MICHELE NORRIS, host:
This is ALL THINGS CONSIDERED from NPR News. I'm Michele Norris.
Next week, almost half the states will vote or caucus to choose a Republican and a Democratic presidential nominee, 24 to be exact. Polls tell us many Americans remain undecided, so we're looking at a handful of the issues in the campaign. Today, the subject is health care. It's always an important issue for Democratic voters, but this year, Republicans are also worried about rising costs, so every candidate has a health care plan.
Mr. MITT ROMNEY (Republican, Former Governor of Massachusetts; Presidential Candidate): A lot of people have ideas about health care and improving health care.
Representative RON PAUL (Republican, Texas; Presidential Candidate): People in this country are actually going to India and getting their heart surgery done…
Senator BARACK OBAMA (Democrat, Illinois; Presidential Candidate): If we didn't have a system in which employers had typically provided health care, I would probably go and…
Senator JOHN MCCAIN (Republican, Arkansas; Presidential Candidate): Will be able to go out and choose their insurer anywhere in America, and they will be…
Senator HILLARY CLINTON (Democrat, New York; Presidential Candidate): I'm proposing health care tax credits that will make health care for everyone affordable.
Mr. MIKE HUCKABEE (Republican, Former Governor of Arkansas; Presidential Candidate): We won't give you deductions for going to a gym or health club, but we'll pay 100,000 bucks if you have a quadruple bypass.
NORRIS: With us to sort through some of these is NPR health policy correspondent Julie Rovner. Hello, Julie.
JULIE ROVNER: Hi, Michele.
NORRIS: Let's start with the Democrats. What's the rub between senators Hillary Clinton and Barack Obama?
ROVNER: Well, as you mentioned at the top, health care is a huge issue for Democratic primary voters. And even though their plans are actually pretty close, there is an effort to exploit any differences they can find.
NORRIS: They had quite a dustup over health care during a debate in Myrtle Beach, South Carolina. Let's listen to Senator Clinton.
(Soundbite of Democratic debate)
Sen. CLINTON: Because if we don't have everybody in the system, we know what will happen. We will begin to have more and more people who are uninsured. The health insurance companies will continue to cherry-pick. The hidden tax that comes when someone does finally show up at the emergency room will be passed on to everyone else. So I am adamantly in favor of universal health care, and that means everybody is covered.
NORRIS: Everybody is covered. So Julie, it sounds like Hillary Clinton's plan would require people to have health insurance.
ROVNER: Yes, that's correct. It's called an individual mandate. John Edwards, who just dropped out, also had one. And Obama has one too, at least for children. Now, this is not a really coincidence. All three of those plans actually came from the same source, Yale University political science professor named Jacob Hacker. And all three were based on the concept of something called shared responsibility, where the government and individuals and employers all get to pay something. It's actually quite similar to what they're doing in Massachusetts. Although, kind of interestingly, then-governor-now-Republican candidate Mitt Romney is sort of running away from that.
Now, the big difference among the Democrats, in fact, really the only meaningful difference, is that while Senator Clinton's plan, until a few days' ago, Senator Edwards's plan would have required everyone to have coverage, Senator Obama's plan wouldn't.
And here's how he defended that decision in the debate last week.
Sen. OBAMA: My core belief is that people desperately want coverage. They desperately want it. And my plan provides those same subsidies. And if they are provided those subsidies and they have good quality care that's available, then they will purchase it.
ROVNER: What he's saying here is basically that if you build it, they will come, that you don't have to have a mandate to get people to buy insurance.
NORRIS: Julie, let me make sure that I have this right. Both Senator Clinton and Senator Obama would let all people keep their existing coverage, if they want to, or buy into a government-sponsored plan, like Medicare, and the government would then subsidize small businesses and the poor? Is that correct?
ROVNER: That's exactly correct. And while economists do agree with Senator Clinton that you won't get everyone covered without some sort of mandate - in fact, the Urban Institute, just this week, put out a study that said without a mandate, you'd probably still have 15 million people uninsured, which is the number Senator Clinton's been using all along - it is still clear that both Democrats' plans would likely cover a lot more of the 47 million uninsured than the plans being offered by the Republicans.
NORRIS: Let's round the corner and turn to the Republicans. They're also more alike than they're different, aren't they?
ROVNER: Yes, they are, although they're not quite as alike as the Democrats' plans. The Republicans, like President Bush, want to rely more on the free market to create more competition to push down the cost of health care. And they want to use the tax code to encourage more individuals to buy their own insurance rather than to get it from their employers. Here's how former Arkansas Governor Mike Huckabee puts it.
Mr. HUCKABEE: You own the health care and it stays with you for a lifetime, hopefully, but certainly for a much longer period of time. So now you and the insurance company are partners in trying to keep you healthier because you're going to be financially rewarded for that and so will they. Once you change that model so that it's profitable for you and profitable for the insurance company to prevent your illness, there's a greater chance they'll put the coverage in.
NORRIS: It seems that personal responsibility is a theme running through all these Republican plans.
ROVNER: Yes, it is. Huckabee, who's probably best known for losing more than 100 pounds, also has another provision in this plan that would allow people who live, quote, "healthy lifestyles" to pay lower health insurance premiums. And John McCain is proposing to pay doctors in hospitals based on how well their patients do.
Sen. MCCAIN: We have to have outcome-based results for health care. We have to emphasize wellness and fitness. One of the most disturbing things in America is the increase in diabetes, obesity and high blood pressure amongst younger Americans, so we have to reward wellness and fitness.
NORRIS: Julie, what about the candidate who's actually implemented a major health reform plan, former Massachusetts Governor Mitt Romney? Where is he at now?
ROVNER: Well, he's in a pretty awkward place. On the one hand, as you point out, he has done what none of the other candidates, particularly Hillary Clinton, can claim. He has signed a major health reform into law. On the other hand, the Massachusetts plan has a mandate attached to it, which is something Republican primary voters aren't really thrilled with.
Here's how tried to put a conservative spin on it just before the New Hampshire primary.
Mr. ROMNEY: I want to underline this. We don't have to have government take over health care to get everybody insured. That's what the Democrats keep by hanging out there. The truth is we can get everybody insured in a free market way. We don't need Hillary-care or socialized medicine.
NORRIS: So he's saying you don't need Hillary-care. So what would Mitt Romney do if he doesn't want to replicate the Massachusetts model on a national scale?
ROVNER: Well, his plan for the nation is to basically let states do whatever they want. If they want to do what Massachusetts did, that's fine. If they want to do something else, that's fine too. He'd actually rolled back the federal standards that are now in place for the Medicaid program for the poor and let states take that money and figure out how to cover the uninsured however they want, which would in fact be a pretty dramatic change.
NORRIS: So candidates from both parties proposing fairly far-reaching health care plans. Could you sum things up for us?
ROVNER: Yeah. I think one of the things that's really interesting is that even though the Democrats' plans would probably cover more of the uninsured, the Republicans' plans would actually probably change the health system more. More people would actually change the way they get their health insurance. But in the end, I think we're really back to the fundamental debate that's been going on for generations, which is that the Democrats' plans would rely more on government and the Republicans' plans would rely more on the free market.
NORRIS: Julie Rovner covers health care policy for NPR. Julie, thank you very much.
ROVNER: You're welcome.
NORRIS: And if you want to learn more about the candidates and the issues, please go to our Web site, npr.org/elections.
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