This is an archived article that was published on sltrib.com in 2008, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
You've heard a lot - probably too much - about which presidential candidate is best qualified to answer that 3 a.m. phone call in the White House. But if the caller were asking about health-care reform, there's no doubt which candidate could give the best answers, even in her sleep. That would be Hillary Clinton.
This is no accident, because Clinton has been through this ringer before, in 1993, when she headed her husband's ill-fated effort to prescribe a cure for the health-insurance crisis. The Clintons bobbled the pill bottle back then, but that brutal political setback taught Hillary Clinton all about one of the most complex public policy issues out there.
Now, 15 years later, the health-insurance system is even sicker, and it's no surprise that among the three major candidates Clinton has put forward the best, most comprehensive plan to heal it.
Despite what you may have heard, HillaryCare - our name, not hers - is not a single-payer, government-financed health plan. Instead, it retains private insurance companies and competition, but makes a number of major reforms in tax policy and the market. And it does attempt to achieve universal coverage; that is, health insurance for everyone.
Barack Obama's plan largely mirrors Clinton's, but with one important difference: He would create a new bureaucracy. John McCain's plan is not far-reaching enough to achieve universal coverage.
HillaryCare basics: HillaryCare would allow Americans, employers and employees alike, to keep their existing coverage or buy group insurance from the same menu of private options available to members of Congress. Or, they could buy a new public plan similar to Medicare, which would compete with private plans.
Rules would create a level field across states and markets, end denial of coverage and limit premiums. Insurers would be required to cover anyone who applies and pays the premium. Policy renewal would be automatic. Insurers would be prohibited from charging large premium differences based on age, gender or occupation. Premiums would have to be dedicated to providing care, not excessive profits or advertising.
Large private employers would be expected to provide insurance or contribute to the cost of coverage; individuals would be required to buy insurance. This is the mandate you may have heard about. Small businesses would receive a tax credit to continue or begin coverage.
The system would retain the current exclusion from taxes of employer-provided health premiums, but it would limit the exclusion for high-end portions of rich plans for the wealthy. Working families would receive a refundable tax credit to help them buy coverage. The credit would be designed to prevent premiums from exceeding a certain percentage of family income.
Medicaid and the Children's Health Insurance Program would provide a stronger safety net to insure the most vulnerable populations.
Universal coverage would end cost-shifting.
Obama's 'me too' plan: As we mentioned before, Obama's plan largely mirrors Clinton's, but there are a couple of differences. The most important is that ObamaCare would create a new bureaucracy, the National Health Insurance Exchange, to help Americans and businesses that want to buy private health insurance directly. Like HillaryCare, it would also offer a new public plan, but the exchange would police standards and require private insurers to offer plans at least as generous as the new public plan. It would evaluate insurance policies and make their differences transparent. Rather than reinventing the wheel, Clinton would accomplish this through the existing Federal Employee Health Benefit Program.
ObamaCare would provide income-based, sliding-scale subsidies for people who need them to buy coverage, but it is unclear whether these would be direct payments or tax credits.
McCainCare: John McCain would attack reform from a different direction, focusing on cutting costs rather than providing universal coverage, although the two are related. He would come closest to decoupling employment from a health-care benefit, providing the option of a $2,500 direct refundable tax credit ($5,000 for families) to help people buy private insurance in a national market. (He does not say how he would create that national market.) He would expand health savings accounts and work with the states to create a guaranteed access plan to help those with pre-existing conditions; states could combine their high-risk insurance pools to achieve efficiencies.
But McCainCare likely would fall far short of universal coverage, does not rein in cost-shifting and does nothing to prevent insurers from cherry-picking their insureds.
So here's our bottom line. Without a mandate for universal coverage, it will be impossible to end cost-shifting and get a handle on costs. HillaryCare shows the most promise for accomplishing these linked goals. This is one area where Hillary Clinton's experience with an issue would pay off for all Americans.