The Scientific Activist

It’s difficult to find too many substantive policy differences between Barack Obama and Hillary Clinton (especially considering the much larger gulf that exists between them and the Republican candidates), but one area that’s brought up time and time again is health care. In light of this, it’s worth taking a look at how much the two agree and disagree here, especially since health care policy is purportedly one of Clinton’s selling points.

To look at the actual plans from each of the candidates, you can click here for Obama’s and here for Clinton’s. The most thorough–but still accessible–comparison that I’ve come across, however, was published earlier this month on FactCheck.org, and I’d suggest spending a few minutes perusing it if you’re interested in the subject. It takes a detailed look at where Obama and Clinton agree and disagree with each other, and where their television ads agree and disagree with reality.

From what I can gather, the comparison between the two plans can really be boiled down to two points:

  1. In short, both plans are very similar. Either one would be a significant step in the right direction, moving the US toward a more workable and sustainable health care system. Of course some of the similarities stem from a necessary lack of detail at this point, but both would point us in the direction of universal coverage, especially by allowing Americans to opt for public health insurance rather than private. And, both would be funded by rolling back some of the Bush tax cuts for those in the higher tax brackets and by increasing the cost efficiency of health care through modernization and focusing on preventative care.
  2. When it comes down to it, though, the Clinton plan truly is more comprehensive–for the sole reason that it mandates that all Americans must have health insurance. Obama’s plan does not (but it does require that all children have health insurance). The oft-quoted number of 15 million left uninsured under the Obama plan is probably at least roughly correct, although it’s very difficult to judge that at this point. It’s important to emphasize that those left uninsured would be uninsured out their own choice–at least as long as Obama is able to deliver the affordable health care options that his plan promises–and would supposedly eventually be lured by these new, more affordable options. Still, experience demonstrates that a sizable population will opt out–however ill-advisedly–of purchasing health insurance, unless it is required. On this point, then, Clinton certainly wins.

But…

  1. I still think that when political realities are taken into account, (A) the Clinton plan would be harder to pass unaltered and (B) Clinton herself will have trouble pushing universal care due to the ghosts of her past efforts in the 90s. It’s unfair, but I think it’s true.
  2. Unfortunately, neither plan effectively addresses the root cause of the inefficiency of the American health care system, which is the patchwork of private profit-driven insurers. Until we do that, we won’t truly fix the problem. Even if Clinton or Obama becomes the next president and one of their health care plans is passed without being watered down too much, we’ll still have a long way to go. But, I suppose you have to take it one step at a time, and either plan would be a step in the right direction.

Just to summarize, then, Clinton’s plan beats out Obama’s–but only slightly–and neither goes far enough.

Comments

  1. #1 Russell
    February 25, 2008

    There is a fraction of the population that will remain uninsured given any positive steps required on their own part to obtain health insurance, and regardless of what penalties are threatened for not doing so. For example, some homeless camp out at the creek a few blocks from my house. Some are addicted. Some have other competency issues. Some are just living the vagabond life for other reason. Whatever their stories, they will not magically become insured under either plan. Nor are they the only ones.

  2. #2 curlyfries
    February 25, 2008

    Absolutely, Russell. We currently mandate auto insurance yet millions voluntarily remain uninsured. That Clinton’s plan is more comprehensive actually works against her, since her plan will waste money attempting to cover those who will give up the insurance.

  3. #3 Thomas Robey
    February 26, 2008

    Hey Nick,

    Nice post. I agree with your conclusions, but think a stepwise approach (see your point #3) is the only feasible way to cause change on this issue. I’ve been working on a similar post for a differnt venue. Do you mind if I link you at that point?

  4. #4 Nick Anthis
    February 26, 2008

    Sure, Thomas, I look forward to hearing your thoughts.

  5. #5 Mike
    February 26, 2008

    It is interesting that you buy into the lie that preventive care will save money. There was a recent blog post by a blogger here at science blogs which discussed a research article showing just the opposite.

  6. #6 Nick Anthis
    February 26, 2008

    First of all, here’s the link to the post at Pure Pedantry that Mike is presumably referring to, since he failed to provide it in his inflammatory comment. I’m guessing the link wasn’t included, because nothing in the post–or the study that it references–indicates that preventative care is a “lie”. Instead, it indicates that some preventative care is cost-saving, and some isn’t. It’s as simple as that. The take-home message is that talking broadly about preventative care isn’t enough. Efforts designed to reduce health care costs, then, need to be pointed. Fair enough, and it would be silly to argue otherwise.

    It should be noted, though, that when people refer to “preventative care” in a political context, often they mean primary care. The point being that the uninsured often have to resort to the emergency room to receive basic health care. This ends up being more expensive for the taxpayers than if these same people had access to much less expensive primary care in the first place. This is a more general usage of the term “preventative care” and it shouldn’t be confused necessarily with the more specific meaning.

  7. #7 Bob Calder
    February 26, 2008

    Health care, at least, is amenable to analysis even if most of the fantasies people hold about why it is as it is are untenable. It’s not like education policy that has nonlinear variables.

    How does someone opt out of a universal and mandatory health care program? Hmmm. Must be a Libertarian.

    The comparison to auto insurance is not apt because people simply cannot afford adequate first and third party coverage limits. This applies to probably 70 percent of all automobile owners because they have less than $300,000 worth of third party coverage.

    What IS interesting is that if we had universal health coverage, car insurance rates for Bodily Injury liability should take a tumble as claims would only apply to long term loss of income occasioned by accidents.

  8. #8 Dave Briggs
    February 27, 2008

    But, I suppose you have to take it one step at a time, and either plan would be a step in the right direction.

    I believe that is true! The main snafu is that no President is an all powerful monarch! They have to work and cooperate with hundreds of other people. Whatever they propose at the start may have only slight resemblance to what actually eventually happens.
    Dave Briggs :~)

  9. #9 Tye Arnett
    February 27, 2008

    So Nick, what role do you see 3rd party insurers having in each plan. I would assume a double tiered system would include an incredible price decrease for private insurers since the public sytem will cover so many of the routine procedures which bring the day to day cost for insurers so high. Also, third party insurers can more clearly define their policies concerning more advanced procedures and risky care options which should lead to a drop in premium cost.

  10. #10 Nick Anthis
    February 27, 2008

    From what I understand, neither system would be that different in practice from what we have now–with the exception that the number of uninsured people should be significantly decreased. Under either plan, you would sign up with the public insurance plan or a private insurance plan, but you would still just have one primary insurer. The scenario that you (Tye) are talking about sounds much more like what you’ll find in the UK or Canada. There, all citizens are covered under a basic government health care scheme, but anyone can purchase additional private insurance if desired. In the long run, I think the US would do well to adopt something more closely resembling this setup, but this isn’t really what the Obama or Clinton plans do.

  11. #11 joe dupont
    September 9, 2009

    Obama lied.. listen to his address tonight..
    mandatory.. he won the nomination because he lied.

  12. I’ve never liked obama’s healthcare plan. that being said, he’s still far and away the best candidate out there.

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