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Sen. Barack Obama (D-IL) at a May campaign stop in New Orleans. Sen. Hillary Clinton (D-NY) speaks with supporters during a meeting at the Lincoln Elementary School in Charles City, Iowa.
Health care is taking center stage in the race for the Democratic presidential nomination. In Iowa City on Tuesday, Illinois Sen. Barack Obama unveiled a comprehensive plan to provide health coverage to every American. Obama's speech comes just days after rival Sen. Hillary Clinton presented the first part of her health plan at George Washington University in Washington, D.C.
If Obama's plan to cover everyone — which he's been promising since January — has a familiar ring to it, it may be because it borrows from a long list of Democratic plans of the past, including those put forward by President Clinton, as well as the last two Democratic presidential nominees, former Vice President Al Gore and Massachusetts senator John Kerry.
Among other things, it would expand public insurance programs for the poor, provide subsidies for private insurance for the middle class, and create a health-insurance exchange to oversee the private insurance market.
"If you are one of the 45 million Americans who don't have health insurance, after this plan becomes law, you will have health insurance available to you," he said in a speech at the University of Iowa. "No one will be turned away because of a pre-existing condition or illness. Everyone will be able buy into a new health insurance plan that's similar to the one that every federal employee — from a postal worker in Iowa to a congressman in Washington — currently has for themselves."
Obama would pay for his plan in a variety of ways: by letting President Bush's tax cuts for the wealthy expire; by requiring most businesses to pay a share of worker premiums; and by focusing on prevention and wringing inefficiencies out of the current system. That latter part is almost identical to the seven-point cost-cutting plan laid out last week by fellow candidate and senator Hillary Clinton.
"The money we save from the waste we eliminate and the way we change how we care for people should be used to help finance coverage for the 45 million Americans who have no insurance," Clinton told an audience of mostly health professionals at George Washington University.
"Also, when you insure everyone, it will maximize the impact of the prevention programs I have recommended — with early care as opposed to emergency care — as well as cutting administrative costs," she said.
Clinton's speech last week focused solely on costs. She said future speeches will address health care quality and insurance coverage for all Americans. But Clinton and Obama aren't the only Democratic candidates with full-scale health plans. Former North Carolina Sen. John Edwards put out his plan to cover everyone in February. Ohio Rep. Dennis Kucinich is a longtime sponsor of the so-called single-payer plan that would have the government replace private insurance.
Harvard School of Public Health professor Robert Blendon says he would be surprised if the Democratic candidates weren't talking a lot about health care.
"To Democratic primary voters, health care is the core of what it means to be a Democrat," he said. "They really think today that government has to do something to help them with their situation."
Republican primary voters, by contrast, tend to worry more about taxes and security. Which may help explain the peculiar case of former Massachusetts Republican governor Mitt Romney. He rarely talks about health care on the GOP presidential campaign trail. Yet he signed the bipartisan health coverage law that's now the basis for many of the national Democrats' plans.
Meanwhile, Drew Altman, president of the Kaiser Family Foundation, says all the big health plans being offered by the Democrats may in the end just cancel one another out. While experts will be able to see the differences between each candidate's plan for information technology or chronic disease management, voters will likely just note that each candidate has a big health plan.
"And if any candidate gains an edge on health, I think it will be the candidate that convinces the voters that they can finally forge a consensus that can finally get something done and get something passed in the Congress," Altman says.
Of course, that assumes the public will prefer the Democrats' approach to the more free-market approach to health care that's likely to be pushed by the Republican nominee.