Obama's Health Plan

Take a closer look


By Joyce Jones


June 19, 2007--Political strategist James Carville, who rarely fails to
amuse, has cooked up a little Cajun ditty about Democratic presidential
candidates Sen. Hillary Clinton of New York and Illinois Sen. Barack
Obama: "Mama needs more spice; Obama needs more seasoning." That's
because, as even many of their supporters will agree, some people
believe Clinton lacks charisma, while others question whether Obama has
enough experience to become the next U.S. president. It's great to be
adored by the masses, as he clearly is, but to be truly successful in
politics, you've got to have a plan.

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So, all eyes were on the junior senator earlier this month when he
released a proposal for universal health care. American voters consider
this issue should be one of the nation's biggest domestic priorities.
There's been much talk about it from as far back as former president
Bill Clinton's first term in the White House, but no real action.


Obama has devised a plan that would rely on a combination of the
employer-sponsored coverage now in place and a public health plan for
individuals who do not have access to group coverage at work or through
public programs like Medicare. According to Obama, under his plan, the
typical American family would save up to $2,500 annually through
information technology investments that would reduce wasteful spending
in the health care system, improved methods of prevention and
management of chronic conditions, and by requiring the insurance
industry to reduce administrative costs and lower premiums for
individuals.


Employers that do not provide insurance coverage would be required to
contribute to the public plan. Parents would be allowed to continue
coverage for their children until they reach age 25. The plan would
also provide reinsurance for catastrophic coverage that will reduce
insurance premiums and eligibility for Medicaid and state insurance
health plans for children would be expanded.


Critics have charged that Obama health plan is not truly universal
because unlike former North Carolina senator and presidential candidate
John Edwards's plan, only children-rather than everyone-would be
required to have insurance. In a statement that commended Obama for his
efforts to make health care more affordable, Neera Tanden, Clinton's
campaign policy director said, ".We have to achieve true universal
health care so that every American has health care coverage." (The
Clinton campaign has not yet put forth a proposal on this issue.)


"Obama proposes a public insurance plan that individuals can elect
into, but he largely leaves employer-sponsored health insurance intact
and I don't think that's the most efficient way to deliver coverage.
For corporations, it's an additional cost they have to pay. Why should
they be responsible for coverage of their workers? Why should employees
have to negotiate health care when they try to contract with
employers?" says Dr. Darrick Hamilton, an assistant professor of
economics at The New School for Management and Urban Policy, who
prefers a single-payer system. "The situation for Americans would be
vastly improved if Obama's plan was initiated, but it doesn't go far
enough. I don't think we'd get universal coverage with his plan."


Dr. Darrell J. Gaskin, associate professor of health economics at the
University of Maryland, believes that the Obama plan has all of the
elements of comprehensive reform, but also has some holes. "He's got a
great outline," says Gaskin, "but the devil is in the details and there
are some questions that must be answered."


The first-and likely number one question-on people's minds is how the
plan will be paid for. The answer, according to Obama when he released
the plan, is, ".we will ask all but the smallest businesses who don't
make a meaningful contribution today to the health coverage of their
employees to do so by supporting this new plan. And we will allow the
temporary Bush tax cut for the wealthiest Americans to expire. But we
also have to demand greater efficiencies from our health care system.
Today, we pay almost twice as much for health care per person than
other industrialized nations, and too much of it has nothing to do with
patient care."


The biggest problem with the theory of cost savings through greater
efficiencies, charges, Gasken, is "how you capture them so you can then
use those dollars to care for the uninsured. If you save a hospital or
physician health plan money, how do you make sure that money goes to
pay for the care? It's not very easy to capture that." He also believes
that people on the right will challenge how much the public portion of
the plan could end up costing. "How do you prevent employers from
dropping coverage altogether, telling employees to purchase the public
plan, or prevent them from telling very sick employees to drop the
[employer-sponsored] coverage and purchase the public plan?" Gaskin
asks. "There's no discussion about what type of firewalls he's going to
create to prevent private insurers, employers, and even patients
themselves from acting opportunistically, paying on the private side
until they get very sick and then switching to the public side. Tax
payers or people who are healthy and enrolled in the public system will
end up carrying the weight.


How the plan would affect small business owners, adds Gaskin, will
depend on how much the mandatory contribution will be for those that do
not provide coverage. "The plan could allow people employed by small
businesses to get health care without impacting their employers' bottom
lines," he says. The plan would also benefit working class African
Americans who cannot easily afford coverage. "Obama's plan will be
comparable to the federal employees' health benefit plan, which is
pretty good, and which they couldn't afford to buy today."