ISSUES AND THE PRESIDENTIAL CANDIDATES: HEALTH CARE

Obama on Health Care

by Marilyn Werber Serafini

Sat. Jun 7, 2008


This is the second in a 10-part series examining the differences between Democrat Barack Obama and Republican John McCain on major issues in the presidential race. The series can also be found at www.national journal.com/njmagazine. Next week: Iraq.

Specific Policy Positions

The uninsured

Obama would require parents to insure their children. The goal is to reach universal coverage by 2012. He might consider mandating that all the uninsured buy coverage and would expand eligibility for Medicaid and SCHIP.

Consumer impact

Individuals and businesses could purchase public or private health coverage through a national health insurance exchange. Insurers could not reject applicants because of illness or pre-existing conditions. The benefits would be similar to those for federal employees. Obama would allow importation of safe drugs from developed countries.

Economic impact

He would pay for his plan (estimated at $50 billion to $60 billion a year) by allowing President Bush's tax breaks to expire for people with annual incomes above $250,000. Obama would toughen antitrust laws to keep insurers from "overcharging" for malpractice insurance. He would promote the use of generic drugs, and would allow Medicare to negotiate directly with drug companies.

Employer-provided health insurance

Most employers would have to cover workers, make a "meaningful" contribution to coverage, or contribute to a public health plan. Obama would exempt some small businesses. He would reimburse employers for some catastrophic health care costs, but employers would have to use the money to reduce workers' premiums.

Performance and innovation

Obama would require medical providers to collect data on costs, quality, preventable errors, nurse-to-patient ratios, and hospital-acquired infections. Federal health care plans would have to use disease-management programs. He also wants to step up efforts to disseminate best-practice information and pay medical providers more for top-quality care.

Key Advisers

David Cutler, professor of applied economics at Harvard University's Kennedy School of Government, is in charge of Obama's health care team. During the Clinton administration, Cutler served on the White House Council of Economic Advisers and the National Economic Council. One of the first things Cutler did as Obama's health care chief was to recruit David Blumenthal, the director of the Institute for Health Policy at Massachusetts General Hospital, a professor of medicine and policy at Harvard University, and a doctor of internal medicine. Cutler and Blumenthal have collaborated on projects at Harvard, and the two worked closely on Obama's plan. Also providing input into Obama's health plan were Stuart Altman, dean of Brandeis University's Heller School for Social Policy and Management, and Gregg Bloche, a professor at Georgetown University Law Center.

Record

SCHIP reauthorization: Voted for 2007 legislation to expand the State Children's Health Insurance Program with $35 billion in new funding, financed by a tobacco-tax increase.

Stem-cell research: Sponsored 2006-07 legislation vetoed by President Bush that would have expanded federal funding of embryonic-stem-cell research.

Avian flu: Congress enacted an Obama proposal to establish an interagency task force on avian flu and provide $25 million for international efforts to combat the disease.

Medical errors: With Sen. Hillary Rodham Clinton, D-N.Y., offered an unsuccessful amendment to a 2005 medical-malpractice bill to encourage early disclosure of medical errors, to compensate victims, and to analyze errors.

Key Interest Groups

Service Employees International Union: It endorsed Obama and supports his effort to attain universal coverage, with employers, individuals, and government sharing the financial burden. The union backs the use of electronic medical records that patients control, and it supports making information about the quality and cost of medical services available to the public.

American Hospital Association: Like Obama, the hospital group favors expansion of government health care programs, focusing on children first.

Families USA: It doesn't endorse candidates, but the group clearly favors Obama's health care proposal. "I think Senator Obama would move us very substantially in the direction of meaningful health reform to make health care more affordable and accessible," Executive Director Ron Pollack said.

America's Health Insurance Plans: The group shares several health care priorities with Obama, including expanding eligibility for government programs such as Medicare, Medicaid, and SCHIP.