There were a lot of fireworks during the Monday night debate among the three major Democratic candidates. Some of the more interesting sparks involved health care reform. What struck me is how closely the debate echoed the health care reform wrangling taking place in California with Senator Hillary Clinton and former Senator John Edwards playing the role of Republican Governor Arnold Schwarzenegger and Senator Barack Obama filling in for the legislature’s Democratic leadership.
The differences among the Democratic candidate’s health care reform plans are inconsequential when compared to those put forward by the Republican candidates for president. (The New York Times offers a quick summary of the proposals). But that’s not going to stop campaigns embroiled in a close nomination fight from emphasizing what differences do exist.
On one side: accessibility. The health care reform plans of Senators Clinton and Edwards emphasize universal coverage. Every American must be insured either through government programs, their employers, or purchasing their own medical plan. Senator Clinton went so far to say advocating anything less than universal coverage was contrary to the principles of the Democratic party.
This accessibility argument mirrors that of Governor Schwarzenegger, who back in January of last year made universal coverage one of the core principles of his health care reform plan. He fought hard to keep it in the compromise plan he reached with Assembly Speaker Fabian Nunez, Assembly Bill ABX1-1. As it is, he was unsuccessful. Studies indicate ABX1-1 will help 70 percent of California’s uninsured obtain coverage, not 100 percent. Think of it as “mostly” universal coverage.
Then there’s the other side: affordability. Senator Obama’s health care plan doesn’t require people to purchase coverage. He believes most Americans want medical insurance and would buy it if it was affordable. His plan focuses to a greater degree than do his opponents’ on the need to corral the spiraling cost of health care and of health insurance premiums.
In leaving out the mandate to buy, Senator Obama’s reform package is similar to that introduced by Speaker Nunez and Senate President Pro Temp Don Perata more than a year ago, Assembly Bill 8. The proposal expanded coverage, but without the mandate to buy. It was, as the sponsors admitted, not universal coverage. The Democratic leadership, and their allies among Labor and liberal groups, thought it unfair to force people to buy coverage that might be priced beyond their means.
In Senator Clinton’s mind, apparently defines Speaker Nunez and Senator Perata, both of whom endorse her, as bad Democrats. (Whether it makes Governor Schwarzenegger a Clinton Republican is unknown).
In tonight’s debate, Senator Obama tried to cast the debate as one between access and affordability. He failed and he remained on the defensive. Calling for universal coverage is simply good politics, even if affordability is potentially the most potent public policy.
What finally bridged the gap in California was the introduction of an “affordability standard” to the mix. As initially introduced, the idea was to exempt individuals from the obligation of obtaining coverage if the cost of premiums and out-of-pocket expenses exceeded a specified percentage of their family’s income. The specifics of the affordability standard evolved during the negotiations, and it is still a source of continued contention. The concept, however, remains the same.
Senator Obama would to introduce an affordability standard into the presidential debte — and to specifically mention how it became a part of the California health care reform compromise. Doing so allows him to remain consistent to his priorities, while showing how his approach can lead to (near) universal coverage. And, of course, aligning himself with Speaker Nunez and Senator Perata before the February 5th primaries couldn’t hurt. Besides, it would be fun to see how Senator Clinton would explain how her Democratic Party litmus test includes the Legislative Leadership, but not her rival for the nomination.