How the Clinton and Obama health plans differ

I’ve been meaning to get to this for weeks now – while I (and others) have reviewed and compared the two plans and parts thereof, I’ve yet to see a brief but (reasonably) comprehensive comparison.
First, what these plans are not. They are not ‘socialized medicine”, single payer, or any version thereof. Both Obama and Clinton rely on private insurers to provide coverage, and make no changes to the health care provider community – they do not become government employees.
We’ll start with what others have said is the only real difference between the two – mandated universal coverage – Clinton’s plan requires a mandate; Obama’s doesn’t. I disagree- there are several other key differences, issues that we’ll highlight here and address in detail in future posts. The issues may seem picayune but the devil is in the details, and details in health care add up to half a trillion bucks or so.
From reading Obama’s campaign literature or speeches, it seems like the Senator is in favor of mandated universal coverage. Unfortunately, Obama’s rhetoric is inconsistent with his plan, leading me to suspect he wants to have his cake, eat it too, and not get fat. Obama does have a mandate, but it is specific to children – he requires all kids to have coverage, but his plan does not require working-age people obtain coverage.
(disclaimer – this is not all-encompassing, but rather meant to hit the high and medium points without getting down to the molecular level)

Here’s where Clinton and Obama (mostly) agree, with differences noted.
Guaranteed eligibility – insurers have to take all comers. That is, individuals with cataracts and family history of cancer and hypertension get coverage – they can’t be denied coverage or care.
Benefit plan design – Both call for a benefit design similar to the Federal Employee Health Benefit Plan – which is not too shabby. By definition, this eliminates individual states’ ability to mandate certain types of care (e.g. acupuncture) and therefore transfers determination and regulation of health plan benefits from the States to the Feds. Obama would allow states to experiment with richer benefits and plans, as long as those exceed the national standard. Nothing controversial here.
Mental health parity is a part of both candidates’ plans.
Insurance buying/regulatory agency – Both will set up a health insurance exchange/agency/entity to regulate insurers, facilitate enrollment, and provide information to consumers and employers. Obama goes quite a bit further, perhaps up to and over the edge of insurance price control – his website says the “plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration.” (so, if a health plan does a really good job of managing care and reducing cost, they are penalized? (sorry, couldn’t resist))
Funding – Both will require contributions from employers, insureds, and taxpayers, who will provide some of the funding for those in lower income brackets. In Obama’s plan, some small employers (no definition provided) will not have to help pay premiums; Clinton offers small employers (again, not defined) a Federal tax credit to help pay for insurance. Obama also promises to cover some portion of employers’ high cost claims; the assumption here is that his plan would have the Feds provide stop-loss insurance for claims above a certain dollar threshold. Clinton provides a similar mechanism, but only for retiree coverage. (this is a significant difference, but one no one is talking about).
In addition, Clinton would partially fund her program by rolling back the Bush tax cuts on families with incomes >$250,000
In contrast to Obama, Clinton’s plan relies on direct tax subsidies for low-income folks to help them buy coverage.
Cost and premiums – Here, Obama’s plan is silent on age rating – the actuarially-sound process of charging older folks more because they are more likely to need care. Clinton specifically prohibits “charging large premium differences based on age, gender, or occupation.” (One wonders, what is “large”?) Clinton will also base premium payments on income.
Portability – people can change jobs and keep their health insurance under both plans.
Pay for Performance (P4P) – both candidates support pay for performance, along with requirements that providers publish their outcomes data.
Prescription drugs – Obama and Clinton will allow reimportation and both will allow the Feds to negotiate pricing for Part D and other Federal programs.
Medical Malpractice reform – Clinton calls for “adoption of a model that provides liability protections for physicians who disclose medical errors to patients and who offer to enter into negotiations for fair compensation.” The plan would reduce their liability if the complied with reporting requirements, a measure that would both cut costs and encourage reporting.
And one other nuance
Clinton’s plan specifically allows individuals to keep their existing coverage or opt to replace it with another private or public plan (modeled on Medicare).
Next – a series of posts on the differences between the two…