Bedside Manner: How Clinton and Obama Truly Differ on Health Care

Despite appearances to the contrary, the recent vitriol between Sens. Hillary Rodham Clinton and Barack Obama masks some genuine differences between the Democratic candidates.

One particularly important difference involves health care. The difference, however, is not so much one of policy. It is really a distinction of process.

On substantive grounds, their health plans are very similar. Both would maintain the employer-based system of private insurance while introducing a public insurance option for consumers. Both would place significant new regulations on private insurers, forbidding them from denying coverage or charging higher rates to those with "pre-existing conditions."

But there is one major distinction: Clinton's plan includes a governmental mandate that every individual has health coverage, and Obama's doesn't.

Clinton argues that without a mandate, healthy people will not buy insurance and will seek health care only when they get sick. This could raise costs for everyone else and threaten the viability of any reformed health care system. Obama argues that the problem is not that people don't want health coverage; it's that they cannot afford it.

Much of the rhetoric between the candidates has muddled the issue: Is the ultimate goal of health reform an individual mandate or expanded coverage? One is an intermediate step; the other is the policy objective itself. Indeed, Obama is not opposed to the concept of mandates; his plan includes one for children, and he has repeatedly said he would consider one for adults if needed. Mandates aren't the issue - universal coverage is.

Or is it? Some have suggested that Obama's plan would leave more people uninsured than Clinton's. As a result, Obama no longer describes his plan as "universal." Clinton, however, still does. This only adds to the confusion. "Mandating" is not "providing" - just because the government requires something does not make it so.

Read Full Article (San Francisco Chronicle)