Barack Obama on Health Care

Democratic nomine for President; Junior Senator (IL)

Health care is a right: something’s fundamentally wrong now

Q: Is health care in America a privilege, a right, or a responsibility?

McCAIN: I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that I have, that will do that. But government mandates I’m always a little nervous about. But it is certainly my responsibility. It is certainly small-business people and others, and they understand that responsibility. American citizens understand that.

OBAMA: Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can’t pay their medical bills--for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.

Source: 2008 second presidential debate against John McCain Oct 7, 2008

FactCheck: Exempts small business, but no $2,500/yr savings

Obama said his health care plan would lower insurance premiums by up to $2,500 a year. Experts we’ve consulted see little evidence such savings would materialize.

McCain misstated Obama’s health care plan, claiming it would levy fines on “small businesses” that fail to provide health insurance. Actually, Obama’s plan exempts “small businesses.”

Source: FactCheck.org on 2008 second presidential debate Oct 7, 2008

Health tax credit is bad idea; it will cost taxpayers more

McCAIN: I want every family to have a $5,000 refundable tax credit so they can go out and purchase their own health care. I want to double the dividend, from $3,500 to $7,000, for every dependent child in America. I know that the worst thing we could possibly do is to raise taxes on anybody.

OBAMA: I make sure that we have a health care system that allows for everyone to have basic coverage. McCain talked about providing a $5,000 health credit. Now, what he doesn’t tell you is that he intends to, for the first time in history, tax health benefits. So you may end up getting a $5,000 tax credit. Here’s the only problem: Your employer now has to pay taxes on the health care that you’re getting from your employer, and if you end up losing your health care from your employer, you’ve got to go out on the open market and try to buy it. It is not a good deal for the American people.

Source: 2008 first presidential debate, Obama vs. McCain Sep 26, 2008

$15B subsidies to private insurers was a lobbyist giveaway

We right now give $15 billion every year as subsidies to private insurers under the Medicare system. It doesn’t work any better through this private insurers; they just skim off $15 billion. That was a giveaway, and part of the reason is because lobbyists are able to shape how Medicare works. They did it on the prescription drug bill. They’ve done it with respect to Medicare.
Source: 2008 first presidential debate, Obama vs. McCain Sep 26, 2008

FactCheck: McCain’s plan taxes employees, not employers

Obama & McCain traded incorrect statements on each other’s health care plan.

Obama said, “You may end up getting a $5,000 tax credit. Here’s the only problem: Your employer now has to pay taxes on the health care that you’re getting from your employer. McCain’s plan doesn’t call for taxing employers on health care benefits; it would instead tax employees. As the law stands now, employees don’t pay taxes on the dollar value of their health insurance benefits. Under McCain’s plan, they would.

McCain also misrepresented Obama’s plan when he said that his opponent favored “handing the health care system over to the federal government.” McCain made a similar claim in his acceptance speech, when he said that Obama’s plans would “force families into a government run health care system.” We called it false then and we stand by that. Obama’s plan mandates coverage for children, but not for adults, and it does not require anyone to be covered by a nationalized system.

Source: FactCheck.org on 2008 first Presidential debate Sep 26, 2008

Give more help to those denied a life of dignity & respect

When any human being is denied a life of dignity and respect, no matter whether they live in Anacostia or Appalachia or a village in Africa; when people are trapped in extreme poverty we know how to curb or suffering from diseases we know how to prevent; when they’re going without the medicines that they so desperately need--we have more work to do.
Source: McCain-Obama speeches at 99th NAACP Convention Jul 12, 2008

Guaranteed health care for anyone who needs it

I’ll end the outrage of one in five African Americans going without the health care they deserve. We’ll guarantee health care for anyone who needs it, make it affordable for anyone who wants it, and ensure that the quality of your health care does not depend on the color of your skin. And we’re not going to do it 20 years from now or 10 years from now, we’re going to do it by the end of my first term as President.
Source: McCain-Obama speeches at 99th NAACP Convention Jul 12, 2008

End-of-life self-medication ok; euthanasia by others not ok

Q: In “The Audacity of Hope,” you write very movingly about your mother’s fight with cancer, and the pain she was in, especially at the end. In that situation, if someone wanted to take active steps to end his or her own life, do you think that would be OK morally?

A: I believe in everybody having a living will so that their views on these issues can be factored in by family members. I don’t think that it’s appropriate to empower doctors themselves to make that decision. But I think that it is important for us to be able to allow people who are terminally ill, in excruciating pain, to get the medicine they need to relieve that pain.

Q: By “relieve that pain” you mean hasten the end of life if they choose to?

A: I think that there has to be very strict guidelines to ensure that somebody who is making a decision to relieve their pain [is acting appropriately]. That is distinguished from euthanasia in which someone else is making the decision for them.

Source: 2008 Democratic Compassion Forum at Messiah College Apr 13, 2008

Hillary’s plan must either be enforced, or leave out people

CLINTON: Sen. Obama has consistently said that I would force people to have health care whether they could afford it or not. My plan will cover everyone and it will be affordable. And on many occasions, independent experts have concluded exactly that.

