By Anne E. Kornblut and Perry Bacon Jr.
Washington Post Staff Writers
Wednesday, May 30, 2007
IOWA CITY, May 29 -- Sen. Barack Obama (Ill.) echoed familiar Democratic themes on Tuesday in calling on businesses, insurance companies and lawmakers to reject the "failed politics" of past debates and overhaul the nation's health-care system to cover every American.
Obama, who is among the front-runners for the Democratic presidential nomination, offered few new ideas in laying out his plan to expand health insurance and to greatly reduce health-care costs. Instead, he cast his proposal in the themes that have defined his candidacy: optimism and a desire to move beyond partisan politics. He offered ideas that have long been proposed to solve one of the country's most vexing problems: increasing subsidies for those who cannot afford insurance but do not qualify for public programs, spending more federal money on disease prevention and making health records electronic.
"We now face an opportunity -- and an obligation -- to turn the page on the failed politics of yesterday's health-care debates," Obama told a crowd of medical professionals. "It's time to bring together businesses, the medical community and members of both parties around a comprehensive solution to this crisis, and it's time to let the drug and insurance industries know that while they'll get a seat at the table, they don't get to buy every chair."
Referring to the failed effort of Sen. Hillary Rodham Clinton (N.Y.), one of his 2008 campaign rivals, to reform health care in the early 1990s, Obama said that achievements nationwide in recent years by Democratic and Republican governors show that expanding health care is no longer too politically dangerous. "We can do this," he said. "The climate is far different than it was the last time we tried this, in the early '90s."
The proposal, part of a series of speeches Obama has given over the past several weeks after he faced criticism from some party activists for speaking too much about his popular themes of hope and optimism rather than policy plans, in many ways resembles the ideas of some of his challengers. It comes as all the Democratic candidates, looking for advantage in a tight primary contest, are trying to find ideas that will connect best with liberals who want to see more aggressive action in expanding health care and ending the war in Iraq.
Like former senator John Edwards (N.C.), who outlined his health-care goals in February, Obama would pay for his plan, which could cost more than $50 billion, by increasing taxes for people earning more than $250,000 and reversing tax cuts that President Bush approved. Obama would require almost all employers to offer insurance to workers or face a tax penalty, an idea that many businesses abhor and that is also in Edwards's proposal. This employer mandate drove much of the opposition to the Clinton plan in 1994.
Like Clinton, who in a speech last week laid out some of her health-care ideas, Obama is focused as much on reducing the costs for those who are insured as on expanding coverage to the estimated 45 million Americans who are not. He called for the federal government to pay part of the costs for patients with chronic illnesses, so that employers would not have to do so, but also emphasized the importance of preventive care. It is important to "listen to our wives when they tell us to stop smoking," he said, referring to his own unhealthy habit.
Like many Democratic politicians, he blamed drug and health insurance companies for stopping the passage of more expansive health-care proposals.
The lack of new ideas in Obama's health plan in part reflects his approach. He has emphasized his freshness as a rationale for his candidacy, but that freshness has been much more about his tone and his rhetoric about hope and bipartisanship than his policy proposals, which have largely mirrored those of his 2008 rivals and the ideas that Sen. John F. Kerry (D-Mass.) offered in the 2004 presidential race.
One concept that Obama's plan does not include is a popular idea from both Democrats and Republicans who work on health-care issues: an "individual mandate" that would require every American to buy health insurance. A landmark plan that was approved in Massachusetts last year made such a requirement, and without it, health experts say, Obama's plan is unlikely to create universal health coverage, although his advisers estimated that it would provide insurance to almost all Americans. Edwards's proposal calls for such a mandate and Clinton is likely to include it in hers as well, her advisers said. Obama would require only that all children have health coverage.
The Clinton and Edwards campaigns quickly criticized Obama for not offering a plan that would require insurance for all. "Any plan that does not cover all Americans is simply inadequate," said Mark Kornblau, an Edwards spokesman.
Obama's advisers argued that such a mandate is less important than adding subsidies and other ways to make health care more affordable. The senator's aides estimated that his plan would save the average family $2,500 per year and would allow those without insurance to buy it through a new health-care option that would resemble the one federal employees can choose. They said it would create a national health entity from which people could buy private insurance plans.
"The key is not the mandate," said David Cutler, an economics professor at Harvard, who advised Obama on the plan. "It's the affordability and the accessibility."
Obama's allies described his proposal as far-reaching and achievable. Obama made a similar argument, telling the crowd in Iowa City that voters are tired of candidates who "offer up detailed health-care plans with great fanfare and promise, only to see them crushed under the weight of Washington politics and drug-insurance-industry lobbying once the campaign is over."
Bacon reported from Washington. Staff writer Christopher Lee in Washington contributed to this report.