Obama v. McCain on health care. Part 2: Requirement to obtain or offer coverage

In Part 1 of this series I outlined my intention to compare the presidential candidates’ positions on health care using the Kaiser Family Foundation’s health08.org framework. In this post I assess part A: “Requirement to obtain or offer coverage.”

First, here is the Kaiser summary:


  • No provision.
  • Opposes mandate for coverage.


  • Require all children to have health insurance.
  • Require employers to offer “meaningful” coverage or contribute a percentage of payroll toward the costs of the public plan; small businesses will be exempt from this requirement.

During the Democratic primary, mandatory purchase of health insurance by individuals was the biggest point of difference between Obama and Clinton. Clinton wanted mandatory coverage for everyone, while Obama said ‘kids only.’ It was a fairly brave and principled position by Obama, reflecting a nuanced understanding of the health care environment but leaving Obama vulnerable to Clinton’s charge that her plan would cover everyone while Obama’s wouldn’t.McCain’s stance is principled, too. His goal is make insurance available to everyone but not force people to buy something they don’t want.

I prefer Obama’s position on this one. He picked a goal that is ambitious yet achievable, and one where there is a lot of common ground. Clinton’s universal mandate wouldn’t have worked because there are too many uninsured people. Even in Massachusetts –a rich state that started with a high percentage of people already insured– it’s proving very expensive and difficult to achieve universal coverage through mandates. Nationally it’s impossible.

I respect McCain’s position that people shouldn’t be forced to buy coverage, but kids are different than adults. They definitely should have access to care, and the best way to do that is to get everyone covered up front so there are no access problems when a child gets sick. Childhood is the time to lay the foundation for good health and wellness; an important part of that is regular access to a pediatrician. Maybe McCain opposes mandates for kids because he’s worried about a slippery slope toward mandates for adults, but I don’t think it’s great policy.

Turning now to mandates for employers to offer coverage, I don’t favor one candidate over the other. Neither one’s position is likely to have any real impact.

In general employers should pursue profit maximization, growth and shareholder value without regard to social policy. That maximizes wealth generation, which can be used to fund social programs including health insurance. Mandates are a hidden tax on companies, which tend to mask the real cost to the economy. On the other hand, almost 100 percent of larger employers provide health insurance now, so a mandate or lack thereof is pretty much irrelevant.

Neither McCain nor Obama require anything of small companies, which is where the uninsured employees are.

Please read Part 3: Expansion of public programs.

September 10, 2008

4 thoughts on “Obama v. McCain on health care. Part 2: Requirement to obtain or offer coverage”

  1. Mc Cain plans to pay for any expansion by taxing the employer participation of currently insured people. I assume that means the employee will pay, as it would put a huge strain on my hospital if they paid. It appears that he plans to give the bill to the already stressed middle class and the lower paid workers, leaning most heavily on the less well paid. (The employer pays the same amount for everyone.)In my work place that means the housekeepers, clerical staff and ancillary staff. Oh, well, retirement postponed even further.

  2. My only problem with the kid’s only plan is that when an infectious disease in involved )in my county, TB is at fairly high levels for example) the parents who lack health insurance keep infecting their covered kids. So you can provide medical care only up to a point. We will eventually have to make sure that everyone has access to care.

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