Question

How does Obama's Affordable Care Act of 2010 compare with Clinton Health Reform Plan?

Answer 1

The basic shape of the Obama plan is to set up insurance exchanges for the uninsured, people in the individual market today and small businesses that want to join. It also expands Medicaid coverage. "And so the 250 or so million Americans who have either private sector based coverage OR are on a public program like Medicare and Medicaid, are untouched by this. By contrast, the Clintons' 1993 plan set up regional alliances, "which were sort of like exchanges, but they covered everyone, so people in employer based coverage today would be shifted into regional alliances.

In addition, its mandate was a lot tougher, it did have an employer mandate as well an individual mandate and was based on expanding the employer based system - so everyone was to be covered by their employers. (Hence small business opposition: they would be required to cover, rather than just getting an option).

Comparison between the two plans can really be boiled down to two points:

1. In short, both plans are very similar. Either one would be a significant step in the right direction, moving the US toward a more workable and sustainable health care system. Of course some of the similarities stem from a necessary lack of detail at this point, but both would point us in the direction of universal coverage, especially by allowing Americans to opt for public health insurance rather than private. And, both would be funded by rolling back some of the Bush tax cuts for those in the higher tax brackets and by increasing the cost efficiency of health care through modernization and focusing on preventative care.

2. When it comes down to it, though, the Clinton plan truly is more comprehensive--for the sole reason that it mandates that all Americans must have health insurance. Obama's plan does not (but it does require that all children have health insurance). The oft-quoted number of 15 million left uninsured under the Obama plan is probably at least roughly correct, although it's very difficult to judge that at this point. It's important to emphasize that those left uninsured would be uninsured out their own choice--at least as long as Obama is able to deliver the affordable health care options that his plan promises--and would supposedly eventually be lured by these new, more affordable options. Still, experience demonstrates that a sizable population will opt out--however ill-advisedly--of purchasing health insurance, unless it is required. On this point, then, Clinton certainly wins.

But...

3. I still think that when political realities are taken into account, (A) the Clinton plan would be harder to pass unaltered and (B) Clinton herself will have trouble pushing universal care due to the ghosts of her past efforts in the 90s. It's unfair, but I think it's true.

4. Unfortunately, neither plan effectively addresses the root cause of the inefficiency of the American health care system, which is the patchwork of private profit-driven insurers. Until we do that, we won't truly fix the problem. Even if Clinton or Obama becomes the next president and one of their health care plans is passed without being watered down too much, we'll still have a long way to go. But, I suppose you have to take it one step at a time, and either plan would be a step in the right direction.