Russ McBee

I thought it would be interesting (and maybe even helpful) to compare the current herd of 2008 presidential candidates side-by-side on the issue of health care. I've posted before on the plans put forth by Clinton, Edwards, and Obama; in this post, I'm going to try and summarize all of the Democratic candidates' proposals in a tabular format, hopefully making the comparison somewhat easier.

Just for giggles, I'll do the same for the Republican candidates, but that will be another post.

In the following summary, I'm only including proposals currently being endorsed by the candidates. Old proposals that never went anywhere aren't included, nor are health care programs they might have implemented while holding office, such as while serving as governor or as a member of Congress. Clinton's 1993 proposal is no more relevant today than some wild-ass proposal Biden might have made or voted for in Congress, or whatever Richardson might have done as governor of New Mexico. I'm only interested in their proposals for the country as a whole, starting on Inauguration Day 2009.

Furthermore, I'm only including specific proposals, and I'm ignoring wishful thinking. Every candidate says, for example, "We must eliminate waste" or "We must reduce costs" or "We need more people getting preventive care;" those are all great soundbites, but they aren't proposals for specific action. I have also ignored bromides disguised as solutions, such as "I propose using modern computer technology to reduce overhead." That's not a proposal -- it's a commercial for Microsoft.

Joe Biden hasn't released a detailed plan on health care as far as I can tell, but he sure does mention the topic in his speeches an awful lot. The only thing I can find on his site relating to health care is a three-paragraph wish list on his "Issues" page. It's relatively devoid of specific recommendations, but it does state that he wants to "modernize the system, simplify the system and reduce errors." He's silent on how to do that. He also wants to "expand health insurance for children and relieve families and businesses of the burden of expensive catastrophic cases," but he doesn't say if this would be accomplished through some kind of publicly funded program or through the always amorphous "market reforms."

Hillary Clinton has focused on three areas: lowering costs, improving quality, and insuring everybody. She's gotten fairly specific about the first part and has released some outlined thoughts on the other two parts. She's delivered one speech on health care so far, focusing mainly on the cost issue. The other two are supposed to be delivered in the coming months. Most (but not all) of her cost-saving measures relate to insurance; very few of her proposals directly address the spiraling costs of the underlying drugs, medical procedures, and doctors' fees which help push insurance premiums higher.

Like Biden, Chris Dodd doesn't seem to have released a detailed plan. He does lay out the skeleton of a few ideas on this page. Dodd wants to make insurance coverage mandatory, funded at least in part by requiring employers to either provide insurance for their employees or contribute to a Health Care General Fund. Everyone not insured by their employer or on a public plan like Medicare or Medicaid would be required to purchase insurance through this fund. This sounds like a combination of pooling and subsidizing through employer contributions, but the description isn't all that clear.

John Edwards has gotten pretty specific. He has specific proposals to drive down insurance costs, require employer-provided coverage, expand public programs, and pool the uninsured. Once these changes take place, he then would make health insurance mandatory for everybody.

I don't really understand Mike Gravel's proposal. Here it is, in its entirety:

Senator Gravel advocates a universal health-care voucher program in which the federal government would issue annual health care vouchers to Americans based on their projected needs. Under the Senator's plan, all Americans would be fully covered and would be free to use their vouchers to choose their own health care professional. No one would ever be denied health insurance because of their health, wealth, or any other reason. A universal health-care voucher plan will also relieve American businesses of the financial responsibility of insuring their workers while ensuring that their workers get adequate care.

First, he's talking about some kind of voucher thing that sounds like rationing, then he mentions insurance, then he says employers won't have to provide insurance any more. What the hell? Are these vouchers a supplement, or a new type of insurance, or what? Is this supposed to represent a single-payer system, or would private insurance still exist?

At the SEIU Health Care Forum in March 2007, Gravel explained it this way:

Under the plan we would issue vouchers to every single American. And the vouchers, you don't pay for them, they're issued to you. You sign up every year for them. And the vouchers will have a very modest co-pay, a very modest deductible, but that's it. Everybody gets the same product universally in the United States of America. And then if you want more than the product you got, you pay for it.

[...]

Now, with these vouchers you'll be able to have choice: Choice of doctors, choice of hospitals, free choice. Now, you'll be able to also have a choice of maybe no more than five or six plans, insurance plans.

[...]

But let's have like public assistance, let's have a central body called a health care board with regional boards that they would then define what the various vouchers are for.

That last statement seems to contradict his earlier statement that you can use the vouchers for whatever health care service you want. However, after reading the rest of that page, it turns out to be one of the more coherent things he said at that forum. His plan seems to reflect a proposal published in the Washington Monthly a couple of years ago; it details universal health care vouchers and mentions a Federal Health Care Board to administer the program. This sounds like Gravel's plan, but I'm not entirely sure.

Dennis Kucinich has the most straightforward proposal: single-payer, universal coverage. Kucinich and John Conyers are the authors and sponsors of HR 676, which I mentioned here. Kucinich describes it as "enhanced Medicare for everyone." The summary of the bill reads as follows:

United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) - Establishes the United States National Health Insurance Program (the Program) to provide all individuals residing in the United States and in U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, and mental health services.

Prohibits an institution from participating in the Program unless it is a public or nonprofit institution. Allows nonprofit health maintenance organizations (HMOs) that actually deliver care in their own facilities to participate in the Program.

Gives patients the freedom to choose from participating physicians and institutions.

Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits.

Sets forth methods to pay hospitals and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization.

Authorizes appropriations and provides for appropriated sums to be paid for: (1) by vastly reducing paperwork; (2) by requiring a rational bulk procurement of medications; (3) from existing sources of Government revenues for health care; (4) by increasing personal income taxes on the top five percent income earners; (5) by instituting a modest payroll tax; and (6) by instituting a small tax on stock and bond transactions.

Requires the Program to give first priority in retraining and job placement to individuals whose jobs are eliminated due to reduced administration.

Establishes a National Board of Universal Quality and Access to advise the Secretary and the Director to ensure quality, access, and affordability.

Provides for the eventual integration of the health programs of the Department of Veterans' Affairs and the Indian Health Service into the Program.

Barack Obama is proposing a plan similar to the plans of Edwards and Clinton. Unlike Clinton, he is proposing a new federal program which would cover those currently uninsured. Like Edwards and Clinton, he also suggests pooling small businesses and the uninsured for collective bargaining with insurance companies.

Bill Richardson proposes opening up the Federal Employees Health Benefits Program to almost everyone in the country, lowering the Medicare eligibility age to 55, and expanding eligibility for Medicaid and SCHIP, among other things.

Here are the proposals from the eight Democrats:

If you notice any errors or omissions in the above tables, please note them in the comments or send me an email; I'll keep this post updated with corrections.