This is a repost of an original that addresses Hillary Clinton’s claim, repeated in last week’s Texas debate, that only her health plan accomplishes universal coverage because it has a individual mandate and Barak Obama’s does not. Senator Clinton goes so far as to say she would garnish wages to enforce her mandate that everyone buy health insurance. Hillary Clinton has gone on the attack in recent days criticizing Barack Obama’s health care plan. She charges that his plan would not cover everyone and hers would.

Is she right?

Senator Clinton has an individual mandate in her plan. That means
that everyone would be required to purchase coverage or suffer a
penalty she hasn’t defined. Senator Obama does not have an individual
mandate in his plan although he would require all children to be
covered. Both candidates would require employers to cover their
employees.

She points to studies that show without a mandate there would still be 15 million people uninsured.

In the sense that the Clinton plan requires everyone to be covered, one could argue that she covers more people. But I will suggest it is not that simple.

The new Massachusetts health plan is really the outline upon which both the Obama and Clinton plans are based. Mass has an individual mandate. But the problem is people still can’t afford to buy insurance. Mass is doing a great job getting people covered with incomes so low that they have their health insurance fully paid for. But, for those families who make too much for a subsidy that pays less than the full cost–or none of the cost–the Mass program is faltering. Only a few thousand uninsured Mass residents whose incomes are above the lowest levels have signed up for the mandated coverage.

For example, a family of three making $50,000 gets no subsidy and the cost of a $2,000 deductible plan is in the $7,000 to $9,000 range. Mass has a law that says they must purchase coverage but how, with such high costs, can they really be expected to?

So, there is a mandate and you can say we are covering everyone because they have to be covered but in fact the mandate is a hollow provision if people can’t afford it.

So, when the day is done, I don’t see much real difference here.

The real issue is how each of the candidates would make premium affordable in the first place.

When I look at Senator Obama’s 12 page health care plan, I see a number of proposals to reduce cost including investment in health information technology, improving prevention and management of chronic conditions, providing reinsurance for big costs, making care universal to reduce uncompensated care, simplifying paperwork, making insurance portable, improving quality of care through disease management, integrated care, and better transparency about costs.

When I look at Senator Clinton’s 12 page plan, I see virtually the same things not only on cost containment but everything else.

Senator Clinton would limit premium payments to a percentage of income, "This guarantee will be be achieved through a premium affordability tax credit that ensures that health premiums will never rise above a certain percentage of family income."

But Obama says that, "Individuals and families who do not qualify for Medicaid and SCHIP but still need assistance will receive income-related federal subsidies to keep health insurance premiums affordable."

Both candidates seem to be offering the same cost containment strategies.

Both candidates are offering a vague guarantee that everyone will have access to "affordable" health insurance premiums.

I don’t see a difference between them here.

When the day is done, as Massachusetts is showing us, a mandate does nothing if people don’t have affordable premiums.

They both claim they are going to give us affordable premiums and would go about it in a very similar way.

I worry that both of them have cost containment strategies that would do little more then dent the continued escalation in health care costs and undermine both of their guarantees for affordable coverage. You can learn more about that by reading my posts on their respective health plans that can be found in the index to the right.