On Healthcare, Primary Opponents Differ Less Than Parties Do

Presidential candidates' healthcare proposals all differ, but their party affiliation matters most.

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Whether and how the next president will find a way to cover the 47 million people who lack health insurance will be on many voters' minds as they head to the polls on Tuesday. If this is your top-priority issue, you could drive yourself crazy trying to pick apart the differences between the Clinton and Obama plans. Ditto the offerings on the Republican side. That's because they're much more alike, within each party, than they are different. But there are significant differences between Democrats and Republicans in how their respective candidates would address the problem, reflecting the two parties' very different political philosophies. Focus on those instead, and your choice is much clearer. Then pick the candidate in that party that you like best.

On the Democratic side, both Hillary Clinton and Barack Obama want to get everyone covered by expanding public programs and private insurance options and subsidizing the cost for people who can't afford it. The main difference between their plans is that Clinton would require everyone to have health insurance, while Obama would mandate coverage only for children.

Much has been made in recent days about Clinton's refusal to spell out publicly what she would do to enforce a mandate if people didn't buy coverage as required. Would she garnish their wages? Impose fines? Enroll them automatically? The Obama campaign has tried to turn her reluctance to be specific into a character issue: "America needs a leader they can trust, not someone who will avoid hard questions," said Obama campaign spokesman Bill Burton on Sunday, according to the New York Times.

These are valid questions. But the effort to draw attention to them really only highlights the fact there's not much separating the two candidates on this critical issue. True, many economists agree with Clinton's assessment that we probably can't get to universal coverage without a mandate requiring everyone, not just children, to have coverage. How else to persuade the so-called "young invincibles"—healthy people in their 20s who may have little cash to spare—to buy insurance? But with both candidates voicing their support for universal health coverage and advocating a healthcare mandate as the way to get there, in the big scheme of things they're not so far apart.

There's been less public squabbling on the Republican side over healthcare proposals. Traditionally, healthcare doesn't rank as a key issue for Republicans in the same way it does for Democrats. Here, too, the candidates' proposals are similar. The three main Republican candidates—John McCain, Mitt Romney, and Mike Huckabee—want to increase access to coverage by encouraging competition among private-sector providers rather than by expanding public programs. Coverage mandates are nowhere on the menu with Republicans; they'd rather expand health savings accounts, or HSAs, so people can save for healthcare on their own. All three propose using tax deductions or credits to make insurance more affordable.

Of course, it's early yet, and these proposals are only outlines of what might eventually come to be. But they're a start. The candidates have laid out their ideas. Now it's your move.