In the epic primary battle between Barack Obama and Hillary Clinton, I chose Obama.
It is true that I found Clinton's stump style very annoying, that Obama was honey to her vinegar, that she never seemed able to disagree without being disagreeable. Still, it wasn't that that put me off, nor was it Clinton's gender, nor her political posse's ability to rationalize using the lowest of means (the 3 a.m. phone call ad, anyone?) to achieve what they viewed as righteous ends.
No, what kept me from embracing Clinton was strictly her approach to policy. I view Hillary as a somewhat smarter version of her husband: a corporate politician with a populist touch. Her policy positions—on the Iraq War, on NAFTA, on health care and the environment—were often Republican in substance, Democrat in style only.
Clinton's position on health care, ostensibly intended to steer toward universal health coverage but without dealing with the for-profit, publicly-traded heath insurance giants that continue to post huge profits by driving up prices and reducing coverage, exemplifies a chronic weakness in her and her party's stated resolve to put the interests of people ahead of the interests of business. Specifically, Clinton's plan, which closely resembles the Massachusetts health care reform law enacted with the bipartisan support of Beacon Hill Democrats and then-Gov. Mitt Romney, a Republican, has as its centerpiece an individual mandate—a requirement that everyone obtain health insurance. While Clinton's plan, like Massachusetts' reform law, offers a publicly subsidized program to those who qualify based on economic need, her plan would force anyone who didn't qualify for the subsidized plan to buy private insurance.
While the individual mandate in Massachusetts has been fairly unpopular, the insurance industry clearly loves it. Two major trade lobbies, America's Health Insurance Plans and the Blue Cross-Blue Shield Association, recently offered to end their practice of excluding people from coverage based on their health or age in exchange for a federal law that forces uninsured Americans to buy private insurance. Meanwhile, Sen. Ted Kennedy is reportedly considering including an individual mandate in whatever measure emerges from his Health, Education, Labor and Pensions Committee.
The individual mandate is a bailout for an industry that should never have been allowed to exist in its current form. Politicians who claim that the imposition of an individual mandate is a necessary step on the road to universal coverage apparently can't envision a health care system from which private insurance companies don't profit.
Insurance, at its root, is a fairly simple concept. If your house burns, or if you have a heart attack or get cancer, the associated costs will likely bury you. But if you and 100 friends get together and form a mutual insurance company, it's very unlikely that all of your houses will burn, or that all of you will have heart attacks or get cancer. So, by pooling your resources—each paying a small fraction of what you stand to lose if you're the one who has a fire or gets sick—you can spread the risk. Some years, the collective losses may be bad enough to force everyone to pay a little more; some years, if the losses are low, everyone gets a refund.
When we allowed mutual insurance groups to become publicly traded corporations, the objectives of insurance companies changed from managing risks faced by a collection of individuals to managing risks and creating profits for corporations. Today's health care system is costly in large part because we allow the insurance industry to participate and profit.
If Clinton and others in her party truly hope to achieve universal coverage, they must be willing to abandon a system that includes private insurers. If they want to mandate individual participation, they should use Social Security and Medicaid as their model, rather than forcing Americans to enrich private corporations.