Source: 2008 Democratic Debate in Cleveland Feb 26, 2008

The problem with health care is about affordability

The problem is not that folks are trying to avoid getting health care; the problem is they can’t afford it. My plan emphasizes lowering costs, not only setting up a government plan so that people who don’t have health insurance can buy into it and will get subsidized, but also making sure that those who have health insurance but are struggling with rising co-payments, deductibles, premiums. Under Bush, families are paying 78% more on health care than they were previously. We put in a catastrophic re-insurance plan that will help reduce those premiums for families by an average of about $2,500 per year. Every expert that’s looked at this has said there is not a single person out there who’s going to want health care who will not get it under my plan. My plan also says children will be able to stay on the parents’ plan up until the age of 25. Both Edwards and Hillary have a hardship exemption, where, if people can’t afford to buy health care, you exempt them, so that you don’t count them.
Source: 2008 Congressional Black Caucus Democratic debate Jan 21, 2008

Subsidies to people who can’t afford care--not single payer

If, in fact, we are not making healthcare affordable enough, which is what’s happening right now, and you mandate on families to buy health insurance that they can’t afford and if they don’t buy it you fine them or in some other way take money for them. What is happening in Massachusetts right now, which is that folks are having to pay fines and they don’t have health care. They’d rather go ahead and take the fine because they can’t afford the coverage. My core belief is that people desperately want coverage, and my plan provides those same subsidies. If they are provided those subsidies and they have good, quality care that’s available, then they will purchase it. That is my belief. I never said that we should try to go ahead and get single payer. What I said was that if I were starting from scratch, if we didn’t have a system in which employers had typically provided health care, I would probably go with a single-payer system.
Source: 2008 Congressional Black Caucus Democratic debate Jan 21, 2008

Bring GOP & Dems together to make haelthcare affordable

Text on screen: “Obama offers universal health care plan.” Obama speaking:

“I’ll be a president who finally makes health care affordable to every single American by bringing Democrats and Republicans together. I’ll be a president who ends the tax break for companies that ship our jobs overseas and put a middle class tax cut into the pockets of working Americans. And I’ll be a president who ends this war in Iraq and finally brings our troops home. We are one nation and our time for change has come.”

Source: FactCheck.org: AdWatch on 2008 TV ad in Nevada, “President” Jan 17, 2008

FactCheck: Reducing obesity would save $18B, not $1T

Obama used an estimate of uncertain provenance when discussing Medicare savings, saying “If we went back to the obesity rates that existed in 1980, that would save the Medicare system a trillion dollars.”

Obama got this claim from a “candidate briefin book” put out by the Center for American Progress, a liberal think tank run by former Clinton chief of staff John Podesta. CAP cites the CDC & the Commonwealth Fund as sources for the estimate, but representatives from both organizations told us that the claim was unfamiliar to them.

We worked up our own back-of-the-envelope estimate: The CDC officially estimates that obesity cost $75 billion in 2003; & that approximately half of the cost burden for both overweight and obese people is borne by Medicaid and Medicare; & obesity rates doubled between 1980 and 2000. So if obesity rates returned to “rates that existed in 1980” they would be cut in half, and Medicare & Medicaid would save about a quarter of $75 billion, or roughly $18.75 billion per year.

Source: FactCheck.org on 2007 Des Moines Register Democratic debate Dec 13, 2007

Reforms in prevention and drug price negotiation save money

I emphasize how important prevention & cost savings can be in the Medicare system. Many of the reforms in my healthcare plan will reduce costs not just for the overall system, but also for Medicare. We’re not going to make some of these changes unless we change how business is done in Washington. The reason we can’t negotiate prescription drugs under the Medicare prescription drug plan is because the drug companies specifically sought and obtained a provision in the Bill that prevented us from doing it.
Source: 2007 Des Moines Register Democratic Debate Dec 13, 2007

Tackle insurance companies on reimbursement system

We need to deal with the insurance companies. On Medicare and Medicaid, the reimbursement system is not working the way it should. Instituting a universal health-care system that emphasizes prevention will free up dollars that potentially then can go to reimbursing doctors a little bit more.
Source: 2007 Democratic debate at Drexel University Oct 30, 2007

Help young people deal with the cost of medical education

We’ve got to deal with the cost of medical education. We have to deal with college costs generally, and that’s why I put forward proposals to get banks and middle men out of the process and expand national service to encourage young people to go into these helping professions where we need a lot more work.
Source: 2007 Democratic debate at Drexel University Oct 30, 2007

Morally wrong that terminally ill must consider money

Q: Why is it so difficult to make health care accessible to everyone in the world’s richest country?

A: It shouldn’t be. And it’s wrong. You know, my mother died of ovarian cancer when she was 53 years old. And I remember in the last month of her life, she wasn’t thinking about how to get well, she wasn’t thinking about coming to terms with her own mortality, she was thinking about whether or not insurance was going to cover the medical bills and whether our family would be bankrupt as a consequence. That is morally wrong. It’s objectionable. That’s why I put forward a comprehensive legislation for universal health care so that all people could get coverage. My attitude is, that since you are paying my salary as taxpayers, you should have health care that is at least as good as mine. And the key to that is not only a good plan, but we’ve also got to overcome the drug & insurance company lobbies, that spent $1 billion over the last 10 years to block reform. As president, I am going to take them on.

Source: 2007 Democratic primary debate on Univision in Spanish Sep 9, 2007

FactCheck: Correct that insurance lobbying cost $1B

Obama used a figure that sounded dubious to us, but it turned out to be correct. Obama said, “We’ve also got to overcome the drug company lobbies, the insurance company lobbies, that spent $1 billion over the last 10 years to block reform.”

According to the Center for Responsive Politics, the pharmaceutical and insurance industries spent $1.2 billion and $949 million, respectively, on all lobbying efforts since 1998. Moreover, the two industries combined shelled out about $193 million in political donations and expenditures backing Republicans, about twice as much as they spent supporting Democrats. So it is reasonable to conclude that the pharmaceutical and insurance industries have indeed spent at least $1 billion combating legislation that Obama favors.

Source: FactCheck.org on 2007 Democratic primary debate on Univision Sep 9, 2007

National smoking bans only after trying local bans

Q: Over 400,000 Americans have premature death due to smoking or secondhand smoke. Would you be in favor of a national law to ban smoking in all public places?

