"Senator Clinton’s plan clearly recognizes that universal coverage cannot be achieved unless health coverage is affordable, and her plan provides subsidies to ensure it is affordable."

Subsidies have worked such wonders at making college affordable, I can't imagine what could go wrong here.

Reprehensible? Really? Relative to the Clinton campaign's various tactics since South Carolina? Or is it absolutely reprehensible?

By mandating that everybody buy coverage, Clinton's plan undermines the idea that health care is a right, turning it into an obligation instead. All the subsidies in the world won't change that underlying narrative. And the letter insinuates that Obama is in bed with the health insurance industry, but it's not clear to me how an industry benefits from *not* forcing people to buy their product.

I fucking hate that Obama's campaign is doing this. It poisons the well.

Subsidies have worked such wonders at making college affordable

Other examples of Nate's glorious comic talent:

"Yes, we'll pay for your operation. [beat] Ha, fooled you, now fuck off and die."

Actually, if you want an undergraduate degree at a good in-state school, and you have a fairly progressive state government, you won't walk away with a diploma and a decade's debt.

(It's when you need the increasingly-demanded postgraduate qualifications that you're screwed.)

What qualifications do you need, btw, to become a street whore in the private insurance gangbang?

Amy, this is nuts:

"By mandating that everybody buy coverage, Clinton's plan undermines the idea that health care is a right, turning it into an obligation instead."

First off, Clinton is not mandating that everyone "buy" coverage, since those who earn less than some set amount will get it for free. As in, other people will subsidize it completely, or nearly so. Basically, this is just an expansion of Medicaid. Based on current attempts to expand Medicaid, a good guess is that the cutoff will be around 250% of poverty. Obama would probably achieve something similar.

Second, the vast majority of people (basically, the same people who wouldn't be getting health coverage for free) are mandated to pay taxes. If you don't pay for your healthcare through a premium, you will pay for it through taxes. Now, you may be counting on Americans being too stupid to realize that they are paying for their health care if they do it through a tax instead of a premium, but it is an obligation nonetheless.

Single payer is not one bit less an obligation than multi-payer UHC, and neither obligation undermines the existence of a right to healthcare. Your parroting of this attack line is a perfect example of what makes Obama's tactic here so foul. I am willing to bet that this argument never occurred to you before the Clinton-Obama debate on healthcare. For the sake of intellectual honesty, you should ask yourself if it happened to be Obama taking the opposite position, would you be confidently assailing Clinton's weak incrementalism and her failure to create a mechanism for universal coverage?

Amy -- quite right. In fact, it's Clinton's plan that better suits the interests of the insurance industry. Gee, I wish I could get the government to pass a law requiring everyone to buy my product, and imposing "sanctions" on them if they don't.

I live in California, where Governor Schwarzenegger and the Democratic Assembly passed a bill much like Senator Clinton's, only with more specifics. It was a mandate that everyone buy insurance, with subsidies for those within 400 percent of poverty. If you didn't buy, the Franchise Tax Board could take actions within its authority to collect (including leins on one's home). What this essentially means is that if you are a family of 4, with a household income over $85,000, you'd be mandated to buy insurance with no subsidies or tax credits. Some argued that this real scenario was preferable to having no insurance at all, and I get that arguement, but the bill failed in the State Senate over apprehensiveness over the financing plan (the state currently has a $16 billion budget deficit). However, the chief opponents of the bill were single payer advocates (the Nurses, some labor and a consumer group), who opposed the bill as a giveaway to insurers and because they felt it lacked the proper affordability provisions. I find it ironic that commentators - including you, Ezra, and Krugman and others - are getting worked up over this mailer because it seemingly attacks Senator Clinton's plan from the right (maybe because the "Henry and Louise" style couple). Knowing Senator Obama's past as a single payer advocate, I wouldn't be surprised if it was actually an attack from the left (as in California) and a true representation of where he is on the issue: It's the affordability, stupid, not the universality. In that context, his plan is courageous because it cedes to Senator Clinton the superior political position of "universal" health care in favor of the principle that what consumers want and need is affordable healthcare. You may not like that position, but it is defendable.

Yes Jim, it could quite easily be that. Obama has a habit of coming at things from an obtuse angle like that.

