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Advisers for Top Presidential Candidates Discuss Health Care

By Sara Lubbes, CQ Staff

February 6, 2008 -- On the eve of the Feb. 5 "Super Tuesday" primaries, health policy advisers for three of the top presidential candidates met in Washington to explain to other health experts why their candidate has the best plan to overhaul America's health care system.

Despite trading some barbs, representatives for Democrats Sen. Hillary Rodham Clinton of New York and Sen. Barack Obama of Illinois also joined forces at the forum—sponsored by health think tank AcademyHealth and attended by medical professionals from around the country —to attack Bush administration health policies and stress why they believe either Democrat's plan would be superior to ideas touted by presumed GOP front-runner Sen. John McCain of Arizona.

"I couldn't be prouder of the Democratic candidates," said Chris Jennings, a former adviser to President Bill Clinton now advising Clinton's campaign. "We couldn't feel better about our candidates and about our future."

Both the Obama and Clinton campaigns want to require employers to make some kind of health care cost contribution or provide health insurance to their workers—the so-called pay or play mandate. But Clinton would require all Americans to carry health insurance, while Obama would require families to carry the insurance for their children.

McCain wants to open up the private insurance market to more people by awarding tax credits to families that want to buy insurance they could carry from job to job. The credit would award $2,500 in tax credits to individuals and $5,000 to families, explained McCain health adviser Tom Miller, a fellow at the conservative think tank American Enterprise Institute.

McCain also would allow people to buy insurance plans across state lines to make the market more competitive and drive down costs, Miller said.

"It's called giving the American people money and letting them make the choice," Miller said. "You could spend your money on [many things] as long as it related to health."

But both Jennings and Obama health care adviser Gregg Bloche, a law professor at Georgetown University and fellow at the left-leaning Brookings Institution, said McCain's plan is based on a "myth" and argued the tax credit would never be enough to cover costs for a family of four.

"Affordability is really a difficult subject reality or families sitting around the table," Bloche said.

Bloche and Jennings did spar a bit over whether Clinton's plan to require every American to have health insurance coverage is the right solution to drive down health costs.

Clinton has argued that unless everyone is covered, the insurance risk pool will never be large enough to convince insurance firms to lower their costs. Obama has said such a plan would be punitive and impossible to pass through a highly-polarized Congress.

Jennings, Clinton's adviser, argued that Obama's plan contradicts itself because it would require insurance for children, although Obama has said he believes it's too much of a burden to cover everyone.

"All we're talking about is a false promise at the end of the day, and that would be a cruel hoax," Jennings said.

But even with their disagreements, the Clinton and Obama advocates were civil: Bloche tampered the debate by noting that Obama is not opposed to a health insurance mandate; he just believes in trying a more "modest" approach first.

"If Obama is open to looking at" mandatory insurance, "we're making progress in this debate," Jennings said with a chuckle.

McCain adviser Miller said the American people will never support either Democrat's health care plan once they realize the costs. Clinton has said she's willing to garnish the wages of people who would refuse to pick up health insurance. And critics of a "pay or play" insurance mandate for employers say it could prompt employers to lower wages or fire people to avoid costs.

Universal health care "doesn't mean ordering your menu of ice cream and someone else pays for it," Miller said. "The money has to come from somewhere, and it's likely to be you."

ChartCart: See select slides from event moderator and Commonwealth Fund president Karen Davis' Presidential Candidates' Health Care Reform Proposals Presentation.

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