A: I think that local communities are making enormous strides, and I think they’re doing the right thing on this. If it turns out that we’re not seeing enough progress at the local level, then I would favor a national law. I don’t think we’ve seen the local laws play themselves out entirely, because I think you’re seeing an enormous amount of progress in Chicago, in New York, in other major cities around the country. And because I think we have been treating this as a public health problem and educating the public on the dangers of secondhand smoke, that that pressure will continue. As I said, if we can’t provide these kinds of protections at the local level, which would be my preference, I would be supportive of a national law.

Q: Have you been successful in stopping smoking?

A: I have. You know, the best cure is my wife.

Source: 2007 Democratic primary debate at Dartmouth College Sep 6, 2007

Reform failed in ‘90s because of drug company lobbying

[All of the candidates] are going to have a plan [for universal coverage]. I’ve got a plan. But we’ve had plan before, under a Democratic president in the ‘90s and a Democratic Congress. We couldn’t get it done because the drug and insurance companies are spending $1 billion over the last decade on lobbying. And that’s why we’ve got to have a president who is willing to fight to make sure that they don’t have veto power.
Source: 2007 YouTube Democratic Primary debate, Charleston SC Jul 23, 2007

Take on insurance companies; drive down health care costs

My emphasis is on driving down the costs, taking on the insurance companies, making sure that they are limited in the ability to extract profits and deny coverage, and the drug companies have to do what’s right by their patients instead of simply hoarding their profits. We’ve got very conservative, credible estimates that say we can save families that do have health insurance about a thousand dollars a year, and we provide coverage for everybody else. We provide mandatory health care for children
Source: 2007 Dem. debate at Saint Anselm College Jun 3, 2007

Address minority health needs by more coverage & targeting

Q: Currently there are major disparities in both access to insurance and health care for racial and minorities. How will your plan address this issue?

A: One of the biggest reasons that there are disparities is that African-Americans & Latino Americans are much more likely not to have health insurance. And so if we set up a system in which everybody’s got health insurance, some of those disparities are immediately going to be reduced. Folks who are working but don’t have health care benefits- those groups are disproportionately minority. [Covering them via their employer] would be the first step. There are some particular issues within the minority community that I think we can address in a targeted way. Lead paint may seem like an ancillary issue except for the fact that incidence of lead poisoning among African-American & Latino youths is sky high. It has huge ramifications in terms of their long-term health. Obesity and diabetes in minority communities is more severe.

Source: SEIU Democratic Health Care Forum in Las Vegas Mar 24, 2007

Health care tied to balancing costs and taxes nation wide

We know that as progressives we believe in affordable health care for all Americans, and that we’re going to make sure that Americans don’t have to choose between a health care plan that bankrupts the government and one that bankrupts families, the party that won’t just throw a few tax breaks at families who can’t afford their insurance, but will modernize our health care system and give every family a chance to buy insurance at a price they can afford.
Source: Annual 2006 Take Back America Conference Jun 14, 2006

Allowing seniors to bulk purchase will save taxpayers’ money

Q: What do you think is wrong with the new federal prescription benefits for seniors?

A: It was fundamentally flawed as a piece of legislation. The central premise of this prescription drug bill that was passed by Bush was that the federal government, through the Medicare program, and senior citizens could not negotiate for the best possible price with the drug companies, so that they could actually get the kinds of discounts the Canadians enjoy for the drugs that are manufactured here in the US. That was done because the drug companies didn’t let it happen. What we have is a bill that’s bad for taxpayers and bad for senior citizens. Taxpayers are hit with a half-a-trillion-dollar tab that was originally estimated at three hundred billion. And about 3 weeks later, seniors have a big donut hole in the middle of their benefits. What I would do is I would say that senior citizens, through the Medicare program they can go and negotiate the best possible price as a consequence of being bulk purchasers.

Source: IL Senate Debate, Illinois Radio Network Oct 12, 2004

Allow prescription drug re-importation

Barack Obama called for a vote on a bi-partisan bill that would allow the re-importation of safe prescription drugs from industrialized countries at lower prices. “I ask for a Senate vote to allow safe imports of US-approved drugs that are manufactured in US-approved plants,” Obama said. “And, I urge Jack Ryan to stop siding with the drug manufacturers and put aside his opposition to the re-importation of lower-priced prescription drugs from Canada.”
Source: Press Release, “Prescription Drug Re-Importation” May 21, 2004

Barack Obama on AIDS

Use whatever works with AIDS, including teaching abstinence

Q: The ministry called True Love Waits, has been credited with lowering the AIDS infection rate in Uganda dramatically from 30% to 6%. It is an abstinence-based program--what is your opinion?

A: When Michelle and I were traveling in Kenya, we took an AIDS test. I compliment George Bush on the PEPFAR program [President’s Emergency Plan for AIDS Relief]. My view is that we should use whatever the best approaches are, the scientifically sound approaches are, to reduce this devastating disease. Part of that should be a strong education component and I think abstinence education is important. I also think that contraception is important; I also think that treatment is important; I also think that we have to do more to make antiviral drugs available to people who are in extreme poverty. So I don’t want to pluck out one facet of it. Now, that doesn’t mean that non-for-profit groups can’t focus on one thing while the government focuses on other things. I think we want to have a comprehensive approach.

