The Scientific Activist

Last night was a historic night, with Barack Obama finally effectively clinching the Democratic nomination by surpassing the “magic number” of required delegates. Barring any last-minute fight over delegate rules from Hillary Clinton’s campaign (something that I think is not likely to happen), Barack Obama in the Democrats’ nominee. Of course, we knew from the beginning that 2008 was going to be a trailblazing election–we just didn’t know which way it would swing. Although it’s been pretty clear since Obama’s string of victories in February that he would eventually be the nominee, now it’s (almost) official.

Obama becomes the first African American major party nominee. But, beyond that, we have someone who is young and inspiring, and a potential agent of change. His nomination has already generated good will toward the US across the globe, and I can personally attest to the near universal interest and enthusiasm toward him that I hear constantly professed here in the UK. All that aside, though, now Obama–and the Democrats in general–have to look toward the general election. Although Obama is in a very good position to do well in November, he has a long, long road ahead of him.

The campaign will have to make a variety of major campaign-defining decisions in the near future. One of these, of course, will be his choice of running mate. At this point, it could be a wide variety of characters (Hillary Clinton included)–although, personally, I think that Bill Richardson would be a great choice. Other decisions, though, could involve major reassessments of his platform and specific policies. Since one of the most pressing national issues in 2008 is health care reform, this would be a natural place to start.

One change I hope that Obama will consider is adopting a health care proposal closer to Clinton’s than the one his campaign has advocated to date. I made a rough comparison of the two proposals back in February. From that, I concluded that although the two plans are very similar, the Clinton plan is stronger and more attractive, mostly just because it’s more comprehensive. Specifically, the Clinton plan mandates universal coverage, while the current Obama plan does not. Obama’s plan mandates coverage for all children, but beyond that it relies on incentives to reach broader coverage in the adult population. Although the Obama plan would certainly be a major improvement to our current system (and would help pave the way for more pervasive change in the future), experience has shown that mandates are particularly effective tools in health care policy.

The most relevant test case we have to date is the state of Massachusetts, which in 2006 enacted its own universal health care plan. Two years later, the first detailed analysis of the plan’s results are out, in a study published in Health Affairs and authored by Sharon K. Long of the Urban Institute. In short, the Massachusetts plan has a been a resounding success. After its first year, the percentage of the population without health insurance dropped from 13% to 7% (for those living at less than 300% of the poverty line, that drop was from from 24% to 13%). Although the plan hasn’t reached the ultimate (but unrealistic) goal of 0% uninsured, I’d even go so far as to call these early results an unqualified success.

One of the criticisms of the Massachusetts plan (and other universal coverage proposals) was that it would “crowd out” private insurers, and that access to employer-provided health insurance would decrease (due either to supply or demand). While I personally think that this would actually be a desirable outcome in the long run, the results of the current study show that in the first year, the percentage of people insured through their employers actually increased slightly. Sure, things haven’t gone perfectly–and the state might actually be facing a shortage of physicians due to increased demand–but at the very least, the primary fears have so far proven to be unfounded. This is a great start, and although Massachusetts certainly is not representative of the US demographically, these results are a strong endorsement of a Clinton-style health care plan.

Hopefully Obama is paying attention.


Update (5 June 2008): It is now being reported that Clinton will concede to Obama this Saturday (7 June).

Comments

  1. #1 Alex W
    June 4, 2008

    You must be off your rocker to imagine Bill Richardson would be a good choice! The man who’s been labeled Judas?! Perhaps you’re not aware of that, or assume politics is somehow not personal.

    The question about healthcare is a tricky one, though. It will be fascinating to see whether and how Obama concedes that Clinton’s healthcare plan is better than his, especially if he does does this side of November (not that I expect he will win – and I certainly won’t vote for the man, he’s an empty suit – we need someone solid, not some soft Western European excuse for a leader). You’re presumably aware of the criticism he has faced over his healthcare plan and the unseemly way in which he attacked Clinton’s.

  2. #2 Mariah
    June 4, 2008

    I’m gonna go read the study. Really–I need to know how they calculated some of the data. Because there are ways to make this look better than it is.

    Firms find ways around state health law: http://www.boston.com/news/health/articles/2007/12/23/firms_find_ways_around_state_health_law/
    *Burger King franchisee raised employee contribution so high that people couldn’t afford the coverage
    *One employer upped the amount of hours required to be an insured employee
    *One company broke itself into smaller units below the threshold

    I think it could be easy to hide some of these situations in the data. But I’ll go look.

