman
takes on that very issue today:

From the beginning, advocates of universal health care were troubled by the incompleteness of Barack Obama’s plan, which unlike those of his Democratic rivals wouldn’t cover everyone. But they were willing to cut Mr. Obama slack on the issue, assuming that in the end he would do the right thing. Now, however, Mr. Obama is claiming that his plan’s weakness is actually a strength. What’s more, he’s doing the same thing in the health care debate he did when claiming that Social Security faces a “crisis” — attacking his rivals by echoing right-wing talking points. … .. … … The fundamental weakness of the Obama plan was apparent from the beginning. Still, as I said, advocates of health care reform were willing to cut Mr. Obama some slack. But now Mr. Obama, who just two weeks ago was telling audiences that his plan was essentially identical to the Edwards and Clinton plans, is attacking his rivals and claiming that his plan is superior. It isn’t — and his attacks amount to cheap shots. … .. Third, and most troubling, Mr. Obama accuses his rivals of not explaining how they would enforce mandates, and suggests that the mandate would require some kind of nasty, punitive enforcement: “Their essential argument,” he says, “is the only way to get everybody covered is if the government forces you to buy health insurance. If you don’t buy it, then you’ll be penalized in some way.” … ..

As for mandates in Clinton’s plan, one of the ways Clinton will enforce them,
which was covered on the media call, is by default enrollment. When you go to
an emergency room you will automatically be enrolled. Clinton proposes working
with employers as well to get everyone covered. There’s a reason this is important,
from Krugman:

… under the Obama plan, as it now stands, healthy people could choose not to buy insurance — then sign up for it if they developed health problems later. Insurance companies couldn’t turn them away, because Mr. Obama’s plan, like those of his rivals, requires that insurers offer the same policy to everyone. As a result, people who did the right thing and bought insurance when they were healthy would end up subsidizing those who didn’t sign up for insurance until or unless they needed medical care.

Edwards, who is very much back on his game, which you would have seen if you
saw him on “Charlie Rose” last night, has also called Obama’s bluff
on mandates: proposing that individuals be required to show proof of insurance
when filing income taxes or receiving health care. If they don’t have
insurance, they won’t be penalized — they’ll be automatically
enrolled in an insurance plan. Krugman applaud’s Edwards’ idea on this
front.

In addition, Mr. Obama is running an ad now that says that his plan covers
everyone even though it clearly does not. The Clinton campaign has made a formal
request for him to pull the ad, which is now runing in New Hampshire. I contacted the Obama camp, which responded with this statement:

“The Clinton campaign didn’t say a word when this ad was released a month ago, and the only thing that’s changed since then is the poll numbers. The truth is, Barack Obama’s universal plan will provide coverage to every single American who can’t afford it and do more to cut the cost of health care than any other plan in this race. Rather than spending their time attacking Barack Obama, the Clinton campaign should explain how exactly they plan to force every American to buy health insurance even if they can’t afford it

Obviously, they’re not going to pull the ad. But the problem is that Obama’s plan doesn’t cover everyone.
As you can see in the statement above, one issue is the cost of the plan. Clinton’s
people said it would cost more to enforce a mandate, $110 billion/year according to the call today, but as Krugman proves in
his column if you don’t have a mandate for everyone it’s hardly equitable across
the board. Frankly, leaving 15 million people uninsured is not “covering
everyone.” It’s just not.

David Plouffe Obama for America P.O. Box 8102 Chicago, IL 60680 Dear David: I am writing concerning a false advertisement you are currently airing, in which Senator Obama claims that his health care plan would “cover everyone.” Your advertisement not only contradicts the judgment of health care experts, but public statements by your campaign and your candidate. Senator Obama has pledged to put “honesty first” in this campaign. In that spirit I respectfully request that you stop running this ad which is misleading voters in New Hampshire. In today’s New York Times, noted economist Paul Krugman wrote that Senator Obama proposed “a relatively weak, incomplete health care plan. Although [Senator Obama] declared, in his speech announcing the plan, that ‘my plan begins by covering every American,’ it didn’t — and he shied away from doing what was necessary to make his claim true.” Health care author Jonathan Cohn looked at the data and concluded that, under the most optimistic scenario, Senator Obama’s plan would leave “15 million people who are uninsured.” The Washington Post reached a similar conclusion, finding that Senator Obama’s plan would not cover “a third” of the 47 million Americans who are currently uninsured. Additionally, a constellation of the nation’s top health care experts – including MIT’s Jonathan Gruber, the Kaiser Family Foundation’s Diane Rowland and the Urban Institute’s John Holland — have concluded that plans like Senator Obama’s, which does not include a requirement for all Americans to have health care, would leave a substantial portion of the American public without coverage. Even Senator Obama himself has admitted that his plan would not cover everyone, calling the plan “virtually universal.” Your top health care advisor, David Cutler, acknowledged that Senator Obama’s plan could leave “significant pockets” of people uninsured and said Senator Obama would “deal with that when the time comes, possibly by mandating insurance.” On an issue of this magnitude Americans are looking for more than a nice ad or a good speech. It’s not enough for Senator Obama to say he covers everyone, especially when that is inaccurate. The American people need a President who will take the action necessary and fight for health care for every single man woman and child. Until the time comes when Senator Obama has a plan that will cover everyone, you should stop running this false advertisement. The American people deserve an honest debate about health care. Sincerely, Patti Solis Doyle Campaign Manager Hillary Clinton for President

Krugman really goes after Mr. Obama today, once again calling him on his political
attacks.

Mr. Obama, then, is wrong on policy. Worse yet, the words he uses to defend his position make him sound like Rudy Giuliani inveighing against “socialized medicine”: he doesn’t want the government to “force” people to have insurance, to “penalize” people who don’t participate. I recently castigated Mr. Obama for adopting right-wing talking points about a Social Security “crisis.” Now he’s echoing right-wing talking points on health care. What seems to have happened is that Mr. Obama’s caution, his reluctance to stake out a clearly partisan position, led him to propose a relatively weak, incomplete health care plan. Although he declared, in his speech announcing the plan, that “my plan begins by covering every American,” it didn’t — and he shied away from doing what was necessary to make his claim true. Now, in the effort to defend his plan’s weakness, he’s attacking his Democratic opponents from the right — and in so doing giving aid and comfort to the enemies of reform.

Honestly, this is no fun to cover. I despise Democrats going at each other’s
throats. But Mr. Obama is acting in a way that would get Hillary pilloried if she ever used such tactics. There
shouldn’t be a double standard, especially when you’re contending to cover everyone
in an ad, but you are clearly not.