Source: 2008 Democratic Compassion Forum at Messiah College Apr 13, 2008

We need condom distribution to deal with the scourge of AIDS

I’m somebody who is willing to talk about these issues, even when it’s hard, in front of black ministers. I’m willing to talk about AIDS at Saddleback Church to evangelicals and talk about why we need to have condom distribution to deal with the scourge of AIDS. So that’s the kind of political courage that I hope all of you recognize is going to be necessary in order for us to create the kind of America that we all want.
Source: 2007 HRC/LOGO debate on gay issues Aug 9, 2007

Homophobia prevents talking about HIV/AIDS

One of the things we’ve got to overcome is a stigma that still exists in our communities. We don’t talk about HIV/AIDS. We don’t talk about it in the schools. Sometimes we don’t talk about it in the churches. It has been an aspect of sometimes homophobia that we don’t address this issue as clearly as it needs to be.
Source: 2007 Democratic Primary Debate at Howard University Jun 28, 2007

Got tested for AIDS, with wife, in public, in Kenya

Q: African-Americans, though 17% of all American teenagers, are 69% of the population of teenagers diagnosed with HIV/AIDS. What is the plan to protect these young people from this scourge?

BIDEN: You’re asking, how do we prevent these 17-year-olds from getting HIV? All the things that were said here [by other candidates] are good ideas; but they don’t prevent that. I spent last summer going through the black sections of my town, trying to get black men to understand it is not unmanly to wear a condom, getting women to understand they can say no, getting people in the position where testing matters. I got tested for AIDS. I know Barack got tested for AIDS. There’s no shame in being tested for AIDS.

OBAMA: I just got to make clear--I got tested with Michelle, when we were in Kenya in Africa. I don’t want any confusion here about what’s going on.

BIDEN: And I got tested to save my life, because I had 13 pints of blood transfusion.

OBAMA: I was tested with my wife. In public.

Source: 2007 Democratic Primary Debate at Howard University Jun 28, 2007

Curing AIDS must be all-hands-on-deck effort

We are all sick because of AIDS and we are all tested by the crisis. Neither philanthropist nor scientist; neither government nor church can solve this problem on their own. AIDS must be an all hands on deck effort. I don’t think we can deny that there is a moral and spiritual component to prevention--I heard stories of men and women contracting HIV because sex was no longer part of a sacred covenant but a mechanical physical act. Having said that, I also believe that we cannot ignore that abstinence--may not be the reality. If condoms and potentially microbicides can prevent millions of deaths, they should be made more widely available.
Source: In His Own Words, edited by Lisa Rogak, p. 10 Mar 27, 2007

Lead global fight against AIDS

[The US should] lead the global fight against the AIDS virus. The US must give its fair share to the Global Fund to Fight AIDS, Tuberculosis and Malaria to avoid both a humanitarian and economic crisis. President Bush’s budget this year actually cuts the U.S. contribution to the Global Fund by 65 percent. As Senator, I will hold President Bush to his word and fully fund our commitment to the war on AIDS. We must also increase the availability of generic drugs to AIDS victims around the world.
Source: Press Release, “Renewal of American Leadership ” Jul 12, 2004

Barack Obama on Universal Coverage

Zero fines & no mandate for small business

McCAIN: Sen. Obama wants, if you’ve got [a small business with] employees, if you don’t adopt the health care plan that Sen. Obama mandates, he’s going to fine you. Now, Sen. Obama, I’d still like to know what that fine is going to be.

OBAMA: Here’s your fine--zero.

McCAIN: Zero?

OBAMA: Zero, because as I said in our last debate and I’ll repeat, I exempt small businesses from the requirement for large businesses that can afford to provide health care to their employees, but are not doing it. I exempt small businesses from having to pay into a kitty. But large businesses that can afford it, we’ve got a choice. Either they provide health insurance to their employees or somebody has to. Right now, what happens is those employees get dumped into either the Medicaid system, which taxpayers pick up, or they’re going to the emergency room for uncompensated care, which everybody picks up in their premiums.

Source: 2008 third presidential debate against John McCain Oct 15, 2008

Reduce premiums and uninsured get same coverage as Congress

OBAMA: If you’ve got insurance through your employer, you can keep your insurance. We estimate we can cut the average family’s premium by about $2,500 per year. If you don’t have health insurance, then we’re going to provide you the option of buying into the same kind of federal pool that both Sen. McCain and I enjoy as federal employees. We’re going to make sure insurance companies can’t discriminate on the basis of pre-existing conditions. We’ll negotiate with the drug companies for the cheapest available prices. We are going to invest in information technology to eliminate bureaucracy and make the system more efficient. We’ve got to put more money into preventive care.

McCAIN: I want to give every family a $5,000 refundable tax credit. Take it and get anywhere in America the health care that you wish. [For employers], if you want to do the right thing with your employees and provide them health insurance, we’ll give you a 50% credit so that you will actually be able to afford it.

Source: 2008 third presidential debate against John McCain Oct 15, 2008

No exclusions for pre-existing conditions

Q: Do you believe health care should be treated as a commodity?

A: Here’s what I would do. If you’ve got health care already, and probably the majority of you do, then you can keep your plan if you are satisfied with it. You can keep your choice of doctor. We’re going to work with your employer to lower the cost of your premiums by up to $2,500 a year. And we’re going to do it by investing in prevention. We’re going to do it by making sure that we use information technology so that medical records are actually on computers instead of you filling forms out in triplicate when you go to the hospital. That will reduce medical errors and reduce costs. If you don’t have health insurance, you’re going to be able to buy the same kind of insurance that Sen. McCain and I enjoy as federal employees. Because there’s a huge pool, we can drop the costs. And nobody will be excluded for pre-existing conditions, which is a huge problem.