Of course everyone is guessing with a lot of this.. JD for instance has put out more detail on the Clinton plan then Clinton has.

on to the Henry and Louise.. hmm so Obama is reprehensible for using a political tactic that has been proven effective against this opponant, and this opponant's plan? Meanwhile personal and racial attacks from the Clinton campaign dont rise to the Rovian level?

The Clinton team just doesnt like it that their policy has such a negative gut level reaction. As they continue to to go negative on Obama it would be nice if they found some policy stances to pick on instead of the racial and cultural bigotry they have been relying on to date.

Calling any plan that relies on the insurance industry as "universal health care" - is a cruel joke.

The mandates as outlined in the Hillary plan are both useless and politically poisonous.

David B,

Is it at all possible EVER to have a discussion on Obama plans and tactics without resorting to, "Well, Clinton did this. Well, Clinton did that."

Good goddess, grow up. Learn how to defend your candidate on his own merits.

It's basically criminal that we refer to the Clinton plan as universal health care for a variety of reasons including the already mentioned fact that it does not really treat health care as a right as much as a responsibility.

Universal coverage is not the same as universal health care.

Think about the auto industry equivalent. We're all expected to have car insurance but no one is running around talking about 'universal auto-body repair.'

Anonymous is right, as is Amy. It is Clinton's plan, above all, that serves the interests of the insurance business. And what the hell is wrong with pointing out that FORCING people to buy something could involve a level of coercion not appropriate to democracy, as it now is? Don't throw car insurance at me, since in driving you can have liabilities to other parties, and the insurance is there to protect them from you, not you from you.

As an Obama supporter I don’t like these tactics from him. I think he should be pivoting away from this relatively minor differences he has with Clinton in tactics (in the long-run, it is likely to just be a question of where you start as opposed to where you end) to the bigger issue of how to create the political will to get something like either of their plans done. However I have a hard time seeing how his basic claim is more objectionable than Clinton’s claim that Obama does not want universal coverage. Both claims it seems to me are true, but only in a limited sense.

In terms of the criticism of the mailer I understand why people think it is unfair to say the mandated coverage could be unaffordable, but I think it depends on a wonkish perspective. Affordability in the terms of policy is meeting an abstract criteria -- it is no more than x percent of income. But people with limited incomes, both those whose coverage would be partly subsidized and those in the range above the subsidy limit, are often in a position where every dollar of income is spoken for and buys something that they want and feel they need. Most would surely give up some of those things for health coverage, but let’s not kid ourselves, for many people, above the level at which the payments would be fully subsidized and below a level at which they feel that their income is fully equal to their day-to-day needs, it would feel pretty unaffordable. There is a simple test to determine whether it would be affordable in this practical sense – would people choose to buy it if it isn’t mandated!

Universal coverage is not the same as universal health care

So Anonymous what is universal health care on New Caprica? Here in the western world on planet Earth, UHC refers to governments expanding coverage to include all but a tiny fraction of its citizens.
In our world, the various countries do not actually force their adult citizens to to utilize the healthcare system and yet they still call it universal health care.
Do the inhabitants of your planet balk at being compelled to visit the Cylon run health clinics?

Ironically, one of the side benefit of Obama supporters talking on these issues is that they are making up terms that conveniently serve private insurance companies. The irony exists only in a Rovian way because they claim that Clinton is the one serving private insurance companies when in fact it is them because guess who wins under their definitions.

These are really, really, TAME mailers compared to the ones sent out by HRC on Obama's present votes or Soc. Sec. taxes folks. I'm not a fan of either set, but some point of reference seems to be useful here.

Regardless of what you think of them, it seems clear that HRC's response over the weekend was poorly conceived. Her tirade about this is not something that's going to play well with undecideds in Ohio.

I'm not entirely thrilled about the mailer, but if Clinton becomes the nominee, the mandate issue would be a huge liability for her. The GOP would slap "nanny state" all over her plan, make veiled misogynistic lines about her being the mommy who wants you to eat all your peas, etc. I find it ironic that the same Clinton advocates who call Obama supporters 'thin-skinned' for objecting to various campaign tactics are resorting to the smelling salts over this.

Akaison,

The insurance industry actually prefers Hillary Clinton's plan to Obama's.

