Health Care and the Democratic Debate

During last night's debate the Democrats had an in-depth back and forth discussion on health care reform. You can watch the video below, but I would like to focus on two specific sub-topics, universality and how we pay for the needed reforms.

John Edwards directly addressed the lack of an individual mandate in Barack Obama's plan and Obama responded.

On this issue of mandatory and non-mandatory. People are not going around trying to avoid buying health care coverage. And in fact if you look at auto insurance, in California there is mandatory auto insurance. 25% of the folks don't have it. The reason is because they can't afford it.

So, John and I we are not that different in this sense that I am committed to starting the process. Everybody who want it can buy it and it is affordable. If we have some gaps that are remaining, we will work on that. You take it from the opposite direction, but you are still going to have some folks who are not insured under your plan John. Because some of them will not be able to some of them will simply not be able to be able to afford to buy the coverage that they are offered.

Obama is correct. No matter what we do, short of passing a single payer plan there will be people who will not be covered. There will be a percentage of the population that subject themselves to the punitive effects of Edward's proposal. It certainly should be much smaller than 25%, given that it is the less well off who often go without car insurance. That same population would have access to care in both Edwards and Obama's plans.

It is actually rather impressive that the degree of universality of the two of the front runners' health care ploans is actually a contentious issue and one that would get fairly detailed attention at a debate, many months before the voters go to the polls. The differences are important, but the overall direction the debate is going is encouraging. And it is always nice to see a California reference (even if it is a bit negative) during an East Coast Debate.

Now for Clinton. She talked at length about the lessons she learned from her first attempt to reform the system and the importance of building up a broad coalition to stem off the insurance companies and pharmaceutical companies onslaught. Then Wolf asked her about how you would pay for major reform. Could you do it without raising taxes?

Well Wolf, here is the challenge. I have put forth approximately a $120 billion in savings from health care changes that can come. Everything from electronic medical records, to better management of chronic care. That is about in the ball park of what all of us believe it will cost to cover everyone. The challenge that I am wrestling with is how do we realize the savings?

It is an excellent question. Electronic medical records will save hospitals, doctors and insurance companies money. They will reap the benefits, with little motivation to pass on those savings to the consumer. These changes will increase the efficiency of our health care system, but what these Democrats want to do is make sure that benefit goes to the American public, in the form of better coverage and care. That will require money and regulation of the industry to ensure they do not simply take the savings and add them to their bottom line.