Source: 2008 second presidential debate against John McCain Oct 7, 2008

Ban insurance companies from discriminating against the sick

Now is the time to finally keep the promise of affordable, accessible health care for every single American. If you have health care, my plan will lower your premiums. If you don’t, you’ll be able to get the same kind of coverage that members of Congress give themselves. And as someone who watched my mother argue with insurance companies while she lay in bed dying of cancer, I will make certain those companies stop discriminating against those who are sick and need care the most.
Source: Speech at 2008 Democratic National Convention Aug 27, 2008

I’ve got a health plan and a plan to get it implemented

I’ve got a plan for creating universal health care, shepherding that through Congress so that I can actually sign a bill, then executing and implementing that. You know, those are things that I worry about.
Source: ABC News: 2008 election interview with Charlie Gibson Jun 4, 2008

AdWatch: My plan costs $2,500 less per family than Clinton’s

Obama TV ad, “Phantom Savings”

Announcer: Hillary Clinton is attacking. But what’s she not telling you about her health care plan? It forces everyone to buy insurance, even if you can’t afford it. And you pay a penalty if you don’t. Barack Obama believes it’s not that people don’t want health care. It’s that they can’t afford it. That’s why the Obama plan reduces costs more than Hillary’s, saving $2,500 for the typical family. For health care we can afford, vote for change we can believe in.

Source: AdWatch of 2008 campaign ad: “Phantom Saving” Apr 21, 2008

FactCheck: Unclear if Obama’s plan costs less than Clinton’s

Obama’s TV ad also makes a dubious claim when it says his plan “reduces costs more than Hillary’s” and would save $2,500 for the typical family. It’s true that Clinton claims her plan will save $2,000. But both candidates are promising savings that a number of experts say they can’t deliver. Jonathan Gruber of the Massachusetts Institute of Technology (author of “Covering the Uninsured in the U.S.”) says, “I know zero credible evidence” supporting the campaigns’ claims of big cost savings.
Source: AdWatch of 2008 campaign ad: “Phantom Saving” Apr 21, 2008

Universal health care means anyone who wants it can get it

CLINTON: I think it’s imperative that we stand as Democrats for universal health care. I’ve staked out a claim for that. Sen. Edwards did. Others have. But Sen. Obama has not.

OBAMA: Well, look, I believe in universal health care, as does Sen. Clinton. And the point of the debate, is that Sen. Clinton repeatedly claims that I don’t stand for universal health care. And, you know, for Sen. Clinton to say that, I think, is simply not accurate. Every expert has said that anybody who wants health care under my plan will be able to obtain it. President Clinton’s own secretary of Labor has said that my plan does more to reduce costs and as a consequence makes sure that the people who need health care right now, all across America, will be able to obtain it. And we do more to reduce costs than any other plan that’s been out there.

CLINTON: [Leaving out a mandate is the same as saying] that we shouldn’t try to get everyone into health insurance.

Source: 2008 Democratic Debate in Cleveland Feb 26, 2008

Insurers are happy to have a mandate; issue is affordability

OBAMA: If we don’t know the level of subsidies that [Hillary’s plan is] going to provide, then you can have a situation, which we are seeing right now in the state of Massachusetts, where people are being fined for not having purchased health care but choose to accept the fine because they still can’t afford it, even with the subsidies. And they are then worse off. They then have no health care and are paying a fine above and beyond that. And the last point I would make is, the insurance companies actually are happy to have a mandate. The insurance companies don’t mind making sure that everybody has to purchase their product. That’s not something they’re objecting to.

CLINTON: And under my plan, it is affordable because, number one, we have enough money in our plan. A comparison of the plans like the ones we’re proposing found that actually I would cover nearly everybody at a much lower cost than Sen. Obama’s plan.

Source: 2008 Democratic Debate in Cleveland Feb 26, 2008

Voluntary universal participation, like in Medicare Part B

OBAMA: Her mandate is not a mandate for the government to provide coverage to everybody; it is a mandate that every individual purchase health care.

CLINTON: [Obama’s plan] would be as though Franklin Roosevelt said let’s make Social Security voluntary --let’s let everybody get in it if they can afford it--or if Pres. Johnson said let’s make Medicare voluntary. Now, if you want to say that we shouldn’t try to get everyone into health insurance, that’s a big difference.

OBAMA: I believe that if we make it affordable, people will purchase it. In fact, Medicare Part B is not mandated, it is voluntary. And yet people over 65 choose to purchase it, Hillary, and the reason they choose to purchase it is because it’s a good deal. And if people end up seeing a plan that is affordable for them, I promise you they are snatching it up because they are desperate to get health care. And that’s what I intend to provide as president of the United States.

Source: 2008 Democratic Debate in Cleveland Feb 26, 2008

Mandating kids’ insurance ok; mandating adults has problems

CLINTON: Sen. Obama has a mandate in his plan. It’s a mandate on parents to provide health insurance for their children. That’s about 150 million people.

OBAMA: I have no objection to Sen. Clinton thinking that her approach is superior. But we still don’t know how Sen. Clinton intends to enforce a mandate.

CLINTON: Sen. Obama would enforce the mandate by requiring parents to buy insurance for their children.

OBAMA: This is true.

CLINTON: If you have a mandate, it has to be enforceable. So there’s no difference here.

OBAMA: No, there is a difference. I do provide a mandate for children, because we have created programs in which we can have greater assurance that those children will be covered at an affordable price. But we don’t want to put adults in a situation in which, on the front end, we are mandating them, we are forcing them to purchase insurance, and if the subsidies are inadequate, the burden is on them, and they will be penalized. And that is what Sen. Clinton’s plan does.

Source: 2008 Democratic Debate in Cleveland Feb 26, 2008

Young adults up to age 25 can be covered under parents’ plan

CLINTON: About 20% of the people who are uninsured have the means to buy insurance. They’re often young people who think they’re immortal.

OBAMA: Which is why I cover them.

CLINTON: Except when the illness or the accident strikes. And what Sen. Obama has said, that then, once you get to the hospital, you’ll be forced to buy insurance, I don’t think that’s a good idea. We ought to plan for it, and we ought to make sure we cover everyone. That is the only way to get to universal health care coverage. But if we don’t even have a plan to get there, and we start out by leaving people, you’ll never ever control costs, improve quality, and cover everyone.

