Tuesday, May 29, 2007

Clinton, Edwards, Obama--Offering Health Care Reform Proposals More Similar Than Different

In sailboat racing there is a strategy called "covering." It means that when your competitor makes a move you make exactly the same move. That way, you have covered their every move and they can't get away from you because of any new tactic they aim to employ.

When you "cover" you intentionally stay even during that phase of the race--you have no intention of getting ahead at that point.

On health care so far in the Democratic race, Clinton, Edwards, and Obama are "covering." They are proposing pretty much the same things and as a result protecting themselves from criticism--when compared to their Democratic rivals--on the issue of health care reform.

Hillary Clinton, John Edwards, and Barack Obama obviously don't intend to win the nomination on health care--but more importantly they don't intend to lose the nomination on this highly volatile issue.

Each of the Democratic front-runners have so far proposed essentially the same health care reform steps.

Months ago, John Edwards proposed a comprehensive plan building on existing public and private programs and largely paid for by ending the Bush tax cuts for the "rich" and mandatory employer contributions. His plan contained an individual mandate and a series of mostly non-controversial cost containment provisions I would label "cost containment lite." His plan looks very similar to the recently enacted Massachusetts health reform plan.

Last week, Hillary Clinton unveiled the first elements of her plan focusing on a series of cost containment proposals using many of the same "cost containment lite" elements. She will discuss her plans to improve access and quality later. Earlier post: Hillary Clinton Outlines the First Elements of Her Health Care Reform Plan

Hillary Clinton may be using the smartest tactics. Politically vulnerable from the failure of her 1993 failed Clinton Health Plan, she has waited for her two main rivals to put their plans on the table and will now offer something very similar. That makes it difficult for her Democratic rivals to use health care as a weakness against her.

Today, Barack Obama released his health care reform outline. It looks a lot like the John Edwards plan (and Massachusetts) and also includes many of the cost containment provisions Mrs Clinton proposed. Obama would also end the Bush tax cuts on the "rich" to pay for his plan. Like Edwards, Obama would create a "more efficient health insurance market" similar to the Massachusetts "Connector" and the Federal Employee Health Benefit plan.

There are some differences. Edwards would mandate that individuals buy health insurance (with substantial support for the low income). Obama would not require that individuals buy insurance but both would require employers to pay for it (Obama would exempt the smallest employers)--and both would also offer substantial payment support for the poor. Obama has also proposed a large claim reinsurance scheme similar to the Kerry proposal.

So, when the day is done the Edwards and Obama plans look a lot alike--incremental expansion of existing public and private plans with plenty of money being spent to subsidize low-income folks. From what we have seen from Mrs. Clinton, all three candidates would employ generally non-controversial cost containment proposals such as the expansion of health information technology, broader use of evidence-based medicine, more preventive care, and chronic disease management.

I fully expect that when Hillary Clinton adds her access and quality components they will look very much like those proposed by Edwards and Obama.

So, when it is all over, each candidate can criticize some nuances in their opponents plans but can't lose a lot of ground to the others over health care.

The are "covering."

A recent post on why these incremental health reform proposals may be the only practical way to achieve health care reform: The “Realistic” Way to Do Health Care Reform

A recent review of the leading Republican health care positions: Giuliani, McCain, and Romney--Where Are Their Health Care Plans?
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