Clinton, Obama differ slightly on health plans
15 04 08 - 11:48
For both, reducing the number of people without health insurance is a priority.
By Stacey Burling
Inquirer Staff Writer
The third of three articles examining key issues in the Democratic primary.
Both Hillary Rodham Clinton and Barack Obama say they want to help the kind of people who filled a health clinic waiting room in Bensalem on a recent morning.
Twenty uninsured patients were at the BCHIP office in a strip shopping center where a doctor and nurse treated their diabetes, asthma, and liver and heart problems for free.
Patients included a waiter who doesn't work enough hours to qualify for insurance, a health worker whose employers for the last two years have not offered affordable benefits, and men on the cusp of Medicare who lost their jobs, and health insurance, late in life.
"I worry from day to day how we're going to survive," said Irene Farr, 42, a cook, who came with her husband, Donald, 57, a disabled construction worker. Between them, they make $24,000 a year.
Like others in the room, Irene Farr wants the country's next president to make insurance affordable.
Sens. Obama and Clinton both say they would. They make reducing the number of people without health insurance - 47 million - a cornerstone of their health plans. Their approaches are so similar that some health experts say this is not the issue that will help most voters decide between the two Democrats. The real fireworks will come in the fall when one of them faces Sen. John McCain, the presumptive Republican nominee, whose proposal is starkly different and represents a greater departure from the status quo.
For now, Drew Altman, president of the Kaiser Family Foundation, said, "the differences between the Clinton and Obama plans mean much more to experts than to voters."
Both Clinton and Obama say they want to build on the current mix of public and private health insurance to make coverage universal and affordable. Both say they would offer tax subsidies to help people buy insurance, require most employers to help pay for insurance, and limit insurance company profits. Individuals and small businesses could join big groups to buy private insurance or a Medicare-like public plan.
The big difference between the two is that Clinton would require everyone to have health insurance and Obama would mandate it only for children.
"Our plan is not a universal access plan," Clinton policy director Neera Tanden said in a swipe at Obama's plan. "It's a universal coverage plan."
Clinton says that no one would have to pay more than 5 percent to 10 percent of income on a health insurance premium. She would work with Congress to set the employer contribution and a mechanism for enforcing the insurance mandate, Tanden said.
Obama contends that most people don't have insurance because they can't afford it - not because they're unwilling to buy it. Obama says his plan would reduce insurance prices by lowering medical costs. It would do that by investing in information technology, preventing disease, insuring more people, and limiting insurance company profits.
Under his plan, employers either would give employees "meaningful" insurance coverage or pay a percentage of payroll to provide coverage for the uninsured. His staff declined to be more specific.
McCain would weaken the link between employment and insurance by taxing health benefits. He would have tax credits for people who buy insurance. His goal is to control costs.
Almost 16 percent of Americans - including 10 percent of Pennsylvanians - lack insurance, according to the Census Bureau. That has consequences for them and people with insurance as well.
Studies show the uninsured delay seeking care, and their health suffers.
Meanwhile, America's system of employer-based insurance, created during World War II as a way to entice workers while wage controls were in place, is eroding. Fewer companies offer insurance now and those that do are charging workers more for it, in part because of the growing numbers of uninsured.
In what health experts call "cost shifting," health-care providers charge patients with insurance extra to cover the cost of patients without it. A Families USA study found that, in 2005, care for the uninsured added $922 to the cost of premiums for employer-provided, family coverage.
Requiring insurance is an effort to combat bad behavior by consumers and insurance companies, health experts said. Currently, companies can welcome young, healthy customers while spurning the older, sicker people who need health care the most. Both Clinton and Obama want to prohibit insurers from denying policies to sick people.
But if people know they can buy insurance any time, some might wait until they're sick to do it. That would likely drive up prices. And, uninsured people can find care now, sometimes at little or no cost. Some might not buy insurance unless they have to.
The Clinton camp says that 15 million people could remain uninsured under the Obama mandate. Obama's staff counters that everyone would have insurance when it's more affordable.
Requiring insurance companies to offer policies doesn't guarantee affordable prices. Clinton wants to move toward community rating, which means that people with all kinds of risk for health problems pay roughly the same amount for insurance. Obama does not propose this but says everyone would have access to a new public-health plan or a buying "exchange" that would offer "affordable, high-quality" options.
It takes only a brief conversation with the Farrs in the Bucks clinic to reveal how complex improving the health of working poor people can be. Irene Farr says she needs a knee replacement and thinks she can find a doctor who will do it for her. The bigger problem is that she can't afford to stop working long enough to recuperate.
She's skeptical about what the politicians will accomplish. "They always promise this while they're running for positions," she said, "but a lot of times, once they get in, they don't follow through."
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Contact staff writer Stacey Burling at 215-854-4944 or sburling@phillynews.com.