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Clinton, Obama, Insurance

By PAUL KRUGMAN
Published: February 4, 2008

The principal policy division between Hillary Clinton and Barack Obama involves health care. It’s a division that can seem technical and obscure — and I’ve read many assertions that only the most wonkish care about the fine print of their proposals.

But as I’ve tried to explain in previous columns, there really is a big difference between the candidates’ approaches. And new research, just released, confirms what I’ve been saying: the difference between the plans could well be the difference between achieving universal health coverage — a key progressive goal — and falling far short.

Specifically, new estimates say that a plan resembling Mrs. Clinton’s would cover almost twice as many of those now uninsured as a plan resembling Mr. Obama’s — at only slightly higher cost.

Let’s talk about how the plans compare.

Both plans require that private insurers offer policies to everyone, regardless of medical history. Both also allow people to buy into government-offered insurance instead.

And both plans seek to make insurance affordable to lower-income Americans. The Clinton plan is, however, more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies.

But the big difference is mandates: the Clinton plan requires that everyone have insurance; the Obama plan doesn’t.

Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.

After all, we already have programs that make health insurance free or very cheap to many low-income Americans, without requiring that they sign up. And many of those eligible fail, for whatever reason, to enroll.

An Obama-type plan would also face the problem of healthy people who decide to take their chances or don’t sign up until they develop medical problems, thereby raising premiums for everyone else. Mr. Obama, contradicting his earlier assertions that affordability is the only bar to coverage, is now talking about penalizing those who delay signing up — but it’s not clear how this would work.

So the Obama plan would leave more people uninsured than the Clinton plan. How big is the difference?

To answer this question you need to make a detailed analysis of health care decisions. That’s what Jonathan Gruber of M.I.T., one of America’s leading health care economists, does in a new paper.

Mr. Gruber finds that a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion. Over all, the Obama- type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.

That doesn’t look like a trivial difference to me. One plan achieves more or less universal coverage; the other, although it costs more than 80 percent as much, covers only about half of those currently uninsured.

As with any economic analysis, Mr. Gruber’s results are only as good as his model. But they’re consistent with the results of other analyses, such as a 2003 study, commissioned by the Robert Wood Johnson Foundation, that compared health reform plans and found that mandates made a big difference both to success in covering the uninsured and to cost-effectiveness.

And that’s why many health care experts like Mr. Gruber strongly support mandates.

Now, some might argue that none of this matters, because the legislation presidents actually manage to get enacted often bears little resemblance to their campaign proposals. And there is, indeed, no guarantee that Mrs. Clinton would, if elected, be able to pass anything like her current health care plan.

But while it’s easy to see how the Clinton plan could end up being eviscerated, it’s hard to see how the hole in the Obama plan can be repaired. Why? Because Mr. Obama’s campaigning on the health care issue has sabotaged his own prospects.

You see, the Obama campaign has demonized the idea of mandates — most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the “Harry and Louise” ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care.

If Mr. Obama gets to the White House and tries to achieve universal coverage, he’ll find that it can’t be done without mandates — but if he tries to institute mandates, the enemies of reform will use his own words against him.

If you combine the economic analysis with these political realities, here’s what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance — nobody knows how big — that we’ll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won’t happen.





Obamania in action

His good judgment and experience are winning over party stalwarts.

Is endorsing Barack Obama the new cool? Not long ago, Hillary Rodham Clinton was the seemingly inevitable front-runner for the Democratic Party's presidential nomination. Obama was the insurgent. He was pulling in young voters, independents and new voters, but he lacked the blessing of the party's heavyweights.

That's changed. Obama's success in moving beyond the traditional party base -- combined with serious Clinton fatigue -- is leading many seasoned Democratic leaders to rethink their earlier assumptions. John Kerry, Patrick Leahy, Claire McCaskill and Tom Daschle, among others, have lined up behind Obama, and the last few days brought Obama a surge of new, high-profile endorsements from such luminaries as Ted Kennedy and Nobel laureate Toni Morrison.

