It’s the time in the political season to make way too much of the impact a vice president can have on the presidential contest.
So I hope you don’t mind if I extend that amusing parlor sport into the arena of health care reform and consider how how Joe Biden’s original proposal for health care reform compares to Barack Obama’s.
If nothing else, it’s a good way to parse a few of the issues likely to be magnified when Obama and McCain yammer back and forth about their health care plans in the coming weeks.
Biden’s plan, unloosed on the public in October 2007 to support his presidential run, isn’t that different from Obama’s.
Both cover the usual list of Democrat health care touchpoints — making
coverage affordable with subsidies to people and businesses, creating
new public options to supplement private offerings, preventing insurers
from denying coverage to the sick, emphasizing prevention and chronic
disease treatment, etc., etc., etc., yada yada and so forth.
Neither plan, significantly, follows the Hillary Clinton proposal for
mandating coverage for all people. Neither does the vaporous plank on
health care in the Democrat’s party platform draft.
[Note: It’s a bit tough to find information on Biden’s plan at this
point in history. The former presidential campaign website is now redirected to a page on Obama’s site
announcing Biden as VP, effectively airbrushing evidence of the Biden
plan from the current debate. We can expect the same from Mittromney.com any day now.]
The key distinctions between the Obama and Biden proposals:
Mandates: Obama requires all kids to have insurance. Biden doesn’t require anybody to be insured.
Uninsured: Like Obama, Biden would use a mix of subsidies, tax breaks
and expanded options to help people buy into either private or public
plans not unlike the one enjoyed by federal employees. Unlike Obama,
Biden would give adults 55-64 the option of buying into Medicare, again
with subsidies as needed.
Insurance regulation: Obama would prohibit insurers from denying
coverage based on pre-existing conditions. Biden would provide
incentives to discourage insurers from doing so.
Drug prices: Obama favors changing laws to permit federal price
negotiation with drug makers over the cost of drugs for Medicare,
reimportation of drugs from other countries, and supporting development
of generic drugs. Biden mentions only allowing bargaining for Medicare
Health Tech: Both support investments in health information technology
in order to make care stronger, safer and better looking. Obama wants
to spend $10 billion over 5 years, then make use of certain tech
mandatory. Biden wants to spend $1 billion per year.
Total estimated costs: Such estimates are fictional, of course, if not
delusional. But Biden costed out his plan at $120 billion per year.
Obama, that tightwad, estimates outlays of $60 to $65 million per year.
Obama says he’ll pay for it by rolling back Bush’s tax cuts for people
making over $250,000 per year. Biden didn’t say how he’d pay the bill.
To the extent this bean-hill of wonkery amounts to much, the public
will never hear about it, of course. One of the easiest predictions on
health care politics over the next many weeks is this:
McCain’s plan will be portrayed as an industry-friendly,
lobbyist-shaped non-reform that leaves millions of people uncovered,
undercovered and suffering while the rich and the lucky who own seven
houses (they think) enjoy gold-plated, platinum-priced coverage.
Obama’s will be dismissed as an act of tax-and-spend FDR-era
extravagance that will create a huge new bureaucracy, drive god-fearing
businesses out of health care entirely, suck the working class dry and
lead the country down that slippery slope toward Stalinistic central
But back to reality. This is easy to predict too:
Any eventual reform to health care, regardless of who wins, is going to
become the usual mess based first on ideological inclination and then
processed through the machine of money, industry influence, political
pandering and either "compromise" or "cooperation," depending on how
one views unwillingness to demand absolutes.
And this will occur no matter who the vice president is.