Barack Obama has taken on Hillary Clinton’s health care plan front and center. His new mailer attacking her proposal resurrects the ghosts of Harry and Louise, the infamous pair in TV commercials sponsored by the insurance industry, which helped sink Bill Clinton’s efforts at reform. In those ads, a man and woman seated at the kitchen table worry that under his plan they wouldn’t be able to choose their doctor. The message: “If we let the government choose, we lose.” In Obama’s mailer, a man and a woman are seated in the same positions at a kitchen table—the woman even has the same long, blonde hair. The message: “Hillary’s plan forces everyone to buy insurance even if you can’t afford it. Is that the best we can do for families struggling with high health care costs?”
The mailer exposes flaws in both the Clinton and Obama proposals, though that was not the story the media chose to tell. Despite the “universal” label both Clinton and Obama love to use, neither plan provides health insurance as a matter of right, paid for by everyone, the way Medicare does for seniors. Through a juryrigged combination of tax credits, insurance market reforms, pie-in-the-sky schemes to make premiums cheaper, and requirements to buy coverage, the goal of both plans is to cover as many people as possible mostly with private insurance in an attempt to reach universality. In the debate last week, Obama pointed out that “about 95 percent of our plans are similar.”
The main difference seems to be that Clinton calls for an “individual mandate” that requires everyone to have insurance. Everyone is covered, no exceptions, no excuses, Clinton told George Stephanopoulos Sunday. She declined to say precisely how her mandate would be enforced. But insurance literati know that unless everyone is in the game—that is in the risk pool—private carriers won’t play, and they will continue to cherrypick the healthiest people who, of course, are the most profitable for them. The sick will go on without coverage, and maybe without health care.
Obama, meanwhile, would mandate insurance only for children. Adults wouldn’t have to buy it, but through the magic of his cost-containment measures—such as better management of chronic conditions, information technology, and making hospitals disclose their prices—premiums, now averaging about $12,000 a year for a family, would become more affordable.
What’s the real story on both these plans? The Harry and Louise look-alike brochures presented an opening to advance the story beyond the mandate vs. no mandate sound bites, which is basically all that the public knows about the proposals. But with few exceptions (like Ezra Klein’s American Prospect blog), stories on the Obama brochures didn’t advance much of anything. Instead, they reported complaints made by the Clinton campaign in a conference call with reporters. Stories quoted Len Nichols, health policy director of the New America Foundation, saying the Harry and Louise picture “is as outrageous as having Nazis march through Skokie, Illinois.” In The Washington Times, Clinton health adviser Dr. Irwin Redlener said: “I almost fell off the chair when I saw this.” In a brief piece on WNYC, Redlener noted that the ad was “right out of the Republican playbook.” An Associated Press story ended with a comment from an Obama spokesman pointing out that Ted Kennedy had endorsed Obama and that Kennedy is a “longtime champion of universal health care”—as if that has something to do with the arguably sleazy mailer. For the most part, the media fell for the Clinton spin. They got lots of good quotes, but didn’t tell us much about what the mailer actually said about problems with both plans.
Here’s a little historical context on one aspect of those problems: Harry and Louise were not solely responsible for the failure of the Clinton health care plan. Credit for that also goes to the National Federation of Independent Business and its members—small employers who objected to the so-called “pay or play” mandate that would have required them to cover their workers. Interestingly, both Clinton and Obama now call for some kind of an employer mandate. Obama says he would require employers to offer “meaningful” coverage, whatever that is, or contribute a percentage of their payroll to the cost of a public plan. Clinton, battle scarred, as she’s told us many times, would make only large employers provide coverage or contribute to its costs. As for small employers, she’d give them incentives to offer coverage, but most wouldn’t have to. We’ve hardly heard a peep from the media about that, or from the employers at all—a huge block of stakeholders, who will certainly weigh in when the time is right.