You know, the mailer is just not that bad. I know it's been called demagogical, and I've tried to see this, but I just don't see it. I mean, it's TRUE that the Clinton plan forces you to buy health insurance. And you know what else? Hillary calling her plan "universal health" anything is the most perniciously misleading move of the campaign. It's just not universal health care in any conventional sense. It's universal health INSURANCE. That has nothing to do with a single payer system as they have in Canada, France, etc. Claims can still be denied--indeed, it will still be in the insurance companies' interest to deny as many claims as possible. What this is most comparable to is a kind of privatized social security plan. There is no doubt that it will be a bonanza for the insurance industry.

The more I think about it, the more I think Obama's emphasis (even if it's only an emphasis) on lower health care costs rather than more extensive insurance coverage is exactly right. In the long run, Obama's approach stands us a better chance of getting to something like a single payer plan down the road, since it doesn't immediately entrench the entire system, both practically and philosophically, in a structure that strengthens the grip of private insurers on our health care. As someone familiar with the French system, health care was a point on which I sided with Clinton, until I understood her plan better (thanks to Ezra's mostly sympathetic descriptions of it). Now I am embarrassed to say that I am one of those delusional people who agree with Obama on almost every point of his domestic agenda except gun control (I think there should be more of it; he's not tough enough on the point.)

Hillary's plan isn't about jack shit but funneling money to. her plan has no enforcement mechanisms to ensure that people covered by these plans are actually going to be covered by them. They will simply do what they do now with serious illnesses: Deny. Deny.Deny and hope the customer gives up and dies rather than sue. All the Clinton plan does is guarauntee the status quo and enshrine it into law. She does not offer universal health care, she is forcing people to buy private health insurance.

And some of you need to get real on mandates. They are not going to be a part of any plan that actually has a chance in hell of passing through congress. They will kill any health care proposals offered that contain them from the get go. No matter how much some woks think they are important, they are politically untenable.

Akaison, Hillary's the largest recipient of health insurance industry money in this race right now. What kind of idiot really thinks there's no good reason for that?

I have a (very possibly lame) idea.

One way to avoid mandates and to means test subsidization at the same time (means testing inherent with the mandate proposals) might be to force insurance companies to break coverage up into three (just for the sake of argument) components covering say, family doctor visits, specialist visits and catastrophic (a.k.a., house insurance) and issue vouchers for one, two or three according to means. Maybe you could even apply vouchers toward whichever component you wanted if you didn't get all three.

I don't know anything about health insurance structures but this might give somebody and idea. All this is until we get sense and go for Medicare for All...

...you know, Medicare for All: just the right program to take advantage of the (FDR/depression type) groundswell to do something, already first-choice in polls and fireproof against the usual Republican nonsense because everybody is already looking forward to it for their own old age (when they will need insurance the most)...

...that's right, Medicare for All: the program that frees up doctor's time to keep as current as possible with the explosion of medical knowledge instead of dribbling away their time dealing with 100+ provider sets of rules and fighting off 100+ care deniers.

For some reason all the above common sense is supposed to be impossible to slip past insurance interests. Funny; if Hill had just gone the Medicare for All route the first time (when the depression type groundswell had not even built up yet) she probably would have gotten it through. I suspect Obama knows all this; he hopefully being the first president we'll have with a real brain since Nixon (and going back through Hoover).

It's probably also worth saying that the letter mischaracterizes the supposed mischaracterization in the mailer. According to the letter, Obama's mailer claims that Clinton would "force people to buy unaffordable health insurance." Notice the absence of a direct quote from the mailer. That's because the mailer doesn't make that ridiculous claim. The exact wording of the mailer is this:
"Hillary's Health care plan forces everyone to buy insurance, even if you can't afford it." This statement is not a judgment on whether the insurance is affordable from some objective--probably government--perspective, but rather places the affordability call in the lap of the buyer. The point is not that insurance, under the Clinton plan, would be expensive, but that, whatever you thought of the insurance, you would have to buy it. It's fine to disagree with this, but it's a reasonable substantive point to make, one that the Clinton campaign would do well to address, rather than dismiss.

Alex-
Can you explain how we can make health care more affordable by forcing insurance companies to cover sick people who will take more out of the system than they put in, while at the same time creating an incentive for healthy people to get out of the system because they know they will not be denied health insurance in case they ever wind up needing it? Obama's plan means more sick people in the system, more healthy people out of it. How is that going to equal lower prices for those of us left in the system?

