Obama's Health Plan Does Not Guarantee Universal Coverage

Obama's incomplete health plan

May 30, 2007

THE CONSENSUS among Democratic candidates for president is that every American ought to be covered by health insurance. Senator Barack Obama came out yesterday with his plan, which comes close but doesn't cover everyone, though he implies it does. As the new Democratic celebrity, Obama faces pressure to supplement his flashy aura with substantial policy ideas. At this point, though, other candidates have more realistic health proposals.

Former senator John Edwards, for instance, would require that everyone obtain health insurance, a national version of the individual mandate that takes effect in Massachusetts July 1. Businesses would have to offer insurance or make contributions (amount not specified) so workers could get it on their own. The government would contribute tax credits. Edwards estimates his plan would cost $90 billion to $120 billion.

Obama's plan includes employer contributions ( unspecified, as with Edwards), cost-saving initiatives, and a requirement that all children be insured. Yet without a broader mandate, he can't be sure adults will buy insurance. The Obama campaign figures the plan would cost $50 billion to $65 billion.

Estimating the cost of covering the 45 million uninsured is tricky, but it is best to guess high. Edwards's figure is more realistic.

Obama and Edwards would pay for their insurance expansions partly by restoring some of the tax cuts approved under President Bush. That's a good use of the money. But Edwards's approach would guarantee that the result is universal coverage.

Of the other candidates, Senator Christopher Dodd and Governor Bill Richardson favor variations on Edwards's mandate. Former senator Mike Gravel would provide healthcare vouchers to every American. Senator Joseph Biden, who doesn't come out for universal coverage, would make sure all children are insured. Senator Hillary Clinton, unveiling her plan in stages, has chosen the easy targets first: pledging to reduce the power of insurance companies and to computerize medical records.

The latter is a favorite Democratic cost-saving device, but the upfront costs would be enormous, and the savings would be realized over many years.

Representative Dennis Kucinich supports a single-payer system, to be financed by increases in the income and payroll taxes, and a tax on stock and bond transactions. This plan, which would supplant private insurance, would certainly provide universal coverage. But it would have to get past furious opposition from the insurance industry and any other group that benefits from the current system. Kucinich's is a grand vision. But if the goal is universal coverage during the term of the next president, Edwards has offered the most comprehensive, politically realistic proposal.

Boston Globe