Topic: Democratic Health Plans—Neither Democratic Nor Healthy? Discuss.

As promised, a closer review of the proposed health plans of the Presidential candidates is being posted at the Pathophilia blog, beginning with the Democratic contenders. (God knows, if I procrastinate long enough, I'll only have the health care plans of 1 or 2 Republican candidates to review next—which may fit on the back of a cocktail napkin, anyway.) Today’s compare-contrast exercise draws on the plans as outlined in pdfs of the respective candidates, available here (Clinton), here (Edwards), and here (Obama). Edwards, although out of the race as of yesterday, is parenthetically included in the mix because his health plan was remarkably close to that of Clinton (or vice versa).

All Democrats' plans offer, despite any individual’s preexisting and/or chronic conditions, "universal" and "affordable" health care coverage, generally promised through the realized savings from greater preventive-care measures and a concentrated investment in cost-saving information technology. Whether any of the proposals are realistic without being supported by additional tax dollars or compromises in health care expectations among Americans is anybody’s guess, but it seems improbable.

Both Clinton and Obama propose universal access for the approximately 45 million uninsured Americans through options available from the Federal Employee Health Benefits Program. In other words, you get the same coverage options as those of your Congressional representatives (as the plan drafters apparently love to point out). Plans also generally confer some type of purchasing power to the uninsured individual through national or regional pools that comprise competing insurance plans. I otherwise elect to concentrate on the major differences among the plans, based on the available online details—although it is certainly possible that I’ve missed some minor (or really major) differences, to which I request comments and corrections.

Businesses must offer coverage to employees: According to Clinton, "large" corporations will be required to provide coverage access, and "small" businesses will be given tax incentives to provide coverage. For Edwards, business-offered coverage was a de facto requirement, and in this respect his plan was not unlike that of Obama, who stipulates that all businesses must either offer coverage to their employees or contribute to a new National Health Insurance Exchange. This exchange will offer individuals the opportunity to enroll in a new public plan (similar to the Federal Employee Health Benefits Program) or purchase an approved private plan, which can be accomplished with subsidies provided through an income-based sliding scale.

Medicaid and the State Children’s Health Insurance Program (SCHIP): Obama (along with Edwards) proposes the expansion of the candidate pool for Medicaid and SCHIP, while Clinton vows to "strengthen" or "fix holes" in these programs.

Other major differences in the plans are tabulated below. Clinton, unlike Obama, specifically proposes health insurance tax credits to taxpayers and the provision of tax credits for qualifying private and public retiree health plans. With respect to constraining prescription-drug costs, Clinton wants to apply the same kinds of purchasing leverages currently exerted by countries with national health care plans, while Obama would allow Americans to buy their medicines from such countries (ie, let Canada do the negotiating for you). In addition, Obama promises to repeal the 2003 ban on Medicare's ability to directly negotiate with pharmaceutical companies for drug prices. Last, Obama is the only candidate who mentions medical-malpractice reform by "strengthen[ing] antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance."

Overall, Obama's plan appears more detailed and comprehensive than that of Clinton—for instance, he provides fixes (or suggested fixes) for issues like catastrophic costs to employer health plans and is the only candidate to address the ban on negotiated Medicare drug pricing and medical-malpractice concerns (at least on paper). While proposing tax credits, Clinton—being the moderate liberal that she is—comes off as somewhat more friendly to any business that otherwise dreads a Democratic President.