Monday, June 04, 2007

Obama in Second Place

Published: June 4, 2007

One of the lessons journalists should have learned from the 2000 election campaign is that what a candidate says about policy isn’t just a guide to his or her thinking about a specific issue — it’s the best way to get a true sense of the candidate’s character.

Do you remember all the up-close-and-personals about George W. Bush, and what a likeable guy he was? Well, reporters would have had a much better fix on who he was and how he would govern if they had ignored all that, and focused on the raw dishonesty and irresponsibility of his policy proposals.

That’s why I’m not interested in what sports the candidates play or speculation about their marriages. I want to hear about their health care plans — not just for the substance, but to get a sense of what kind of president each would be. Would they hesitate and triangulate, or would they push hard for real change?

Now, back in February John Edwards put his rivals for the Democratic nomination on the spot, by coming out with a full-fledged plan to cover all the uninsured. Suddenly, vague expressions of support for universal health care weren’t enough: candidates were under pressure to present their own specific plans.

And the question was whether those plans would be as bold and comprehensive as the Edwards proposal.

Four months have passed since then. So far, all Hillary Clinton has released are proposals to help reduce health care costs. It’s worthy stuff, but it’s hard to avoid the sense that she’s putting off dealing with the hard part. The real test is how she proposes to cover the uninsured.

But last week Barack Obama, after getting considerable grief for having failed to offer policy specifics, finally delivered a comprehensive health care plan. So how is it?

First, the good news. The Obama plan is smart and serious, put together by people who know what they’re doing.

It also passes one basic test of courage. You can’t be serious about health care without proposing an injection of federal funds to help lower-income families pay for insurance, and that means advocating some kind of tax increase. Well, Mr. Obama is now on record calling for a partial rollback of the Bush tax cuts.

Also, in the Obama plan, insurance companies won’t be allowed to deny people coverage or charge them higher premiums based on their medical history. Again, points for toughness.

Best of all, the Obama plan contains the same feature that makes the Edwards plan superior to, say, the Schwarzenegger proposal in California: it lets people choose between private plans and buying into a Medicare-type plan offered by the government.

Since Medicare has much lower overhead costs than private insurers, this competition would force the insurance industry to cut costs — making our health-care system more efficient. And if private insurers couldn’t or wouldn’t cut costs enough, the system would evolve into Medicare for all, which is actually the best solution.

So there’s a lot to commend the Obama plan. In fact, it would have been considered daring if it had been announced last year.

Now for the bad news. Although Mr. Obama says he has a plan for universal health care, he actually doesn’t — a point Mr. Edwards made in last night’s debate. The Obama plan doesn’t mandate insurance for adults. So some people would take their chances — and then end up receiving treatment at other people’s expense when they ended up in emergency rooms. In that regard it’s actually weaker than the Schwarzenegger plan.

I asked David Cutler, a Harvard economist who helped put together the Obama plan, about this omission. His answer was that Mr. Obama is reluctant to impose a mandate that might not be enforceable, and that he hopes — based, to be fair, on some estimates by Mr. Cutler and others — that a combination of subsidies and outreach can get all but a tiny fraction of the population insured without a mandate. Call it the timidity of hope.

On the whole, the Obama plan is better than I feared but not as comprehensive as I would have liked. It doesn’t quell my worries that Mr. Obama’s dislike of “bitter and partisan” politics makes him too cautious. But at least he’s come out with a plan.

Senator Clinton, we’re waiting to hear from you.