Throughout the primary camapaign Hillary Clinton has resorted to using dishonest mailers to distort Obama’s positions on the issues. The Politico reports on a mailer now being sent on health care. The mailer asks, “Which of These People Don’t Deserve Health Care?” The implication is that Obama would leave people out while Clinton’s health plan would include them. This is untrue as the only people who would be left out are those who choose not to have coverage.
On a conference call today, Ted Kennedy responded to Clinton’s charges:
“They both effectively have universal health care programs,” Kennedy said. “The point of this ad is to undermine people’s belief that Barack Obama is committed to universal health care, and that is simply a distortion, a misrepresentation… that is the kind of distortion that we had back in 1994.”
To be exact on this, Obama’s plan might not be called universal as people have the option not to participate. However if Obama’s plan is not considered universal, then Clinton’s plan could not be called universal as not everybody obeys government mandates. Robert Reich has argued that Obama’s plan would actually cover more people:
She says his would insure fewer people than hers. I’ve compared the two plans in detail. Both of them are big advances over what we have now. But in my view Obama’s would insure more people, not fewer, than HRC’s. That’s because Obama’s puts more money up front and contains sufficient subsidies to insure everyone who’s likely to need help – including all children and young adults up to 25 years old. Hers requires that everyone insure themselves. Yet we know from experience with mandated auto insurance – and we’re learning from what’s happening in Massachusetts where health insurance is now being mandated – that mandates still leave out a lot of people at the lower end who can’t afford to insure themselves even when they’re required to do so. HRC doesn’t indicate how she’d enforce her mandate, and I can’t find enough money in HRC’s plan to help all those who won’t be able to afford to buy it. I’m also impressed by the up-front investments in information technology in O’s plan, and the reinsurance mechanism for coping with the costs of catastrophic illness. HRC is far less specific on both counts. In short: They’re both advances, but O’s is the better of the two. HRC has no grounds for alleging that O’s would leave out 15 million people.
It would be a simple matter to resolve the free rider argument. There are numerous ways in which incentives can be built into the system to provide incentives to join and consequences for trying to wait until one needs the coverage.
Medicare has just such a situation with the Medicare D program which covers prescription drugs. People who do not currently have expensive drug costs might be tempted not to participate and wait until they do. This problem was solved by charging a higher premium should you join later. Those purchasing the insurance later would be charged both the higher rate than in effect as well as an additional charge. Should people try to game the system it doesn’t matter because down the road the system picks up increased premiums when people do join, eliminating the fears that the free riders are making the coverage more expensive for all.
Another way in which the Medicare D Program discourages free riders is to have open enrollment only during a brief period every year. This makes people consider the fact that should they develop a medical condition which requires expensive medications to treat after the open enrollment period, they will have to pick up the cost for several months. Other incentives could also be built into any system to make it more costly to join later, including waiting periods and temporary exclusions on preexisting conditions as currently exist.