Soullite-
You claim a plan with mandates is untenable politically, but yet the Obama plan is going to be even more difficult to pass because the opposition is going to claim that it will cause prices to sky rocket because it requires coverage of all who want it, but does not require more people to pay into the system to cover those costs. They are going to say that if Obama's plan passes then you will not be able to afford your health insurance any more. Not exactly something that will make people likely to support the plan.

And on this question of affordability- can I afford the payroll taxes I have to pay for social security and medicare? I certainly don't think so considering my debt and other expenses I struggle to pay. Is Obama going to make those programs voluntary? If he did I am sure he could get even more of the independents and Republican lites to vote for him.

Anonymous,

Look, I think you ask exactly the right question. And believe it or not, there are some answers. First, the cost of insurance goes down if the cost of health care goes down. If we get improve the efficiency of the health care system, health insurance costs improve also. Second, the concern about adverse selection, while fair, is probably overstated. I am healthy as can be and young, but have health insurance because, since I share the cost with my employer, it's cheap. So again, if the insurance is cheap, the healthy will buy it, if only to protect against that fateful trip to the emergency room. Third, we can make the insurance costs lower by setting up a government re-insurance plan for costs above a certain amount. This means that insurance costs don't skew toward the few who require really expensive care. There are many other things we can do as well.

By the way, I'm for single payer, so I agree with the spirit of your question completely. I just don't think that Hillary's plan gets us anywhere close, and might make it harder to get there later.

National Academy for State Health Policy

Welcome to politics in the real world...ya' know, the world where one must produce.

The two most important health reforms that actually have a shot of happening in the next couple years are the creation of a government plan that people can opt into (to provide real competition to the insurance industry for once) and setting up an agency to evaluate the efficacy of competing drugs, procedures and devices.

It's very frustrating that these stupid side arguments may wind up torpedoing efforts to get these two realistic and worthwhile reforms through.

What's also frustrating is that I've received no less than 5 calls from Obama volunteers/recorded messages in the past 4 days, because I live in Texas. I wonder if he's TRYING to lose Texas with this crap.

Learn how to defend your candidate on his own merits.

When you are defending your candidate from specious charges made in bad faith, the first step is to point out that the charges are, indeed, specious, and made in bad faith.

As to the merits, Jim E and Dan have done so admirably.

I do understand and sympathize with the argument that everyone has to be covered in order to distribute the risk appropriately so that the cost of insurance doesn't go up for everyone, but keep in mind that right now, we all as taxpayers are picking up the cost of all the uninsured people in the form of ER visits, Medicare coverage, etc... I suspect that the percentage of healthy members who choose not to get health insurance will not be high enough to seriously wreck "the system". The bottom line is that in the short run, both plans wouldn't fundamentally change the economic bottom line, so it makes sense to me to focus on the most relevant issue for us... affordability. Both candidates would subsidize lower-income members of society, so in the long run the question of how a sustainable health care system would work depends on whether it is affordable for everyone. I'm lukewarm to the idea of a mandate because I fear that it could easily turn into a political bludgeon in the future...

Anonymous, nothing you wrote carries 1/10th the emotional impact of the phrase 'garnish wages'. Your political judgment is severely lacking.

Scott, I agree. And the other most important issue is which plan has the greater chance of ultimately getting us to a universal, single-payer system. I think Obama's does for several reasons, one of which is that it can unify people around the notion that we have a right to health care and the government has an obligation to help us get it. If we play our cards right, this can provide the leverage we need to achieve a truly universal system in the long run. In contrast, HRC's plan divides people between those who are comfortable with the idea of government mandating behavior and those who are not. No matter how you parse it, that is the dominant message that her plan sends, and it is very divisive and therefore counterproductive.

Alex,
First, I am glad to hear your insurance is cheap, I know mine sure as hell isn't. I worry that under Obama's plan your employer will try to buy you out of your insurance reasoning it will cost them alot less to just pay you more than to cover the cost of health insurance for you. And if you honestly don't use that much health care I find it admirable that you would be willing to pay into a system on the off chance that you may need emergency care at some point, but I have a feeling that most people would not feel the same way. I also would envision under Obama's plan that there would spring up a market for people to purchase insurance only for emergency room visits due to accidents, etc.

