Democratic Health Plans More Alike Than Different

While Democratic presidential hopefuls Hillary Clinton and Barack Obama continue to draw battle lines over the differences in their health-care reform policies, some health policy experts say the disparities between their plans are far less significant than either potential candidate might lead you to believe.

Indeed, both senators plan to promote health insurance for individuals who do not have employer-provided health care and who do not qualify for other existing federal programs. And through their plans, both hope to move the country one step closer to universal health-care coverage.

But, the question that the candidates are battling over is whether it is better to mandate that all uninsured Americans buy insurance, or rather to lure the uninsured into buying it through more subsidies and lower insurance rates?

It's a detail that may evade all but the most wonkish political followers.

"The one thing [health policy experts] agree on: The two plans are much more alike than it seems with the current emphasis on their different views on mandates," said ABC News medical editor Dr. Tim Johnson.

But to the rival campaigns, the subtle differences in how universal health coverage is implemented represent sacred ground.

Mandate … or Man-Don't?

Clinton's campaign has espoused the idea that her health-care plan, which mandates individual health insurance for every American, is more progressive and inclusive that Obama's plan, which would mandate only that children are insured. Clinton maintains that covering everyone will help reduce health-care costs overall.

However, according to some health policy experts, a mandate to buy health insurance is not necessarily the end-all-be-all to achieving universal health-care coverage.

"While it is almost certainly impossible to get to universal coverage without a mandate, I'm skeptical that a mandate will actually achieve universal coverage," said Michael Tanner, director of Health and Welfare Studies at the Cato Institute in Washington, D.C. "At the very least, a mandate raises questions about how it will be implemented and enforced."

According to health policy experts, the success of such a mandate would depend on both the size of subsidies available to pay for the coverage of the uninsured as well as how the government plans on penalizing those who refuse to enroll in any of the available insurance programs.

"The only country that has ever attained universal coverage without mandates is Switzerland. Or, at least they came very close," said Joe White, chair of the department of political science at Case Western Reserve University. "But they provided very strong financial incentives, both negative and positive, for people to get insurance — much stronger than I've seen any American politician propose. And even the Swiss eventually decided to move to mandates a few years ago."

Clinton has offered no details as to how she plans on penalizing those who do not enroll in one of the available insurance plans.

Obama, however, believes that an initial mandate is unrealistic, as it forces people to buy health insurance before it becomes affordable to them. Instead, he proposes that the government push for lower health-care costs first, considering a mandate only afterward if it becomes necessary.

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