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Democrat Hillary Rodham Clinton called for universal health care on Monday, plunging back into the bruising political battle she famously waged and lost as first lady on an issue that looms large in the 2008 presidential race.
“This is not government-run,” the party’s front-runner said of her plan to extend coverage to an estimated 47 million Americans who now go without.
Her declaration was a clear message to Republicans, the insurance industry, businesses and millions of voters who nervously recall what sank her effort at health care reform 13 years ago in her husband’s first term — fear of a big-government takeover.
In unveiling her plan, she called for a requirement for businesses to obtain insurance for employees, and said the wealthy should pay higher taxes to help defray the cost for those less able to pay for it. She put the government’s cost at $110 billion a year.
Mindful of the lessons of her failed attempt, Clinton said that under her new plan anyone who is content with their health coverage can keep what they have. She insisted no new government bureaucracy would be created even as it seeks to cover tens of millions uninsured.
“I know my Republican opponents will try to equate health care for all Americans with government-run health care,” Clinton said. “Don’t let them fool us again. This is not government-run.”
The New York senator said her plan would require every American to purchase insurance, either through their jobs or through a program modeled on Medicare or the federal employee health plan. Businesses would be required to offer insurance or contribute to a pool that would expand coverage. Individuals and small businesses would be offered tax credits to make insurance more affordable.
“I believe everyone — every man, woman and child — should have quality, affordable health care in America,” Clinton told an audience at a medical center in Iowa, the early voting state that launches the nomination process.
As the front-runner, Clinton drew swift criticism from Democratic and Republican rivals, including party foes Bill Richardson and John Edwards who argued she was merely following their lead in offering a similar plan.
Clinton framed her quest as a moral imperative in which individuals, businesses, the insurance industry and the federal government each had a role to play. She said her plan would be bipartisan and would only be successful through negotiation — a sharp departure from her earlier effort.
Then, the Clinton health care task force met in secret and tried to drive legislation through Congress. Now, Clinton, a senator for seven years, spoke of compromise although she vowed to accomplish her goal in her first term if elected.
“She’s running against essentially not just the other candidates but her own plan. She’s trying to convince you that this is a new Clinton plan,” said Robert Blendon, a professor of public health at Harvard Medical School.
To pay for her plan, Clinton said the tax cuts for Americans making $250,000 or more that were enacted under President Bush would be allowed to expire. She also projected she would identify $56 billion in savings through computerized record keeping, reducing the price of prescription drugs and cutting Medicare overpayments to hospitals and HMOs.
Despite the focus on letting people who are happy with their insurance keep what they have, her plan would raise taxes on some coverage for the wealthy.
The current exclusion from taxes of employer-provided health premiums would be limited for those who make more than $250,000 and have “very generous” plans. For such people, a portion of the premiums paid by the employer could become taxable income for the employee.
Joking that her proposals “won’t make me the insurance industry’s woman of the year,” Clinton said companies would no longer be able to deny coverage for pre-existing conditions or genetic predisposition to certain illnesses.
The centerpiece of Clinton’s latest effort is the so-called “individual mandate,” requiring everyone to have health insurance just as most states require drivers to purchase auto insurance. Such a mandate has detractors at both ends of the political spectrum, and questions abound over how it would be enforced.
“Perhaps more than anybody else I know just how hard this fight will be,” said the New York senator.
Clinton adviser Laurie Rubiner said the mandate could be enforced in a number of ways, such as denying certain tax deduction to those who refused to buy insurance. But she stressed that a specific mechanism would be worked out once the plan was passed.
Rival John Edwards has also offered a plan that includes an individual mandate, while the proposal outlined by Barack Obama does not. Obama has insisted individuals can’t be forced to buy insurance until its costs are substantially reduced.
Obama released a statement Monday saying Clinton’s plan is similar to one he proposed in the spring. He took a swipe at the Clinton administration’s closed-door sessions on health care in the 1990s, saying “the real key to passing any health care reform is the ability to bring people together in an open, transparent process that builds a broad consensus for change.”
For his part, Edwards said that on his first day in office he will submit legislation that would pull health insurance for the president, members of Congress and all political appointees unless they pass universal health care within six months.
Republican Mitt Romney, in New York City for a fundraising stop, criticized Clinton’s proposal, saying, “‘Hillary care’ continues to be bad medicine … in her plan, we have Washington-managed health care. Fundamentally, she takes her inspiration from European bureaucracies.”
The plan that Romney helped institute while governor of Massachusetts requires the same individual insurance mandate as Clinton’s and uses state subsidies to help reduce the cost of private coverage. Since then, Romney has said he would leave it up to the states to decide whether they supported such a mandate.
Campaigning in Florida, Republican Rudy Giuliani said Clinton’s plans was a “pretty clear march to socialized medicine.”
“Government command and control only increases costs and decreases quality,” the former New York mayor said. “My approach is to encourage people to buy their own health insurance … give people incentives to buy health insurance, not demand that they do it.”
Associated Press writers Ashley M. Heher in Chicago, Curt Anderson in Fort Lauderdale, Fla., and Nedra Pickler in Washington contributed to this report.
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