I am for single payer as well, but that is why Obama's plan is so troubling to me. The only way to get single payer is for our society to start viewing health care as a shared responsibility- something everyone has to pay to provide for everyone else. (Just like education, law enforcement, etc.) Obama's plan is not universal in the sense that not everyone has to pay into it. His arguments against mandates undercut the message of shared responsibility and in doing so only make a single payer system less likely, not more likely. The truth is hardly anyone can afford the health care they need, that is why we all get insurance- to spread around the costs. If we want everyone to share the benefits of out health care system, everyone has to share the costs. Obama's plan operates under the illusion that everyone can benefit, but not everyone has to share that cost. This is wrong economically, and it is wrong morally. Clinton's plan at least stands for the right values- it says that our society needs to acknowledge that it is a disgrace that people believe they don't have a responsbility to help provide for the health care needs of their fellow citizens. It doesn't eliminate the insurance companies, but once we accept that everyone is going to have to bear the cost of paying for everyone else's health care needs than it won't be long before people start to figure out it just doesn't make sense to have a system where insurance companies are making billions in profits providing those services. No one seriously pushes for the privatization of law enforcement or public schools because our society views these things as a shared responsibility. We need to lump health care in that same boat if we ever want to get anywhere on that issue. Obama in his approach to this issue has basically surrendered on that front and allowed conservative values to frame and dominate the debate. He has set us back on this issue not forward. I am a liberal, I believe in shared responsbility. I believe in a society where we ALL share the costs and we ALL share the benefits. Obama wants all us to share the benefits but claims we can do it without us all having to share the costs. If it were that easy even the selfish, ignorant Republicans would be for it. I am willing to accept that our society may not actually be ready for a truly progressive agenda, that we may not be ready to make the hard sacrifices that are necessary to have a truly just society. It is looking more and more that the best we can hope for is Barack Obama and his empty rhetoric and dishonest message of feel good liberalism without any sacrifices for the commone good. It beats the hell out of Republican Rule, but let us not be fooled into believing it is something other than what it is.

Soulitte-
How is garnished wages any different from payroll taxes? It may scare the ignorant and stupid and unfortunately that may be a large number, but it is nothing compared to being told that you won't be able to afford the health insurance you have now. The uninsured aren't exactly a major political force. Those with health insurance that they are already paying through the nose for are!

Anonymous, i absolutely agree that people should be motivated by altruism and shared sacrifice, but they're not. If they were, we would have a single-payer system for public schools instead of one in which the children of the rich inhabit a completely different educational universe than the children of the poor. I would love to think it will be different for health care, but i just don't see the evidence. And by the way, I don't think there's anything wrong with a system motivated by self-interest, as long as one person's interest doesn't interfere with someone else's. Medicare and social security are extremely popular and based on self interest, but i don't hear any liberals attacking them on those grounds.

anonymous, You seem to have a problem with reality. It doesn't matter if people shouldn't think of wage garnishment as being different from taxation, the fact is they do.

Some of you need to learn to deal with the human species that actually exists, and stop pretending that we have the human species we want.

Anonymous, In human beings, Pathos beats Logos.

Keep making logical arguments in the face of emotional ones, see how well that works out for you in the real world.

What's also frustrating is that I've received no less than 5 calls from Obama volunteers/recorded messages in the past 4 days, because I live in Texas. I wonder if he's TRYING to lose Texas with this crap.

We've only got one call so far-- a robocall for Clinton. Sometimes living in a tiny state like VT has its advantages!

more people covered by the health insurance companies = more people owned by criminal mafia organizations. billary wants to rob from the poor and give to rich white gangsters? all "health care reform" is a lie until the insurance companies are destroyed.

I mentioned the California health care reform bill earlier. For a comprehensive analysis of the bill, see this link:

http://info.sen.ca.gov/pub/07-08/bill/asm/ab_0001-0050/abx1_1_cfa_20080125_153139_sen_comm.html

Let me start by stating the Obama flyer is reprehensible and wrong. And I am no fan of mandates. But the Ezra does not go far enough in stating how distorted and biased this reply is either. And at least half the signers are advisors to Clinton campaign, and at least one is I doubt medically able to fully follow the debate and sign-on.