Though skeptics contend that Obama lacks "experience," this concern makes sense only if you think you have to be a Washington insider to be qualified to run for president. Obama began his career as a community organizer and civil rights attorney in Chicago -- relevant background for someone who will have to deal with tough economic and social justice issues as president. He was elected to the Illinois Senate in 1996 and the U.S. Senate in 2004; in all, he's spent 11 years being directly accountable to voters (that's four more than Clinton).

Is that "enough" experience? Remember that if you never develop good judgment, racking up "experience" just tends to make you older, not necessarily smarter. Dick Cheney and Donald Rumsfeld were "experienced," and they brought us the Iraq war. Clinton, who's billing herself as the "experienced" candidate, voted for that war.

Meanwhile, Obama, as a D.C. outsider, said in 2002 that a war in Iraq would be "a dumb war. ... A war based not on principle but on politics." He predicted, accurately, that the Iraq war would distract the U.S. from domestic priorities (such as the economy) and from our more pressing national security priorities (going after Al Qaeda, nuclear nonproliferation, forging a better energy policy).

Obama has good judgment, which trumps mere experience every time. On Iran, he called for engagement and a toning down of bellicose rhetoric. Clinton was instead fanning the flames by voting for an amendment favored by the Bush administration that called the Iranian Revolutionary Guard a terrorist organization. Obama's judgment was vindicated when the National Intelligence Estimate asserted that Iran had already stopped its nuclear weapons program. On Pakistan, Obama consistently raised questions about the unqualified U.S. support for Pervez Musharraf -- and was vindicated again as it became increasingly clear that Musharraf was neither a democrat nor a reliable U.S. ally against extremism.

Obama has solid legislative accomplishments under his belt too. In the sink-or-swim Illinois statehouse, he brokered compromises on politically sensitive issues such as children's health coverage, racial profiling and tax credits for the working poor. In the U.S. Senate, Obama sponsored ethics reform legislation, legislation to ensure accountability of private military contractors and -- with Republican Sen. Richard Lugar -- a successful bill on securing global stocks of conventional weapons. That wasn't glamorous, but it was important. Conventional weapons, not WMD, kill U.S. troops in Afghanistan and Iraq.

Equally important, Obama's background and message are enabling him to reach beyond any narrow demographic slice of the electorate, and this bodes well -- both for his ability to beat a GOP rival and for his ability to lead effectively and without divisiveness once elected. Obama's high-powered endorsers also may have noticed something the mainstream media seem largely to have missed: If you add up the delegates won in Iowa, New Hampshire, Nevada and South Carolina, Obama's ahead, so far, with 63 delegates to Clinton's 48.

True, Clinton still has more super delegates -- those are the Democratic Party elites who each get a vote at the August convention and are not bound by the votes in their respective states -- but that's a vestige of her former status as the "inevitable" establishment candidate. Most of those super delegates came out for Clinton months before the primaries and caucuses began, and they're a notoriously fickle lot. With Edwards out, it's down to Obama and Clinton. And if Obama continues to win real delegates in real primaries, many of the super delegates in Clinton's column may instead join Kennedy in endorsing Obama.

There's been such a rush to endorse Obama that I'm starting to feel a bit left out. Admittedly, I'm not a senator or a Nobel laureate, but ... I'm starting to think I should endorse him myself. Why should Ted Kennedy get to have all the fun?





This has gone out before. But it is worth another read.

Where Have All The Leaders Gone?

Remember Lee Iacocca, the man who rescued Chrysler Corporation from it's death throwes? He has a new book, and here are some excerpts.
_____________________________________________________________
Says:

"Am I the only guy in this country who's fed up with what's happening? Where the hell is our outrage? We should be screaming bloody murder.

We've got a gang of clueless bozos steering our ship of state right over a cliff, we've got corporate gangsters stealing us blind, and we can't even clean up after a hurricane much less build a hybrid car. But instead of getting mad, everyone sits around and nods their heads when the politicians say, "Stay the course"

Stay the course? You've got to be kidding. This is America , not the damned "Titanic". I'll give you a sound bite: "Throw all the bums out!"

