- The Washington Times - Monday, February 18, 2008

Photo: On the campaign trail Sen. Hillary Rodham Clinton often gets her loudest applause when she talks about her failed health care reform effort, and the candidates’ promises to tackle universal coverage have become a major flash point on the campaign trail.

The New York senator says she learned from her mistakes and will give Americans a choice of health care plans, while attacking rival Sen. Barack Obama as having abandoned the core principle of universal care because he doesn’t mandate insurance coverage.

Mr. Obama says their plans aren’t so different on substance — they both would open the congressional insurance plan to everyone, for example — but lately he has toughened his language. The Illinois senator says the Clinton plan “forces” families to buy insurance, and argues subsidizing health care costs is more important than mandating coverage.

Democratic congressional leaders mostly have avoided getting in the middle of the health care issue.

Leadership aides say privately they expect Congress to start laying the groundwork for the broader health care proposal they would likely have to consider if a Democrat is president in 2009. Among those initiatives are creating an electronic medical-records system to cut costs and making sure health care providers use technology to offer the most-efficient care.

In the meantime, health care has provided for the most heated exchanges on the campaign trail, on television in Wisconsin and in nasty mailers each candidate has sent to voters.

The issue has allowed Mrs. Clinton to showcase her credentials on a key issue and provided Mr. Obama a tangible example of his warning that he’s the better choice because America does not want to refight the battles of the past two decades.

Mrs. Clinton says a president would not be able to stand up to special interests and pass a plan unless the president is committed to universal coverage from the start, and she says only a candidate who starts out with a mandated plan to cover everyone will be able to beat the Republicans.

“When it comes to universal health care, my opponent is saying ‘No, we can’t,’ ” Mrs. Clinton said at a stop in Washington earlier this month. “Well, I say, yes, we can, and yes, we will, if we make the right decision in this election.”

She has framed the issue as a “moral” one, and told voters in Virginia, “If you care about health care for everyone I hope you will vote for me.”

This weekend Wisconsin voters were treated to a mailer featuring seven persons under the headline, “Barack Obama, which of these people don’t deserve health care?”

It also charges the Obama plan “wastes billions” and that his plan says, “No, we can’t” have universal coverage.

The mailer prompted Obama supporter Sen. Edward M. Kennedy to label it as “basically fear-mongering,” and criticize the Clinton campaign for trying to distort the Obama plan.

The Massachusetts Democrat, who has championed universal care for decades, told reporters yesterday he was “shocked and very surprised” by the mailer because similar tactics helped derail the Clinton efforts in 1994.

But Mr. Obama has done his share of twisting Mrs. Clinton’s health care plan. He sent voters a mailer accusing his rival of wanting to “force” families to buy insurance even if they can’t afford it, and her campaign shot back he is using Republican talking points.

“Punishing families who can’t afford health care to begin with just doesn’t make sense,” the Obama mailer blared.

That line from the mailer refers to Mrs. Clinton’s plan to mandate coverage. She has said in interviews she will have some kind of “enforcement mechanism” that could be a tax system, automatic enrollment or even “going after people’s wages.”

Mr. Obama only seeks mandatory coverage for people younger than 25.

Voters who favor Mrs. Clinton consistently say they choose her because she will fight for universal health care and voters for either candidate often cite health care as their top issue, but few seem to care about the details.

Obama backers say he is better positioned to create coalitions that will actually pass health care through a closely divided Congress.

Rep. Jim Cooper of Tennessee said he still has a sour taste lingering from the health care battles in the 1990s and thinks a mandate similar to Mrs. Clinton’s proposal would make Republicans less likely to sign on.

“We should not let the best be the enemy of the good,” he said. “In practice, you’ve got to get this through Congress.”

He also pushed back on Mrs. Clinton’s all-or-nothing approach, saying the government took incremental steps in major legislation such as the creation of Social Security.

Mrs. Clinton tells voters she is “proud” that she and former President Bill Clinton fought for universal health care during his first term, even though they failed to get anything through Congress. Her supporters laud those efforts, calling her tough and dedicated to the issue.

But the failure is fodder for her rivals to remind voters of criticism from those days, and Republicans still brand any health care proposals they don’t like as “Hillarycare.”

“The Clintons’ efforts to reform health care in the 1990s didn’t fail for a lack of good ideas, but because the process was too secretive and they were unable to bring people together behind their plan,” the Obama campaign argued in a memo.

Mr. Cooper lamented the 1994 Clinton proposal as “drawn up by a secret task force,” adding, “She did not want us to alter a comma in her plan.”

Mr. Obama has said he would open his health care meetings to the public and have them broadcast on C-SPAN.

On the campaign trail Mr. Obama touts his own efforts to expand health insurance in Illinois as a state senator. He predicts his plan — which he estimates would lower costs for the average family by $2,500 annually — could become law by the end of his first term.

At the core of Mrs. Clinton’s “American Health Choices Plan” is a choice between improving coverage and keeping what you have, and she offers tax credits to subsidize costs. On the trail she discusses how the failed 1994 effort inspired her to create the Children’s Health Insurance program, and she adds that she expanded rural health care as first lady in Arkansas.

Both candidates’ plans would prohibit insurance companies from denying coverage due to pre-existing conditions, and both offer plans that would follow a person after a job switch.

Their plans would open coverage to self-employed people and small businesses. Both would decrease costs with technological improvements to the health care system, including electronic medical records, and would focus on preventive care and healthy living.

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