Obama's Plan
(in this section, text not in [brackets] is taken directly from Obama campaign materials, found here)
- Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions.
- Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care. [This plan will be available to all Americans.]
- Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.
- National Health Insurance Exchange: The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.
- Mandatory Coverage of Children: Obama will require that all children have health care coverage.
- Reducing Costs of Catastrophic Illnesses for Employers and Their Employees: Catastrophic health expenditures account for a high percentage of medical expenses for private insurers. The Obama plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers' premiums.
- Lower Costs by Modernizing The U.S. Health Care System. [A variety of measures, including mandatory electronic recordkeeping, disease management programs, emphasis on prevention, and incentives for using proven best practices, are purported to reduce an average family's annual costs by "up to $2,500".]
- $55-60 billion annually, after fully phased in, to be paid for by efficiency improvements and repealing the Bush tax cuts for those making over $250K/year. (Obama Health FAQ)
- Does not mandate coverage. Obama's plan does not require that everyone have health insurance. Though insurers will be required to cover everyone, and the government will provide an unspecified level of subsidy for poor people not covered under Medicaid or SCHIP, economists estimate around 15,000,000 Americans will choose to remain without insurance. (The New Republic June 2007; Cohn blog post)
- Claims about efficiency gains seem contentious. Jonathan Cohn, who I trust knows more than I do about this, calls the proposal "detailed and well thought-out" in this area (The New Republic June 2007). But the Obama campaign's numbers for administrative overhead in healthcare are at the very highest end of what's out there; and John Mongan has convinced me that replacing medical recordkeeping systems is very hard to do (although I mostly remember arguments about doctor personalities, which may matter less in national policy than in private campaigns). I remain unconvinced that these predictions are realistic.
Clinton's Plan
(in this section, text not in [brackets] is taken directly from Clinton campaign materials, found here)
- The Same Choice of Health Plan Options that Members of Congress Receive: Americans can keep their existing coverage or access the same menu of quality private insurance options that their Members of Congress receive. In addition to the broad array of private options that Americans can choose from, they will be offered the choice of a public plan option similar to Medicare.
- Individuals: will be required to get and keep insurance in a system where insurance is affordable and accessible.
- Insurance and Drug Companies: insurance companies will end discrimination based on pre-existing conditions or expectations of illness and ensure high value for every premium dollar; while drug companies will offer fair prices and accurate information.
- Reducing Costs: By removing hidden taxes, stressing prevention and a focus on efficiency and modernization, the plan will improve quality and lower costs.
- Provide Tax Relief to Ensure Affordability: Working families will receive a refundable tax credit to help them afford high-quality health coverage.
- Limit Premium Payments to a Percentage of Income: The refundable tax credit will be designed to prevent premiums from exceeding a percentage of family income, while maintaining consumer price consciousness in choosing health plans.
- $110 billion, to be paid for by efficiency improvements and repealing the Bush tax cuts for those making over $250K/year. (Full, detailed breakdown in Clinton Health Plan)
- The only substantial criticism I found is that even with the mandate, some people -- perhaps ~1.5%, or 4.5 million -- will go uninsured, given realistic levels of subsidies. (Washington Post blog, November 2007)
Edwards's Plan
(in this section, text not in [brackets] is taken directly from Edwards campaign materials, found here)
- Requiring businesses and other employers to either cover their employees or help finance their health insurance.
- Making insurance affordable by creating new tax credits, expanding Medicaid and SCHIP, reforming insurance laws, and taking innovative steps to contain health care costs.
- Creating regional "Health Care Markets" to let every American share the bargaining power to purchase an affordable, high-quality health plan, increase choices among insurance plans, and cut costs for businesses offering insurance.
- Once these steps have been taken, requiring all American residents to get insurance.
- Edwards claims he will "use [his] power as president to take [Congress's] healthcare away" (TV ad, cited by factcheck.org) unless his plan is passed. This seems like an empty threat, since Congressional healthcare is provided for by legislation, and the only legal way to revoke it would be with more legislation. Written campaign materials make the weaker claim that he will "submit legislation" to achieve this end (which, presumably, would be voted down by Congress). And Edwards has defended this plan, saying "The most powerful tool that the president has is the bully pulpit. And that means making the case to America, submitting legislation to support exactly what I just said, and then making the case to America in any place--any congressional district or any state where a senator is opposing it--saying `your senator, your congressman is defending their health care at the same time that they're not providing health care for you.'" (Face the Nation, quoted in Mike Kuykendall's blog)
- Maybe I'm just tired, but I didn't see this on the webpage or in the detailed plan PDF. Elsewhere, "Campaign estimates cost to be $90-$120 billion a year. Would finance the plan by rolling back tax cuts for those earning more than $200,000 a year." (KFF)
- This appears to me to be esentially the same as Clinton's plan, though less specific (and with the addition of the Health Care Markets, and the Congressional bribe). So, again, the only criticism is that an individual mandate is less likely to provide truly universal care than a single-payer system would be.
- Announced in Feb 07, Edwards was the first of the candidates with identical plans. Obama announced in May, and Clinton May-Sep. (KFF)
Paul's Plan
(in this section, text not in [brackets] is taken directly from Paul campaign materials, found here)
- Making all medical expenses tax deductible.
- Eliminating federal regulations that discourage small businesses from providing coverage.
- Giving doctors the freedom to collectively negotiate with insurance companies and drive down the cost of medical care.
- Making every American eligible for a Health Savings Account (HSA), and removing the requirement that individuals must obtain a high-deductible insurance policy before opening an HSA.
- Reform licensure requirements so that pharmacists and nurses can perform some basic functions to increase access to care and lower costs.
- not provided.
- This plan seems unlikely to substantially alter the current situation.