You might think I'm getting senile, that I've gone off my rocker, and maybe I have. But someone has to speak up. I hardly recognize this country anymore.

The most famous business leaders are not the innovators but the guys in handcuffs. While we're fiddling in class, the Middle East is burning and nobody seems to know what to do. And the press is waving 'pom-poms' instead of asking hard questions. That's not the promise of the " America " my parents and yours traveled across the ocean for. I've had enough. How about you?

I'll go a step further. You can't call yourself a patriot if you're not outraged. This is a fight I'm ready and willing to have. The Biggest "C" is Crisis!

Leaders are made, not born. Leadership is forged in times of crisis. It's easy to sit there with your feet up on the desk and talk theory. Or send someone else's kids off to war when you've never seen a battlefield yourself. It's another thing to lead when your world comes tumbling down.

September 11, 2001 , we needed a strong leader more than any other time in our history. We needed a steady hand to guide us out of the ashes.

A Hell of a Mess

So here's where we stand. We're immersed in a bloody war with no plan for winning and no plan for leaving. We're running the biggest deficit in the history of the country. We're losing the manufacturing edge to Asia , while our once-great companies are getting slaughtered by health care costs Gas prices are skyrocketing, and nobody in power has a coherent energy policy. Our schools are in trouble. Our borders are like sieves.

The middle class is being squeezed every which way. These are times that cry out for leadership.

But when you look around, you've got to ask: "Where have all the leaders gone?" Where are the curious, creative communicators? Where are the people of character, courage, conviction, omnipotence, and common sense? I may be a sucker for alliteration, but I think you get the point.

Name me a leader who has a better idea for homeland security than making us take off our shoes in airports and throw away our shampoo?

We've spent billions of dollars building a huge new bureaucracy, and all we know how to do is react to things that have already happened.

Name me one leader who emerged from the crisis of Hurricane Katrina. Congress has yet to spend a single day evaluating the response to the hurricane, or demanding accountability for the decisions that were made in the crucial hours after the storm.

Everyone's hunkering down, fingers crossed, hoping it doesn't happen again. Now, that's just crazy. Storms happen. Deal with it.

Make a plan.

Figure out what you're going to do the next time.

Name me an industry leader who is thinking creatively about how we can restore our competitive edge in manufacturing. Who would have believed that there could ever be a time when "The Big Three" referred to Japanese car companies? How did this happen, and more important, what are we going to do about it?

Name me a government leader who can articulate a plan for paying down the debt, or solving the energy crisis, or managing the health care problem. The silence is deafening. But these are the crises that are eating away at our country and milking the middle class dry.

I have news for the gang in Congress. We didn't elect you to sit on your asses and do nothing and remain silent while our democracy is being hijacked and our greatness is being replaced with mediocrity. What is everybody so afraid of? That some bonehead on Fox News will call them a name? Give me a break. Why don't you guys show some spine for a change?

Had Enough?

Hey, I'm not trying to be the voice of gloom and doom here. I'm trying to light a fire. I'm speaking out because I have hope, I believe in America .

In my lifetime I've had the privilege of living through some of America 's greatest moments. I've also experienced some of our worst crises: the

"Great Depression", "World War II", the "Korean War", the "Kennedy Assassination", the "Vietnam War", the 1970s oil crisis, and the struggles of recent years culminating with 9/11. If I've learned one thing, it's this: "You don't get anywhere by standing on the sidelines waiting for somebody else to take action. Whether it's building a better car or building a better future for our children, we all have a role to play. That's the challenge I'm raising in this book. It's a call to "Action" for people who, like me, believe in America . It's not too late, but it's getting pretty close. So let's shake off the crap and go to work. Let's tell 'em all we've had "enough."

Excerpted from "Where Have All the Leaders Gone?".
Copyright (c) 2007 by Lee Iacocca. All rights reserved





Brazos County Democratic Party
P.O. Box 4568
Bryan Texas 77805
979-779-5600 Fax 979-779-5601

America was not built on fear. America was built on courage, on imagination and an unbeatable determination to do the job at hand.
Harry S. Truman, Democrat, President of the United States of America