Obama's flyer and argument on Clinton viz. NAFTA by the way is entirely valid, although whether he is really much of a FAIR Trader is questionable too.

Whether or not you support Clinton, she did make the tough political decision and include an individual requirement to purchase coverage (as did Edwards). Obama's been on the defensive ever since Edwards pointed out at the June CNN debate that his plan leaves 15 million uninsured.

As other bloggers have said, you cannot eliminate medical underwriting without an individual requirement for coverage. To do so would provide incentives for people to wait until they get sick to purchase coverage. Frankly, I'd rather buy a new computer or go on a posh vacation every year than buy health insurance. Who wouldn't if they knew that insurance companies would have to offer coverage when they get sick.

Imagine a risk pool with only people with chronic illness. Instead of spreading risk across the population (the purpose of insurance), only the sick pay in significantly increasing the per capita cost of coverage. Rather Darwinian, but if you like that idea, McCain has a plan you will love.

As for the ad itself, it is misleading to say that she would make you buy coverage "even if it is unfordable." Her subsidies, unlike Obama's, limit health insurance premiums to a certain percentage of family income. Obama provides a subsidy that is not correlated to health insurance costs, so even with the subsidy, premiums could be out of reach for some. Hmm...no wonder he chose not to include a mandate...

Maybe you don't like her...but her policy reflects a strong understanding of the health care system. As for enacting a single payer plan in this country in our lifetimes...good luck with that.

Kate-
Stop using logic. It is bias against Obama and his supporters. As Bush has proven, and Obama is illustrating, and Soullite is so good at pointing out, you can only win elections in this country by appealing to people's feelings and asking them to ignore reason. To win you have to carry the SPAT crew- the some of the people who you can fool all of the time. Bush had them, now Obama has them. Just accept it and be glad that at least Obama is not dumb and evil like Bush.

Kate,

Notice that our current system doesn't have a mandate, and many healthy people still buy insurance. If they didn't, the insurance industry wouldn't be as robust as it is! So I think your hypothetical scenario in which no healthy people get insurance and all the sick ones do is perhaps a bit too hypothetical. Also, the increasing risk pool only lowers costs if the insurance industry has to compete. Otherwise, in a situation of oligopoly, they can collude to their heart's content, and even turn the mandate into a boon. The check for this would a regulatory body to promote competition among insurance companies. Obama has proposed this. Clinton opposes it.

I would direct you and Anonymous to the article Ezra links to above. The idea is that there isn't a very meaningful difference between Clinton's and Obama's policy, and Ezra seems to agree: http://www.latimes.com/news/opinion/commentary/la-oe-hacker26feb26,0,3044897.story

Alex,

I concur that my hypothetical was just that, an extreme hypothetical to illustrate a point. And yes, many healthy people do buy health insurance (in part, because some have learned from the experience of others that once they are diagnosed with an illness most state insurance laws would permit insurance companies to exclude them from coverage, primarily in the small group and non-group health insurance markets.) That disincentive to wait until you get sick will be removed under the Obama plan because of the insurance market reforms.

And while you are absolutely correct that our current system does not have a mandate, our system does have 47 million uninsured and an estimated $922 "free-rider tax" on family health insurance premiums each year that is the result of health care providers cost-shifting from the uninsured to the insured.

I also agree that the Obama plan will do much to mitigate the cost of health insurance coverage for employers and their workers through system reforms, purchasing pools and subsidies (even McCain's plan has those in different forms). The Hacker opinion notwithstanding, independent experts such as Jon Gruber at MIT and John Holahan at the Urban Institute have estimated that as many as 15 million people will remain uninsured under the Obama plan. Now before anyone brands them Clinton operatives, the Obama campaign claimed Gruber as an advisor when Senator Obama unveiled his plan.

Regardless of these estimates, reasonable people can disagree over the issue of whether some people who can afford health insurance should be free to opt out of health insurance coverage. Frankly I hope Senator Obama is right -- that people will do the right thing and purchase coverage once it is affordable, but the number of uninsured today with annual incomes over $45,000 makes me understandably dubious. As noted, this policy forces others who have acted responsibly to foot the bill if the "free-riders" who can afford coverage become sick or injured and can't afford to pay for the cost of their care.