    Full disclosure: I’m on the MA plan. But it isn’t all that great.

  3. #3 Obama Supporter
    June 4, 2008

    Forget him jumping on Clinton’s bandwagon. He just just support HR 676!

  4. #4 Dan
    June 4, 2008

    While suturing a cut on the hand of a 75 year old Texas rancher, whose hand was caught in a gate while working cattle, a doctor struck up conversation with the old man.

    Eventually the topic got around to Obama and his bid to be our President.

    The old rancher said, ‘Well, ya know, Obama is a ‘post turtle’.’ Not being familiar with the term, the doctor asked him what a ‘post turtle’ was. The old rancher said, ‘When you’re driving down a country road and you come across a fence post with a turtle balanced on top, that’s a ‘post turtle’.’

    The old man saw a puzzled look on the doctor’s face, so he continued to explain. ‘You know he didn’t get up there by himself, he doesn’t belong up there, he doesn’t know what to do while he is up there, and you just want to help the dumb ass get down.’

  5. #5 Eric
    June 4, 2008

    Bill Richardson is a serial resume-builder and from what I’ve been able to tell, not a particularly bright or innovative person. Can anyone, off the top of their head, list any great accomplishments he had as Secretary of Energy? Wouldn’t it have been nice to have a strong energy policy back then?

    I first became disenchanted with him when I heard him on the Diane Rehm show a few years ago:

    http://wamu.org/programs/dr/05/11/07.php#8117

    And then there are these:

    http://www.youtube.com/watch?v=eB8bW4vDaOk
    http://www.youtube.com/watch?v=L6AtNi39m5U

    Obama could do a lot better than Bill Richardson. Whomever Obama chooses s/he will have grey hair and have experience in foreign policy.

  6. #6 epikorean
    June 4, 2008

    I believe the second sentence in the first paragraph,”Baring any last-minute fight over delegate rules,” has a typo. Barring is what I think you meant. Typos happen to me all the time when I type fast!

    I guess according to Alex W this country needs a hard, American style leader? Wait a minute, isn’t Ahmadinejad a hard style leader? I guess unilateralism is the way to go for superpowers and dictators alike since softness won’t get us anywhere, Alex W.

  7. #7 Tye
    June 4, 2008

    I am also wary of the Richardson choice, I’d like more of a bulldog in the VP role so Obama can try to stay out of the mudtossing come September and October while the Veep can come out with strong words against McCain.

  8. #8 Nick Anthis
    June 5, 2008

    Typo fixed. Thanks, epikorean.

  9. #9 Oldfart
    June 5, 2008

    My dream team was Clinton/Obama which might have lead to 16 years of Democratic rule and outlived the scabrous Bush Supreme Court appointments. Oh Well. How about Webb as VP? Or Clinton.

    John McCain is NOT that strong and will constantly shoot himself in the foot with his mouth and his so-called “straight talk.” Hopefully, Obama will take full advantage of that. As for white racism, I’m sure that lurks in the background of almost all whites. Until they get to know a person. Then they are capable of treating them as an individual. So, Obama should keep the background chanting muffled, introduce himself to the whites in places that voted heavily for Hillary, adopt some of her ideas and maybe even her and take every advantage of McBush’s goofs which will be many. And try to stay above the fray when the real right wing shows it’s ugly head as November draws closer and the old Swiftboat boys press every evil button in the American soul to try to defeat Obama.

  10. #10 Martin
    June 5, 2008

    I’ve said this before, but (and OldFart before you start getting all sensitive and accusing me of being anti-American again, the same applies for British politics too) I don’t really buy into all the excitement on Scienceblogs, because I don’t see why a Democrat president is necessarily any better than a Republican one.

    In fact, there’s published, peer-reviewed research (that I’m desperately trying to dig out so I can blog it) that demonstrates that in fact there is very little correlation between U.S. foreign policy and which party is in charge. During the 20th century, Republicans and Democrats have actually behaved pretty much the same.

    They only looked at foreign policy, but on health and science I’ve not seen any real evidence that Obama is better than McCain. They both (along with Clinton) have allowed themselves to be sucked into vaccine woo, pandering the the Jenny McCarthy lobby. They both have links to batshit insane preachers. They’re both about equal on climate change, but then so was Bush before he got elected.