OBAMA: With respect to the young people, my plan specifically says that up until the age of 25 you will be able to be covered under your parents’ insurance plan, so that cohort that Sen. Clinton is talking about will, in fact, have coverage.

Source: [X-ref Clinton] 2008 Democratic Debate in Cleveland Feb 26, 2008

My plan does more than anybody to reduce costs

Both Clinton and I want to set up a system in which any person is going to be able to get coverage that is as good as we have as members of Congress. We are going to subsidize those who can’t afford it, and make sure that we reduce costs by emphasizing prevention. I want to make sure that we’re applying technology to improve quality, cut bureaucracy. I want to make sure that we’re reducing costs for those who already have health insurance. So we put in place a catastrophic reinsurance plan that would reduce costs by $2,500 per family per year. So we’ve got a lot of similarities in our plan. We’ve got a philosophical difference: Clinton believes the only way to achieve universal health care is to force everybody to purchase it. My belief is that people don’t have it is not because they don’t want it but because they can’t afford it. So I emphasize reducing costs. My plan does more than anybody to reduce costs, and there is nobody out there who wants health insurance who can’t have it.
Source: 2008 Democratic debate at University of Texas in Austin Feb 21, 2008

My health plan does not leave 15 million people uncovered

There are legitimate arguments for why Clinton and others have called for a mandate, and I’m happy to have that debate. But the notion that I am leaving 15 million people out somehow implies that we are different in our goals of providing coverage to all Americans, and that is simply not true. We think that there’s going to be a different way of getting there. I admire the fact that Clinton tried to bring about health care reform back in 1993. She deserves credit for that. But she did it in the wrong way because it wasn’t just the fact that the insurance companies, the drug companies were battling here, and no doubt they were. It was also that Clinton and the administration went behind closed doors, excluded the participation even of Democratic members o Congress who had slightly different ideas than the ones that Clinton had put forward. As a consequence, it was much more difficult to get Congress to cooperate. I’m going to do things differently. We have to open up the process.
Source: 2008 Democratic debate at University of Texas in Austin Feb 21, 2008

Adults will get health care as they can afford it

When Clinton says a mandate, it’s not a mandate on government to provide health insurance, it’s a mandate on individuals to purchase it. Massachusetts has a mandate right now. They have exempted 20% of the uninsured because they have concluded that that 20% can’t afford it. There are people who are paying fines and still can’t afford it, so now they’re worse off than they were. They don’t have health insurance and they’re paying a fine. To force people to get health insurance, you’ve got to have a very harsh penalty, and Clinton has said that we won’t go after their wages. The reason a mandate for children can be effective is we’ve got an ability to make affordable health care available to that child, right now. There are no excuses. If a parent is not providing health care for that child, it’s because the parent’s not being responsible, under my plan. Those children don’t have a choice. But adults are going to be able to see that they can afford it and will get it under my plan.
Source: 2008 Democratic debate at University of Texas in Austin Feb 21, 2008

AdWatch: punishing uninsured families doesn’t make sense

Hillary’s health care plan forces everyone to buy insurance, even if you can’t afford it. Is that the best we can do for families struggling with high health care costs?

Hillary’s health care plan forces everyone to buy insurance, even if you can’t afford it... and you pay a penalty if you don’t.

Punishing families who can’t afford health care to begin with just doesn’t make sense. Bill Clinton’s own Secretary of Labor, Robert Reich, wrote, “I’ve compared the two plans in detail... But in my view Obama’s would insure more people, not fewer, than HRC’s.“

Source: FactCheck.org: AdWatch of 2008 healthcare mailer Feb 4, 2008

FactCheck: Hillary’s plan does mandate; but so does Obama’s

Obama said that his health care plan has “about 95%” in common with rival Hillary Clinton’s. Nevertheless, his campaign sent out a piece of direct mail that could mislead those who are not familiar with Clinton’s plan.

The mailer focuses on the primar difference between the two candidates’ proposals: whether they would require everyone to obtain coverage. Clinton’s plan would require all Americans to get insurance, though she hasn’t said what will happen if they don’t. Obama’s plan would require insurance for all children but not for adults.

The Obama campaign is trying to shift the focus to some unspecified “punishment” that Clinton’s plan would mete out for those who didn’t obtain coverage. It’s true that a “mandate” implies penalties for noncompliance, and Clinton’s campaign has yet to outline what those would be. But Obama’s plan, which would mandate coverage for children, would presumably also have some enforcement mechanism, and he doesn’t make explicit what that would be, either

Source: FactCheck.org: AdWatch of 2008 healthcare mailer Feb 4, 2008

No one turned away due to illness or pre-existing condition

Source: Campaign booklet, “Blueprint for Change”, p. 6-9 Feb 2, 2008

Buy private insurance via National Health Insurance Exchange

National Health Insurance Exchange:
The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participat-ing insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend on how healthy you are. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.
Source: Campaign booklet, “Blueprint for Change”, p. 6-9 Feb 2, 2008

Against enforcement mechanism for mandating insurance

CLINTON: [Obama & I] do have differences on health care. I believe absolutely passionately that we must have universal health care. It is a moral responsibility [to] move us to universal health care.

OBAMA: About 95% of our plans are similar. We both set up a government plan that would [cover] pre-existing conditions. We both want to emphasize prevention. But I emphasize reducing costs. If we provide subsidies to those who can’t afford it, they will buy it. Sen. Clinton has a different approach. She believes that we have to force people who don’t have health insurance to buy it, or there will be a lot of people who don’t get it. But if you are going to mandate the purchase of insurance & it’s not affordable, then there’s going to have to be some enforcement mechanism that the government uses. And they may charge fines to people who already don’t have health care, or take it out of their paychecks. And that, I don’t think, is helping those without health insurance. That is a genuine difference.

