The Obama campaign just released this memo... Health CareObama and Clinton both have solid plans to improve our health care system. Their plans are very similar – they both reduce cost and provide universal coverage. The key difference is that Obama believes that the reason people do not have health insurance is because they cannot afford it, not because they do not want it. Clinton supports forcing people to buy health insurance even if they cannot afford it. Presumably under Clinton’s plan those who do not buy health insurance will be penalized in some way like paying a fine or having their wages garnished. After 17 debates, Clinton still has not revealed how she would enforce this mandate in her health care plan.
Yesterday, more than 85 health care experts released a letter debunking Senator Clinton’s critique of Obama’s plan.
Letter:
The leading Democratic and Republican candidates for president have proposed major changes to our health care system. These proposals are worthy of serious consideration. Rising medical costs threaten our country's long-term fiscal stability. And our failure to provide health insurance to 47 million Americans is cause for shame.
As this year's competitive primary election season builds to a climax, arguments within each party are bound to become heated. As candidates seek a competitive edge, it is natural to magnify small differences. But if the political debate over health reform is to inform Americans about the choices we face, it should be grounded on facts.
The remarkably similar health plans proposed by Senators Clinton and Obama have the potential to reduce the number of uninsured Americans (citizens, permanent residents, and others lawfully present in the U.S.) to two percent or less of the population. Achieving this goal would require full implementation of these plans' subsidies and insurance market reforms, plus robust outreach efforts to get everyone to sign up for coverage.
The necessary outreach will not be easy, and it will be fruitless unless health insurance is made affordable and accessible to all. Some believe that an individual mandate to buy health insurance should be part of this effort; others hold that a mandate would be paternalistic or too onerous for families at the margins of affordability. Regardless of our feelings on this issue, what is clear from the evidence is that mandates alone, without strong incentives to comply and harsh punishments for violation, will have little impact on the number of uninsured Americans.1 Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions. There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible.
The inaccurate claim that an individual mandate alone would reduce the ranks of the uninsured by 15 million draws attention away from the challenges we must surmount to make good medical care available to all. These challenges include adequate public subsidies, insurance market reform, outreach to people at the margins of American life, and long-term control of medical costs. Individual mandates may have a role in health care reform, but there is risk of a specious "Mission Accomplished" moment. It is a time for rolling up our sleeves and addressing the hard work required to get everyone care. The central challenge is to make health insurance affordable and accessible, and to reach out to all Americans to help them obtain coverage. Voters should insist that candidates for president address these very real issues.
1 S.A. Glied, J. Hartz, and G. Giorgi, "Consider It Done? The Likely Efficacy Of Mandates For Health Insurance," Health Affairs 26 (2007): 1612-1621.
Signers:
Stuart Altman
Dean and Sol C. Chaikin Professor of National Health Policy
Heller School for Social Policy and Management
Brandeis University
M. Gregg Bloche, MD, JD
Professor of Law
Georgetown University
Non-Resident Senior Fellow
The Brookings Institution
Adjunct Professor
Bloomberg School of Public Health
Johns Hopkins University
Nicholas A. Christakis, MD, PhD, MPH
Professor
Department of Health Care Policy
Harvard Medical School
Department of Sociology
Faculty of Arts and Sciences
Harvard University
David Matchar, MD
Professor of Medicine
Director, Center for Clinical Health Policy Research
Duke University Medical Center
E. Richard Brown, PhD
Professor of Health Policy
UCLA School of Public Health
Henry J. Aaron
Senior Fellow, Economic Studies
The Bruce and Virginia MacLaury Chair
The Brookings Institution
Paul Weiler
Emeritus Professor of Law
Harvard Law School
Elliott S. Fisher, MD, MPH
Professor of Medicine and Community and Family Medicine
Director, Center for Health Policy Research
Dartmouth Institute for Health Policy and Clinical Practice.
