Dems Debate Health Care

The health care goals and plans of seven presidential candidates, all Democrats, are being laid side by side for the first time Saturday as the Center for American Progress and Service Employees International Union host the “New Leadership On Health Care” presidential forum in Las Vegas. (You can comment on the debate here.)

Former senator John Edwards kicked off the presidential forum by laying out his previously announced health care plan. He stressed that his plan “covers all Americans” through “shared responsibilities.” He noted that “employers are required to either cover their employees or to pay into a fund” that will provide coverage.

And regarding our government’s role, Edwards said:

Government plays an important role, [setting] up health care markets all across America. And in each of those markets, if you’re the consumer, you can go in and choose what your health care plan will be.

Some of the choices are private insurers. And then one choice is a government plan, basically a Medicare-plus plan.

The idea is to determine whether Americans actually want a private insurer, or whether they’d rather have a government-run, Medicare-plus kind of single-payer plan. And we’ll find out over time which way people go.

He also emphasized cost containment. In response to a small businessman struggling with high costs, Edwards said that through mandatory preventative care coverage and competition between private insurers and government plans that have “extraordinarily low” administrative costs, those costs would “dramatically” drop.

But he did not flinch at addressing the “transitional” costs to a new system, saying it would cost $90 to $120 billion a year, which he would pay for by rolling back President Bush’s tax cuts for those making more than $200,000.

New Mexico Governor Bill Richardson said the “cornerstone” of his plan is to allow all Americans and business to be able to purchase the same coverage that members of Congress have, while offering “help” for those will low incomes. He also argued for an expansion of Medicare to cover those 55 and older, and a “cooperative relationship” between individuals, businesses and states “catalyzed by the government.”

Without naming Edwards, he argued that additional sources of revenue are not necessary, saying increased efficiency, preventative care and an exit from Iraq will provide enough revenue to expand coverage. But it wasn’t clear if Richardson was pledging to achieve universal coverage.

Illinois Sen. Barack Obama reiterated his pledge to achieve universal health care by the end of his first term as president, and urged voters to “judge” his performance on that pledge.

He downplayed policy details, saying “every four years someone trots out a white paper,” when the question is, “Are we able to bring a majority of people together to solve the problem now?” Nonetheless, he promised “a very detailed plan on our website” after a series of roundtable discussions with experts and voters during the next couple of months.

What he did offer was basic principles for his health care vision.

  • “Everbody’s in” the plan, “employers are going to have to play or pay”—offer coverage directly or help fund coverage—and subsidies should offered to those who struggling to afford health care.
  • The plan should “save money” by emphasizing prevention, chronic care management and medical technology.
  • There should be a “pooling of cost and risk,” and money should be spent more efficiently to improve quality.

Much of that tracks what Edwards has offered, and in fact, Obama offered that Edwards’ plan is “very credible.”

When asked if additional tax revenue is needed, Obama did not dismiss the possibility, saying we need to “do whatever it takes” but noted there is much savings to be reaped with a more efficient system. He also said he would need to “put some money on the front end in creating a new system” and then “get those savings on the back end,” emphasizing that “those savings [should] go into the pockets of families, and not just insurance companies or drug companies.”

New York Sen. Hillary Rodham Clinton passionately recalled the “battle scars” from the days when she tried to launch a detailed health plan when her husband, Bill Clinton, was president, into what proved to be an unforgiving political environment.  In her opening statement, unlike Edwards, she chose to stick to general principles rather than details, but in response to questions she said she would support a plan that would require employers who do not purchase private health insurance for their employees to pay into a pool for a Medicare-for-all-type plan.

Clinton was particularly critical of insurance companies, promising to introduce a bill in this session of Congress that would eliminate barriers that prevent insured people from getting the care to which they are entitled. Recalling the story of a constituent whose insurance company refused to authorize coverage for an urgently needed medical procedure, Clinton said it shouldn’t take a call from a senator’s office to get an insurance company to provide the coverage patients pay for.

Clinton spent a little more time than the other candidates on stressing the importance of getting younger, healthy people into the insurance system and on people taking better care of themselves. She said it would take her two terms to get a universal health care system in place.

Connecticut Sen. Christopher Dodd said his plan was based on four principles: universality (“everyone participates, everyone benefits,” prevention, extend Medicaid to more families, and improving the use of technology. He referenced his leadership in getting the Family Medical Leave Act written into the law as proof of his commitment to working families and to the health care issue. (He also mentioned his two young children and his status as perhaps the only lawmaker in Congress who “gets mail from the AARP and from diaper services.”)

As did some of the other candidates, Dodd said that all Americans should be able to get the same type of health care plan as members of Congress.

Ohio Rep. Dennis Kucinich used the forum to continue his vigorous pitch for a single-payer health care system, arguing that the plans of the other major candidates were too dependent on insurance companies and others with a profit motive that was antithetical to the notion of universal, nondiscriminatory care. To critics who raise the fear that a totally government-run system would end up rationing care to control costs, Kucinich said that insurance companies already ration care. He also scoffed at the argument that private-sector competition would reduce costs, saying that the opposite has been the case in health care.

“Health care is a right, not a privilege. It is a right. It is a human right,” Kucinich said.

Former Alaska senator Mike Gravel proposed a single-payer system of sorts, but under his system each American would get a health care voucher that they would use to purchase their choice of five or six private insurance plans. “Everyone gets the same product. If you want more than the product you’ve got, you pay for it,” he said. Gravel said he would not expand Medicare or Medicaid unless “we don’t see the private insurance companies shape up.”


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