Ultimately, my frustration is prompted not by Senator Obama's lack of an individual mandate on adults, but rather by disappointment with Senator Obama in his reaction to the criticism that 15 million Americans will remain uninsured under his plan. His reaction was to go on the attack against Clinton who made a difficult political decision by requiring coverage. His response was to 1)criticize her for not saying how she would enforce the mandate, 2) saying that she doesn't cover undocumented immigrants so she doesn't cover everyone, and 3) criticizing her for requiring people to buy coverage "even when they can't afford it," notwithstanding the provisions to guarantee affordability that are included in her plan.

Further Senator Obama failed to acknowledge that his own proposal includes a mandate on parents to cover their children. This borders on hypocrisy to me.

We should probably both review the proposals -- I haven't read either plan for a number of weeks -- but I haven't exactly seen the insurance industry's endorsement of the Clinton plan despite the individual mandate. Perhaps you are reading more into both plans than I am, but it appears that while Clinton would limit insurance industry loss-ratios (the amount of premium dollars that may go toward marketing, profit and overhead), Senator Obama's proposal is less specific on the issue of the action he would take to regulate insurance prices, seeming to monitor with possible unspecified future action, but does not limit insurance industry profit and overhead. Perhaps there is a document other than those posted on his website in this regard?

Plan differences aside, I think, that the biggest losers in this debate will be neither Clinton nor Obama, but those Americans who stand to benefit from health care reform. My concern is that the actions taken by the Obama campaign in sending out the "Harry and Louise" mailers in South Dakota, Ohio and other states has effectively put us on a different playing field as we go into a 2009 health reform debate.

Members of Congress, not known for their political courage in the best of times, now have seen a recent first-hand sample of what they can expect back home in their states and districts if they so much as consider politically controversial stances such as an individual requirement for coverage...and this from their own party. Et tu Brute?

Enjoyed the discourse, and sorry for the length.

Best,
Kate

Alex-
Healthy people buy insurance now because they know that they have to be in the system in case they develop a chronic illness later. This would no longer be the case under the Obama plan because it prevents insurance companies from denying people coverage based on pre-existing conditions.

Also your non sense about the insurance companies not having to compete under Clinton's plan is just wrong. Clinton's plan allows citizens to buy into the coverage offered to members of Congress, as well as to a public plan that will be created. Obama's plan originally did not have public vs private competition, he added it to make it more like Clinton and Edwards. Competition will exist under either plan.

I also think your claims of insurance company collusion under the Clinton plan are bunk because it ends discrimnation by the inusrance companies as well as limits people's preminums to a percentage of their incomes.

There is only one difference between Obama's plan and Clinton's. Clinton's views health care as a shared responsibility and requires that everyone pay into the system so that everyone can take out. Obama's plan is based on the delusion that everyone can have all the health care they need without everyone having to accept the responsibility of sharing the costs of providing it. Much like the candidate himself it is too good to be true.

SEE THESE THREE GREAT WEBSITES TO KNOW BARACK OBAMA'S EXPERIENCE,SUBSTANCE,VOTES & QUOTES & STANDS ON THE ISSUES.

www.AskObamaNow.com
www.OnTheIssues.org/Barack_Obama.htm
www.WomenForBarackObama.com

George Shieman gshieman@aol.com
SanFrancisco/Eureka

I think the Harry and Louse ad is quite clever when you fully unpack it.

If you thought 1993 Hillarycare was bad, the ad will probably cause you to tie her new plan to the old and assume that the new one is bad as well. In this view, it's a cheap shot.

If you thought 1993 Hillarycare was good, the ad should remind you that Hillary can't work with Congress to get even a good plan passed.

Given that this is primary and not a general, the recipient of the ad is most likely to be in the latter group, who thought that the 1993 plan was a decent one. And to this group, the ad does the most damage because it shifts the argument from the policy itself to the ability to get the policy passed. In this respect it's very effective since both Clinton and Obama have similarly good plans but Obama is campaigning on being able to sell good bills across the aisle.

So the imagery in the ad doesn't "unfairly and unconstructively attack Senator Clinton’s universal health care reform plan." Instead, it somewhat fairly attacks Senator Clinton's ability to get support for her universal health care reform plan.