Democratic Health Plans More Alike Than Different

Indeed, many experts contend that without offering a comprehensive strategy for lowering overall health costs, a mandate to achieve universal coverage will still fall short of solving the health policy issues we face today.

According to White, the burden of mandates weighs heavily on the poor and underserved populations who simply cannot afford even the cheapest of available insurance plans. Even if these citizens were forced to obtain insurance, they still might not be able to afford the high price of treatment costs in our country.

"After all, a relatively low-income person with high-deductible coverage may not be able to afford services within the deductible, so not even get to the insurance," White explained. "How does this constitute coverage?"

In fact, even in Massachusetts, where a law was passed in 2006 requiring every citizen to obtain or purchase health insurance, only about 300,000 of the projected 500,000 uninsured Massachusetts residents gained health coverage by the end of 2007.

And in addition to the failure of this plan to provide universal coverage for all Massachusetts citizens, hospitals have been left with unpaid bills and mounting expenses to care for the uninsured.

Moreover, just as it remains unclear whether or how the Massachusetts government will find the money to meet the rising costs of its subsidies, it's equally uncertain how either of these candidates plans to implement cost controls to afford such subsidies.

"No presidential candidate has urged cost controls that stand a chance of making a visible difference," said Dr. Alan Sager, director of the Health Reform Program and the Program in Health Policy and Management at the Boston University School of Public Health. "This has been generally ignored."

A Blended Approach?

Mandates or not, most public health experts agree that the best solution may be some combination of the two plans, allowing for both mandates and lower health-care costs so insurance can be afforded by all.

After all, both Democratic candidates' health-care proposals include stipulations that aim to drive down the number of uninsured Americans — about 44.8 million people, or 15.3 percent of the population, according to 2005 statistics from the U.S. Census Bureau.

These proposed changes, coupled with mandatory coverage of children, will cover a large chunk of uninsured Americans. Government subsidies to individuals and employers, creating insurance pooling mechanisms and expanding current public programs may help pick up the remainder.

As it stands, every other affluent nation in the world either provides a health-care system to which all legal residents are entitled or requires that all legal residents purchase health insurance by making special arrangements for low-income citizens to help them purchase insurance. In other words, the United States is the only affluent country that makes health insurance voluntary for citizens younger than 65.

But just as details now provide a battleground for the two potential Democratic candidates, they could pose a hazard later when it comes to implementing health-care reform, should either of them get the chance. While both Obama and Clinton clearly favor universal coverage, neither has provided a clear-cut explanation for the necessary steps to achieve their proposed health care reform goals.

But health policy experts stress that Clinton and Obama will have to modify their dreams as they attempt to put these policies in action.

"Sen. Clinton starts with the actuarial and ethical design that any good policy wonk would adopt," explained Uwe Reinhardt, the James Madison professor of political economy at Princeton University. "Sen. Obama appears to believe that Americans will always want to have the cake and eat it too— in other words, imagined rights to health care but no responsibility to contribute to its financing."

ABC News Medical Editor Dr. Tim Johnson and Dan Childs contributed to this report.

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