    So my question to Americans is the same one I asked to British people before Blair came to power in 1997 – why do you think it’s going to be any better under the other lot?

  11. #11 Alex W
    June 5, 2008

    Well, epikorean, I guess I asked for that. I sometimes wonder whether Obama might turn out to be an American version of Britain’s Blair and France’s Sarkozy. But what I meant by solid was someone who knows how to handle Washington politics. Madeline Albright was right when she said “Clinton knows how a Whitehouse works”. Obama’s going to be moving into an arena in which is a true novice. Bush Jr was a figurehead for a campaign. If Obama’s going to be more than that, he will need assistance. He needs someone solid, whether that be Hillary Clinton, Strickland, Webb or somebody else. Tye put it very succinctly.

  12. #12 Nick Anthis
    June 5, 2008

    Martin, when I see a comment like yours, I feel kind of like I do when a creationist asks me to prove evolution, or a denialist asks me to prove that global warming exists: I don’t know where to begin, and if you really don’t believe there exists a major difference between the two parties, I doubt I can change your mind.

    (I should be perfectly clear, though, that I am in no way trying to compare you to a denialist–I’m just trying to get across an idea of where I’m coming from.)

    Off of the top of my head, though, I can give a couple of examples of how Democrats have historically been better for policy in general. In terms of foreign policy, the landscape changes so quickly that it’s difficult to draw too many conclusions. But, do you honestly believe that Gore’s foreign policy would have been near as bullish and destructive as Bush’s has been?

    In domestic policy, the differences are much clearer. The great domestic policy achievements of the 20th Century have come almost exclusively from Democratic administrations–from social security to civil rights legislation. In terms of health care, remember that Clinton attempted a major overhaul of the health care system in the early 1990s, but it was Republican opposition that prevented it from coming to fruition. Then, we had eight years of a Republican administration in which this idea was completely off of the table. Now, with a Democrat likely to be the next president, it’s back on the agenda. These are just a couple of examples, but the list goes on and on.

  13. #13 Coriolis
    June 5, 2008

    Also Martin, during the cold war our foreign policy was indeed rather more set in stone than it is now. I don’t know that historical comparisons (with the cold war at least) are of much use since this is a transition period.

    You are of course right in a fundamental way – I would love it if either democratic candidate could stop playing this whole “War on terror” game and just come right out and say that there is no reason, other then irrational fear, for “the world’s only superpower” to be running scared from a couple thousand terrorists living in caves. But that is expecting too much at this point. Changing our policy from “kill em all” to “maybe do some diplomacy for a change” would be good for now.

    And lastly like Nick said, democrats did try to push healthcare, and hopefully this time they’ll really do it. The republicans are of course against it.

  14. #14 Tye
    June 5, 2008

    Living in a heavily populated Republican state (Texas) I know the fight for universal health coverage will be a heated one.

    The misinformation regarding the implementation a solidified, non-fractionated insurance program is hard to wade through when local media and advertising groups essentially silence the view of the Left. This problem is especially evident in states such as mine that deal with illegal immigration issues. Invoking racial tensions and the fear of financially supporting the care of illegals is a common theme from conservative voices.

    A true discussion of the cost and implementation of such a plan will be necessary to woo the Right. An appeal will have to be made that convinces Republicans that coverage and early treatments (maybe more importantly screening) for the whole population will personally benefit them both in terms of industry efficiency and reduced personal cost burden.

  15. #15 Life Insurance Canada
    June 6, 2008

    As a Toronto life insurance broker I may look as a member of evil
    insurance business, but while looking at Canadian health care system, I think role of market and private insurance is inevitable, at least to some extent, on the other hand, if I should choose between Obama and McCain, I would choose Obama…
    Lorne

  16. #16 Josh
    June 22, 2008

    For better or worse, I think politics would dictate Obama keeping his plan as is.

    Yes, the Clinton/Edwards plan is more universal. Yes, it’s also more realistic (mandates are the only way to make sure the system stays afloat so that the healthy buy in to defer the costs of the sick).

    But, selling any “mandate” from the government will never work and nothing will change. Let’s back Obama’s plan and take at least take one decently large step in the right direction. When the importance of mandates becomes more immediately apparent, it will be easier to take that next one.

  17. #17 stephen
    January 11, 2011

    Health Care has so many flaws this is one of the reasons why so many people are still uninsured out there it should be basic citizen right.