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).