STEVE INSKEEP, Host:
Obama's campaign sent out flyers in Ohio, which votes next week. The flyers attacked Clinton's positions on trade and health care. Hillary Clinton said her positions were distorted.
INSKEEP: This is the kind of attack that gives aid and comfort to the very special interests and their allies in the Republican Party who are against doing what we want to do for America. So shame on you, Barack Obama.
INSKEEP: When it comes to health care, the two candidates differ over something called an individual mandate. Clinton's plan requires everybody to get insured. Obama's plan does not. We asked NPR's Julie Rovner to examine what both are really proposing.
JULIE ROVNER: At the candidates' debate in Austin, Texas Thursday night, Senator Clinton wasted no time hitting Senator Obama with the health care club she's been wielding against him for months.
INSKEEP: When I proposed a universal health care plan, as did Senator Edwards, we took a big risk because we know it's politically controversial to say we're going to cover everyone. And you chose not to do that. You chose to put forth a health care plan that will leave out at least 15 million people. That's a big difference.
ROVNER: And is it true that Senator Obama's plan would leave that many people uncovered? Linda Blumberg, a health economist at the Urban Institute, says that's certainly a plausible number. And she says Clinton's larger point about the need for an insurance mandate is also correct.
M: There is clear evidence that without a requirement that everyone have health insurance, or absent that, a government program where everyone is automatically given health insurance without having to sign up for it, that you won't get everyone.
ROVNER: And having a voluntary system, Blumberg says, causes problems because only those who expect to need health care will sign up.
M: So you have to really be careful. Even if you set up a system where everybody can come into a particular purchasing pool and get coverage if they want it with subsidies, which is what Senator Obama is suggesting, even those pools can become very expensive quickly if they're really only become attractive to individuals with high health care needs.
ROVNER: But Obama and his health advisors, like Harvard economics professor David Cutler, insisted they can cover nearly all of those uninsured people without a mandate.
INSKEEP: The way to get people who don't have insurance coverage to be able to have insurance coverage is to make it affordable and make it accessible. And if you do that, virtually everybody will buy insurance.
ROVNER: And Cutler says that if that turns out not to be the case, Obama, who already has a mandate for covering children in his plan, would be willing to look at adding a mandate for adults later.
INSKEEP: It's kind of strange to think that you only get one shot at health care reform. The idea that if you don't do everything all at once, you'll never get to do it isn't really the right way to think about this.
ROVNER: On the other hand, Obama doesn't hesitate to use Clinton's mandate and what it might take to enforce it as a weapon of his own. Here's what he said Thursday night...
INSKEEP: In order for you to force people to get health insurance, you've got to have a very harsh, stiff penalty. And Senator Clinton has said that we will go after their wages.
ROVNER: Actually, going after people's wages is not part of Clinton's plan, although she hasn't ruled that out. But Linda Blumberg of the Urban Institute says Obama is giving aid to enemies of universal health coverage by suggesting that enforcing a mandate would, by definition, be punitive. She says that's particularly dangerous for him since he has a mandate in his plan, at least for children.
M: You know, a lot of people have this idea that, oh, you know, you don't buy health insurance, we're going to send you to jail. That's not how rational people are thinking about this. You're basically talking about using an enforcement mechanism as a way of getting people enrolled in health insurance coverage and paying the back premium that they should've paid if they enrolled on the right date.
ROVNER: Of course, while both Clinton and Obama say their goal is coverage for all, they both leave out a sizable group of residents: the estimated 12 million people who are in the U.S. illegally. Blumberg says that will hurt either candidate's ability to pay for their health programs.
M: The safety net providers, the public hospitals, they still need those government dollars to help support individuals who are going to be uninsured, and we can't take that money and use it to help finance a new program.
ROVNER: Julie Rovner, NPR News, Washington.
INSKEEP: You can compare details of the Democratic and Republican candidates' health plans for yourself by going to npr.org.
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