An article from Saturday's Wall Street Journal:
Clinton, Obama Split On Insurance Mandate
By LAURA MECKLER
February 23, 2008; Page A5
WASHINGTON -- Among the sharpest policy disputes between Democratic presidential hopefuls Hillary Clinton and Barack Obama is whether all Americans should be required to get health insurance, as Sen. Clinton proposes. She has said repeatedly that her plan is the only one that would cover everyone.
Now, after months on the defense, Sen. Obama is hitting back by emphasizing the downside of her policy: mandating insurance means penalties for those who fail to get it. His policy requires parents to insure their children, with penalties for those who don't, but his mandate is much less sweeping than the one proposed by Mrs. Clinton, which affects all Americans.
The Illinois senator has hit the point hard in fliers mailed to voters' homes and in a televised debate Thursday night. "In order for you to force people to get health insurance, you've got to have a very harsh, stiff penalty. And Sen. Clinton has said that we will go after their wages," Mr. Obama said during the debate broadcast on CNN.
If Mrs. Clinton wins the Democratic nomination, the New York senator is sure to hear similar points from the Republicans this fall.
It is a powerful argument that shows how dangerous it can be to give details about health reform. Making major change to the American health-care system involves trade-offs. In hopes of achieving universal coverage, both Mrs. Clinton and former Sen. John Edwards, who dropped out of the presidential race, issued plans that would require punishing people who fail to get insurance.
This dispute aside, the Democrats' health plans are remarkably similar. Both Mrs. Clinton and Mr. Obama would let people keep the insurance they have. They both would offer new options, including a Medicare-like government-run plan, with subsidies based on income. Both would require large employers to provide coverage or help pay for it, and would require insurance companies to take all comers.
But the question of the mandate remains a great dividing point that the Clinton campaign has been trying to exploit since last year.
Her policy is based on a sense of shared responsibility, with employers, individuals and government all given new burdens. Further, absent a requirement to buy insurance, some, such as young, healthy people who don't think insurance is worth the cost, will fail to buy it and remain uninsured.
And healthy people, who are relatively inexpensive to cover, are needed in the insurance pool to balance out sick people, who are expensive to cover. If healthy people aren't in the pool, everyone with insurance pays a "hidden tax" to cover the uninsured when they can't pay their health-care bills, Mrs. Clinton said Thursday.
Her health-policy adviser, Chris Jennings, argues that hers is the responsible plan. "Hillary Clinton made the policy choice, not the political choice," he said.
Indeed, she holds the upper hand with many health-care-policy experts, who agree that a mandate is the only way to assure that everyone has health coverage, short of a government-run, single-payer system. They say that without a requirement, as many as 15 million Americans will remain uninsured.
Mr. Obama responds that people will buy insurance if it is affordable. Both candidates have a series of ideas for reducing health-care costs. Mr. Obama's plan takes a big step aimed at bringing down the price tag by shifting some costs of some of the most-expensive patients to the federal government.
"My belief is the reason that people don't have it is not because they don't want it, but because they can't afford it," he said. Once the cost comes down, he said, there will be few people left without insurance. If people are gaming the system and purposefully not buying coverage, he said, he will consider a requirement down the line.
The Clinton camp thinks his plan smacks of hypocrisy: if Mr. Obama is willing to punish parents who fail cover their kids, why not everyone else? And since he is promising to make insurance affordable, then why would a mandate be such a burden on Americans? They also note that Mr. Obama and his advisers have said they would be open to a mandate if one is needed.
Mr. Obama is pressing his case in fliers mailed to voter homes in Ohio and other states. "Hillary's health care plan forces everyone to buy insurance, even if you can't afford it," the flier says. "Is that the best we can do for families struggling with high health care costs?"
The flier features a photo of a couple at their kitchen table -- an image that reminded some of the insurance industry's "Harry and Louise" ads that helped sink the plan Mrs. Clinton helped develop during her husband's presidency.
Jacob Hacker, a political scientist at Yale University who advised both Mrs. Clinton and Mr. Obama on their health plans, has said a mandate is important but its importance is being overstated. If the government works to automatically enroll people into a health-care system, he said, many will sign up even without a mandate.
Still, he said, Mrs. Clinton deserves credit for staking a position that is so politically risky. "A lot of things that the health-policy experts agree need to be done are ideas that, by themselves, are overwhelmingly not that popular and carry political risks."
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