Harold Pollack, MPP, PhD
Faculty Chair, Center for Health Administration Studies
Associate Professor
School of Social Service Administration
University of Chicago
Lainie Friedman Ross, MD, PhD
Carolyn and Matthew Bucksbaum Professor of Clinical Ethics
Professor, Departments of Pediatrics, Medicine, and Surgery
Associate Director, MacLean Center for Clinical Medical Ethics
University of Chicago
David Blumenthal, MD, MPP
Director, Institute for Health Policy
Physician, Massachusetts General Hospital
Samuel O. Thier Professor of Medicine
Harvard Medical School
Professor of Health Care Policy
Harvard Medical School
Theodore Marmor, PhD
Professor Emeritus of Public Policy and Management
Professor Emeritus of Political Science
Yale School of Management
Barbara Starfield, MD, MPH
University Distinguished Professor
Johns Hopkins University
Paula Lantz, PhD
Professor and Chair
Department of Health Management and Policy
University of Michigan
Mark Schlesinger, PhD
Professor of Health Policy
Yale University
Nancy L. Keating, MD, MPH
Associate Professor of Medicine and Health Care Policy
Harvard Medical School
Gerald F. Kominski, PhD
Associate Dean for Academic Programs
Professor, Department of Health Services
UCLA School of Public Health
Diane S. Lauderdale
Associate Professor
Department of Health Studies
University of Chicago
David Cutler
Otto Eckstein Professor of Applied Economics
Harvard University
Einer Elhauge
Petrie Professor of Law
Director, Petrie-Flom Center in Health Law Policy
Harvard Law School
Kathleen A Cagney
Associate Professor
Department of Health Studies
University of Chicago
Ronald S. Sullivan Jr.
Clinical Professor of Law
Director, Harvard Criminal Justice Institute
Harvard Law School
Henry J. Steiner
Jeremiah Smith, Jr. Professor Emeritus
Harvard Law School
Martha Minow
Jeremiah Smith, Jr. Professor
Harvard Law School
Jerry Mashaw, PhD
Sterling Professor of Law and Management
Yale University
Laurie Zoloth, PhD
Director, Center for Bioethics, Science and Society
Director, Brady Program in Ethics and Leadership
Professor of Medical Humanities and Bioethics
Feinberg School of Medicine
Northwestern University
Dayna Bowen Matthew
Associate Dean of Academic Affairs
Professor of Law
University of Colorado School of Law
Elizabeth Bartholet
Morris Wasserstein Professor of Law
Faculty Director, Child Advocacy Program
Harvard Law School
Ellen Meara, PhD
Department of Health Care Policy
Harvard Medical School
Donald E. Fry, MD, FACS
Professor Emeritus
Department of Surgery
University of New Mexico School of Medicine
Mark E. Courtney
Ballmer Endowed Chair for Child Well-Being
School of Social Work
University of Washington
Jacqueline Fox
Assistant Professor
School of Law
University of South Carolina
Oliver Oldman
Learned Hand Professor of Law, Emeritus
Harvard Law School
Jane Loewenson
Partner
Nueva Vista Group LLC
Laurence H. Tribe
Carl M. Loeb University Professor
Harvard Law School
Thaddeus Mason Pope, JD, PhD
Visiting Professor, Widener University School of Law
Senior Scholar, Thomas Jefferson University Medical College
Assistant Professor of Law
University of Memphis School of Law
Mervin Shalowitz, MD Visiting Scholar
Kellogg School of Management
Northwestern University
Barbara A. Noah
Associate Professor
Western New England College School of Law
William Pitsenberger
Adjunct Professor, Health Law and Policy
Washburn University School of Law
Philip J. Rosenthal
Professor
Department of Medicine
University of California, San Francisco
Sarah-Anne Schumann, MD
Clinical Associate
Department of Family Medicine
University of Chicago Pritzker School of Medicine
Chicago Family Health Center
Daniel H. Lowenstein, MD
Professor of Neurology
Director, Physician-Scientist Education and Training Programs
University of California, San Francisco
Jonathan Skinner, PhD
Professor
Dartmouth College & Medical School
Robin Henry Dretler MD, FIDSA
President
Infectious Disease Specialists of Atlanta
Laurel Coleman, MD, CMD, FACP
Physician
Augusta, Maine
Ann M Labriola, MD
Associate Professor of Medicine
Division of Infectious Diseases
Department of Medicine
George Washington University Medical Center
Jens Ludwig
Professor of Social Service Administration, Law, and Public Policy
University of Chicago
Norman Daniels
Professor of Ethics and Population Health
Harvard School of Public Health
Donald H. Taylor, Jr. Ph.D.
