"Clinton Attack on Obama Overlooks Some Realities"

NY Times:

Senator Hillary Rodham Clinton has been attacking Senator Barack Obama’s health care plan, saying that while her proposal would provide universal coverage, his would leave out 15 million people.

“I don’t think we should start by giving up on 15 million Americans,” Mrs. Clinton said Monday in Clear Lake, Iowa, adding, “That’s why my health care plan covers everyone.”

Mr. Obama would require all children but not all adults to get health insurance. Mrs. Clinton would mandate that everyone obtain coverage. Both plans intend to lower the cost of health insurance so employers would be more willing to provide it and virtually all individuals could afford it.

But while Mrs. Clinton is right that Mr. Obama’s plan would leave out millions, she is being misleading in implying that her own plan covers everyone. Mandates rarely achieve 100 percent compliance. In addition, they are almost impossible to enforce.

Because of those difficulties, Mrs. Clinton’s own plan would probably leave out millions.

Mandates have not worked with auto insurance. While all drivers are required to have it, 15 percent of the nation’s drivers have none, according to the Insurance Research Council.

Mr. Obama’s health plan could actually have a better compliance rate. The 15 million who would supposedly be left out equal about 5 percent of the population — a smaller portion than are going without auto insurance, said Joseph Antos, a health policy expert at the American Enterprise Institute, a nonpartisan group.

“If Obama’s plan were to leave 15 million people without insurance, I think Senator Clinton’s plan would certainly do the same, not because of a mandate but because of the fundamental problems of getting people to recognize that they should buy insurance and making them buy it,” Mr. Antos said.

The 15 million figure apparently originated in The New Republic. While experts say the article was well researched, the 15 million is an estimate; no one appears to have a better figure.

The experience in Massachusetts, which has enacted universal coverage with a mandate that everyone obtain health insurance, shows how difficult it is to force everyone to comply. About 20 percent of people in that state do not have health insurance even with the mandate. The average cost of a policy is $12,000 a year for a family and $5,000 for an individual. It is likely to take years before costs come down enough so that lower-income people can afford health insurance and are willing to pay for it.

Austan Goolsbee, an economics professor at the University of Chicago and senior economic adviser to the Obama campaign, said the Clinton campaign should acknowledge that its plan would leave out at least as many as Mr. Obama’s — partly because Mrs. Clinton has not said how she would enforce her mandate.

“She has not suggested a penalty,” Mr. Goolsbee said. “If there’s not a major penalty for skipping out on insurance, people will skip out on it.”

Barack Obama