Source: 2008 Democratic debate in Los Angeles before Super Tuesday Jan 30, 2008

FactCheck: Yes, Obama favored single-payer, despite denial

Clinton charged that Obama’s position has shifted on health care, from favoring a single-payer, universal system when he was a Senate candidate to the plan he favors now, which has no requirement. Obama denied that he had ever said he would work to get a single-payer plan, saying, “I never said that we should try to get single-payer. I said that if I were starting from scratch, I would probably go with a single-payer system.”

But Obama’s denial doesn’t hold up. In a speech in June 2003, Obama said: “I happen to be a proponent of a single-payer health care program. I see no reason why the US cannot provide basic health insurance to everybody. A single-payer health care plan, a universal health care plan. And that’s what I’d like to see.“

After his election, Obama tempered his position, saying in May 2007, ”If you’re starting from scratch, then a single-payer system would probably make sense. But managing the transition would be difficult. So we may need a system that’s not so disruptive.

Source: FactCheck.org on 2008 Congressional Black Caucus Dem. Debate Jan 21, 2008

FactCheck: No, US costs are not twice as much as others

Obama repeated an old chestnut about health care costs, saying “Our medical care costs twice as much per capita as any other advanced nation.” This is an exaggeration. The United States does spend nearly twice as much on average as most developed nations, but it is inaccurate to say that it spends twice as much as “any other.”

In a 2007 Kaiser Family Foundation report comparing the health care spending of Organisation for Economic Co-operation and Development member countries, the United States came in first at $5,711 per capita. But Luxembourg spent $4,611, only $1,100 less per capita than the U.S. The next biggest spender, Switzerland, spent $3,874, also far more than half of U.S. spending. KFF noted, however, that the United States’ spending was “over 90% higher than in many other countries that we would consider global competitors.”

Source: FactCheck.org on 2008 Facebook/WMUR-NH Democratic debate Jan 5, 2008

AdWatch: Pressure insurance & drug companies to change

Obama TV ad in Iowa:
Announcer: While Iowans struggle with health costs, outside groups are spending millions to stop change, including false attacks on Barack Obama’s health plan. But experts say Obama’s plan is “the best.” It “guarantees coverage for all Americans.” Putting “pressure on insurance and drug companies,” his plan cuts costs more than any other--saving $2,500 for the typical family. The same old Washington politics won’t fix health care. But we can.
Source: FactCheck.org: AdWatch of 2008 campaign ad, “Interest” Jan 3, 2008

FactCheck: OPPORTUNITY to insure all, but no GUARANTEE

Obama’s ad touting his health care plan quotes phrases from newspaper articles and an editorial, but makes them sound more laudatory and authoritative than they actually are.
Source: FactCheck.org: AdWatch of 2008 campaign ad, “Interest” Jan 3, 2008

AdWatch: Don’t make it illegal not to have health care

Radio ad running in Iowa:

[Female announcer]: Here’s what the experts say. President Clinton’s own Labor Secretary Robert Reich says, quote, “I’ve compared the plans in detail. Obama’s plan would insure more people than the others.” The Pioneer Press confirms Obama guarantees coverage for all Americans.

[Male announcer]: But here’s the real difference on health care. Senators Edwards and Clinton favor mandates which the Daily Iowan says would, quote, “force those who cannot afford health insurance to buy it, punishing those who don’t fall in line.”

[Female announcer]: Barack Obama believes the solution isn’t making it illegal not to have health care. It’s making it affordable.

[Male announcer]: And that’s why his plan cuts costs for a typical family by twenty-five hundred dollars.

[Female Announcer]: As the Concord Monitor says, when it comes to honesty about health care, Obama has the edge.

Source: AdWatch of 2008 campaign ad, “Health care” Jan 1, 2008

Being poor in this country is hazardous to your health

Q: Both Latinos and Blacks receive significantly worse medical care than whites in the US, when they get care. What can the president do to address this, and can we afford it?

A: The president can do everything to address this and can afford it if we are able to bring people together to get it done. And this is something that I am committed to doing as president. But it is indisputable that if you are poor in this country that is hazardous to your health, if you are black or brown, too, and poor, it can be downright deadly. Right now, even when blacks or Latinos have the same health insurance as whites, they are not receiving the same quality of care. And that means that we’ve got to have more black and brown doctors and nurses; we’ve got to have studies in terms of making sure that we are eliminating these disparities; we’ve got to make sure that we are doing outreach in these communities ahead of time to prevent disease.

Source: 2007 Iowa Brown & Black Presidential Forum Dec 1, 2007

Problem isn’t mandating coverage, but affording it

I do provide universal health care. The only difference between Clinton’s plan and mine is that she thinks the problem for people without health care is that nobody has mandated, forced them to get health care. What I see are people who would love to have health care & can’t afford it. My plan that makes sure that it is affordable to get health care as good as the health care that I have as a member of Congress. That’s what the American people are looking for & what I intend to provide as president.
Source: 2007 Democratic debate in Las Vegas, Nevada Nov 15, 2007

FactCheck: Coverage plan might leave 8.5 million uninsured

Both Clinton & Obama dabbled in exaggerations on their opponents’ health care plan. Clinton said, “His plan would leave 15 million Americans out. I have a universal health care plan that covers everyone.” Obama responded, “I do provide universal health care.”