Assistant Professor of Public Policy
Duke University
Colleen Grogan
Faculty Director, Graduate Program on Health Administration and Policy
Associate Professor
School of Social Service Administration
University of Chicago
Leon Wyszewianski, PhD
Associate Professor
Director, Executive Master's Program
Department of Health Management and Policy
University of Michigan School of Public Health
John Henning Schumann, MD
Section of General Internal Medicine
MacLean Center for Clinical Medical Ethics
Human Rights Program
University of Chicago
Michael Pine
Lecturer in Medicine
University of Chicago
Wade S. Smith, MD, PhD
Professor of Neurology
University of California, San Francisco
Keith W.L. Rafal, MD, MPH
Assistant Clinical Professor
Brown University Medical School
Bob Arnold
Professor of Medicine
Leo H Criep Chair in Patient Care
Chief, Section of Palliative care and Medical Ethics
University of Pittsburgh
James Tulsky, MD
Professor of Medicine and Nursing
Duke University
William M. Altman, JD, MA
Senior Vice President of Strategy and Public Policy
Kindred Healthcare, Inc.
Rebekah E. Gee, MD, MPH
Robert Wood Johnson Clinical Scholar
University of Pennsylvania
Clarissa K. Wittenberg
Health Education Consultant
Jason Block, MD
Physician
Brigham and Women's Hospital
Harlan M. Krumholz, MD SM
Harold H. Hines, Jr. Professor of Medicine
Yale University
S. Claiborne Johnston, MD, PhD
Professor of Neurology and Epidemiology
Director, Stroke Service
University of California, San Francisco
Richard Kronick
Professor
Department of Family and Preventive Medicine
University of California, San Diego
Maggie Czarnogorski, MD
George Washington University
Carl Vogel Center, Medical Director
Howard P. Forman MD, MBA
Professor of Diagnostic Radiology, Management, and Public Health
Lecturer, Economics
Director, Yale MD/MBA Program and Yale MBA for Executives: Leadership In Healthcare
Yale University
William Terry, MD
Brigham and Women's Hospital
Rahul Rajkumar, MD, JD
Physician
Brigham and Women's Hospital
Frederick A Masoudi, MD, MSPH
Associate Professor of Medicine (Cardiology)
Denver Health Medical Center
University
David A. Richardson
Health Care Consultant
Helen Levy, PhD
Research Assistant Professor
University of Michigan
Robert Burt, JD, MA
Professor
Yale Law School
David B. Wilkins
Kirkland & Ellis Professor of Law
Director Program on the Legal Profession
Harvard Law School
Gene Webb, PhD
Manager of Planning
Biological Sciences Division
Pritzker School of Medicine
University of Chicago
Nikhil Wagle, MD
Physician
Brigham and Women's Hospital
Clifford E. Douglas, JD
Executive Director, University of Michigan Tobacco Research Network
Adjunct Lecturer, University of Michigan School of Public Health
Senior Policy Fellow, Michigan Public Health Institute
Thomas G. McGuire
Professor of Health Economics
Department of Health Care Policy
Harvard Medical School
Robert A. Berenson, MD
Senior Fellow
The Urban Institute
Stanley S. Wallack
Professor
Heller School for Social Policy and Management
Brandeis University
Charles J. Ogletree, Jr.
Jesse Climenko Professor of Law,
Harvard Law School
Jon Klein, MD, PhD
James Graham Brown Foundation Endowed Chair in Proteomics
University of Louisville
Sara Rosenbaum
Chair, Department of Health Policy
Harold and Jane Hirsh Professor of Health Law and Policy
Professor of Health Care Sciences
George Washington University
John C. Coates IV
John F. Cogan, Jr. Professor of Law and Economics
Harvard Law School
Peter J. Hammer
Professor of Law
Wayne State University Law School
Meredith B. Rosenthal, PhD
Associate Professor of Health Economics and Policy
Department of Health Policy and Management
Harvard School of Public Health
Barron H. Lerner, MD, PhD
Professor of Medicine and Public Health
Columbia University
Lucian L. Leape, MD Harvard School of Public Health
Kasturi Haldar
Charles E. and Emma H. Morrison Professor
Department of Pathology
Northwestern University
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