campaign desk

The Definition of Universal, Again

Ted Kennedy's take on it
February 20, 2008

Ted Kennedy should know better. After all, he has spent a good part of his Senate career fighting for national health insurance and losing at every turn. He should know how difficult it will be to craft a truly universal plan–one that includes everybody, and is paid for by everybody. And he should know that it will be equally difficult to achieve such universality in a market-based model, as proposed by both Hillary Clinton and Barack Obama. The financial difficulties faced by his home state of Massachusetts, which chose to cover all residents with a marketplace approach, should tell him that too.

But there he was on Sunday talking to reporters and trying to blunt the thrust of a Clinton mailer in Wisconsin that questioned whether Obama’s plan was really universal. The mailer showed a group of seven people and asked, “Barack Obama, Which of These People Don’t Deserve Health Care? Will It Be You?” The mailer claims Obama’s plan will leave 15 million people without coverage.

Kennedy told reporters that the mailer “does a great disservice,” that it was a “distortion, misrepresentation, and what I think is basically fear-mongering.” He said he would not have backed Obama if he did not think he had the best chance of passing universal health care. “They both effectively have universal health care programs,” Kennedy said.

But the real disservice is that all of them–Clinton, Obama, and now Kennedy– keep fooling the public, saying that their plans will achieve “universal” health coverage. They won’t. Instead the plans will try to cover as many people as possible in a sort of Rube Goldberg creation, using existing programs, a public program people can buy into, and a requrement that some or all of the population buy insurance policies from commercial carriers. Clinton says that her individual mandate and her mandate for large employers and incentives for small ones to cover their workers will result in insurance for everyone, but there would undoubtedly be exemptions and exceptions as there are in Massachusetts. Obama would require only kids to get insurance and calls for employers to provide “meaningful” coverage. Whether they will, of course, depends on what meaningful means and who would be left out.

The word “universal” as it applies to the candidates’ plans has become a form of campaign propaganda. If voters hear it often enough, they’ll begin to believe it, which is what the candidates hope. The bottom line is that nobody really knows how many people will be left out of either Obama’s or Clinton’s plan, and residents of Wisconsin and other states need to know that neither plan will really achieve universal coverage in the traditional definition of the word. With these jury-rigged proposals, there are just too many “ifs” and no guarantees. Obama’s plan might achieve universality if all uncovered people decide they need insurance and can afford the premiums that he has promised will come down. Clinton’s plan might work if employers play ball, her mandates are enforced, and people don’t rebel against penalties she might impose. Both plans might work if the tax subsidies they call for are high enough to cover the premiums, which always seem to go up. That’s a lot of ifs.

As for the 15 million people who supposedly would be uninsured under Obama’s scheme, the number originated with The New Republic‘s Jonathan Cohn, who says that he suggested that about one-third of the people currently without insurance, or 15 million, might still lack coverage under an Obama plan. The stat got its sea legs in November when the Clinton camp seized upon it. Cohn explained himself in his blog, saying that he got the number from some policy wonks, some of whom used economic models to reach consensus. But it’s loose. Cohn himself called the number a “very, very rough estimate” of how many might still be uninsured and added that “at least a few well-respected authorities, none of them tied to one candidate, think it makes sense.” Right now the 15 million gives Clinton and Obama something to talk about, and they will continue to do that until the press points out what the number really means.

Sign up for CJR's daily email
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.