Clinton uses a dubious statistic when she claims Obama’s plan would leave out 15 million of the uninsured. But Obama’s statement that his proposal provides “universal” health care is also suspect. Clinton based her claim on a column by The New Republic’s Jonathan Cohn, who loosely estimated Obama’s plan would leave 15 million uninsured. Cohn offered an estimate based on the best information available, not a hard and fast calculation. The best available information says that Obama’s plan would leave between 8.5 million uninsured, up to 18 million people uninsured if Obama has no individual mandates. The Obama plan does include limited mandates, including a requirement for employers to either provide health insurance or pay into a public fund.

Source: FactCheck.org on 2007 Democratic debate in Las Vegas Nov 15, 2007

Cautious incremental plan offers choice & subsidy

[Obama’s record] leads to the conclusion that caution and synthesis would be his standard operating procedure.

You can see these tendencies in Obama’s healthcare plan, which bars insurers from refusing coverage to anyone, lets people choose between private plans and a public one, and offers subsidies to those who cannot afford the rates. This approach borrows heavily from John Edward’s much-praised scheme, but it falls short of his call for universal coverage. At any rate, The New Republic estimates that Obama’s plan would leave about fifteen million American uninsured.

It can be argued that an incremental attitude is the best way to pass liberal legislation these days. Obama has said as much. “For a political leader to get things done, he or she ideally should be ahead of the curve, but not too far ahead.”

Source: The Contenders, by Laura Flanders, p. 72 Nov 11, 2007

Added 20,000 children to Illinois healthcare

Obama also has a record of success on health care in Illinois. He sponsored the legislation expanding Kid Care and Family Care that added 20,000 children to the state health insurance program. Obama was a cosponsor of the Senior Citizen Prescription Drug Discount Program Act, which enabled senior citizens and the disabled to obtain prescription drugs at discount rates. Obama also cosponsored smaller reforms such as SB989, which allowed Medicaid money to care for mentally or emotionally disturbed children as outpatients rather than the far more expensive option of institutionalizing them, and SB1417, which required all insurance companies operating in Illinois to pay for screenings of colorectal cancer.
Source: The Improbable Quest, by John K. Wilson, p.148 Oct 30, 2007

Government healthcare like members of Congress have

Q: You favor universal coverage for everyone without exception?

A: That’s correct. Part of the reason that you’re confused about the candidates’ differences is because the differences probably matter less than the commonalties. All of the major Democratic candidates are advocating some form of universal health care. The question is, how do we get there? My proposal says:

Source: Huffington Post Mash-Up: 2007 Democratic on-line debate Sep 13, 2007

Increase competition in the insurance and drug markets

Source: Campaign website, BarackObama.com, “Resource Flyers” Aug 26, 2007

National Health Insurance Exchange for private coverage

Source: Campaign website, BarackObama.com, “Resource Flyers” Aug 26, 2007

Health plan cuts typical family’s premium by $2,500 a year

My plan will cover every American and cut the cost of a typical family’s premium by up to $2,500 a year. It’s a plan that lets the uninsured buy insurance that’s similar to the kind members of Congress give themselves. And if you can’t afford that, you’ll get a subsidy to pay for it.

It goes further than any other proposed plan in cutting the cost of health care by investing in technology and preventive care so that children are getting regular check ups instead of having to go to the emergency room for treatable illnesses like asthma, and by breaking the stranglehold of the drug companies and the insurance industries--we are tired of them dictating our health care markets--and helping businesses and families shoulder the cost of the most expensive conditions so that an illness doesn’t lead to bankruptcy. And I promise you this: I will sign a universal health care plan that covers every American by the end of my first term as president.

Source: Take Back America 2007 Conference Jun 19, 2007

Give people the choice to buy affordable health care

We’ve got these savings and we’re still going to have to do a little bit more, partly because you’ve got to invest up front in, for example, information technology so that rural hospitals that don’t have computers are able to buy them. And they’re going to need some help. But on this issue of mandatory versus non-mandatory, people are not going around trying to avoid buying health care coverage. If you look at auto insurance, in California there’s mandatory auto insurance. Twenty-five percent of the folks don’t have it. The reason is because they can’t afford it. I’m committed to starting the process. Everybody who wants it can buy it and it’s affordable. If we have some gaps remaining, we will work on that. You take it from the opposite direction, but you’re still going to have some folks who aren’t insured under your plan, John, because some of them will simply not be able to afford to buy the coverage they’re offered.
Source: 2007 Dem. debate at Saint Anselm College Jun 3, 2007

National insurance pool & catastrophic insurance

Let me tell you what [my health care plan] would do. Number one, we should have a national pool that people can buy into if they don’t have health insurance, similar to the ones that most of us who are in Congress enjoy right now. It doesn’t make sense to me that my bosses, the taxpayers, may not have health insurance that I enjoy. And we can provide subsidies for those who can’t afford the group rates that are available. The second thing is to make sure that we control costs. We spend $2 trillion on health care in this country every year, 50% more than other industrialized nations. And yet, we don’t have, necessarily, better outcomes. If we make sure that we provide preventive care and medical technology that can eliminate bureaucracy and paperwork, that makes a big difference. The third thing is catastrophic insurance to help businesses and families avoid the bankruptcies that we’re experiencing all across the country and reduced premiums for families.
Source: 2007 South Carolina Democratic primary debate, on MSNBC Apr 26, 2007

Employers are going to have to pay or play

Employers are going to have to pay or play. I think that employers either have to provide health care coverage for their employees or they’ve got to make a decision that they’re going to help pay for those who don’t have coverage outside the employer system. So I think that’s one important principle, & the second important principle is that we’re going to have to put more money into prevention, chronic care management, & medical technology, because that is how we’re going to accrue the needed savings
Source: SEIU Democratic Health Care Forum in Las Vegas Mar 24, 2007

Need political will to accomplish universal coverage

I will be putting out a plan over the next couple of months that details how I would approach the basic principles that by the end of my first term, that we’re going to have universal health care for every single American. Some basic principles: