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Democratic Candidates Discuss Health Care Proposals in Forums

December 25, 2007 at 6:10 PM EDT

GWEN IFILL: In nine days, voters in Iowa begin choosing a presidential nominee. NewsHour correspondent Susan Dentzer participated in discussions with many of the candidates about one of the year’s biggest issues, health care. Tonight, we listen in.

The Health Unit is a partnership with the Robert Wood Johnson Foundation.

SUSAN DENTZER, NewsHour Health Correspondent: Health care is now the top domestic issue for Democrats, and that includes those running for president in 2008, so candidates were invited to discuss the topic in a recent series of forums at the Kaiser Family Foundation in Washington, D.C.

SEN. HILLARY CLINTON (D), New York: All Americans should have quality, affordable health care.

FORMER SEN. JOHN EDWARDS (D), Presidential Candidate: We must have a universal health care system.

GOV. BILL RICHARDSON (D), New Mexico: Doesn’t matter who you are, whether you’re a ditch digger or a CEO. We have to make sure everybody is insured.

SUSAN DENTZER: The forums were organized by the left-leaning Families USA, an advocacy group, and the right-leaning Federation of American Hospitals, which represents for-profit investor-owned hospital chains.

Five Democrats agreed to participate: New York Sen. Hillary Clinton; former North Carolina Sen. John Edwards; New Mexico Gov. Bill Richardson; Delaware Sen. Joe Biden; and Ohio Congressman Dennis Kucinich.

A panel of journalists, including me, probed the candidates for roughly an hour apiece on a range of health issues, but most of the discussion centered on two key ones: expanding health insurance coverage for those who don’t have it, and reining in health costs for everybody.

SUSAN DENTZER: The candidates were unanimous in responding to our first question.

Do you believe all Americans should have health insurance coverage?

JOHN EDWARDS: The answer is yes to the question. I’m proud of the fact that I was the first presidential candidate, Democrat or Republican, to come out with a comprehensive, truly universal health care plan.

GOV. BILL RICHARDSON: We have a federal government that hasn’t made a serious effort on health care reform in over a decade.

SEN. HILLARY CLINTON: We have a health care crisis in America, 47 million Americans uninsured. We have to act. And it appears as though there’s a growing consensus to do that.

SUSAN DENTZER: But after that note of agreement, the candidates diverged.

Kucinich: same coverage for all

SUSAN DENTZER: Ohio Congressman Dennis Kucinich favored the most extreme change: moving from America's blended system of private and public health coverage to a completely government-financed health care system.

REP. DENNIS KUCINICH (D), Ohio: I'm the only candidate running who's talking about a single-payer, not-for-profit health care system, Medicare for all. We're already paying for it. We're just not getting it.

Sixteen percent of our gross domestic product is spent for health care. That's about $2.3 trillion a year. If we took all that money for health care, we'd have enough to cover everyone.

SUSAN DENTZER: Kucinich was the lone Democrat to say his plan would also cover an estimated 12 million undocumented immigrants, and he added his plan would put the private health insurance industry out of business and require all for-profit entities engaged in health care to convert to nonprofit status.

Laura Meckler of the Wall Street Journal asked him about that.

LAURA MECKLER, Wall Street Journal: How would you compensate the shareholders who have invested in these for-profit companies and which are now going to just go away?

REP. DENNIS KUCINICH: There would be a market-value compensation that would be involved to the company.

LAURA MECKLER: Who will be paying that? I'm an investor who has invested in this hospital.

REP. DENNIS KUCINICH: The national health care plan repays them.

LAURA MECKLER: So the government is going to be paying all of those people?

REP. DENNIS KUCINICH: The government pays that; that's right.

LAURA MECKLER: How could the government possibly afford that? It's got to be in the billions.

REP. DENNIS KUCINICH: By amortizing the cost with treasury bonds over a period of time, just like you pay for a lot of other capital expenses, period.

Clinton and Edwards less strident

SUSAN DENTZER: By contrast, other Democrats emphasized that they would not replace the current health insurance system, but would instead build on it. They offered plans to expand both public health coverage, like Medicare, and to facilitate access to private health insurance plans.

SEN. HILLARY CLINTON: I have proposed the American Health Choices Plan. Here's how it would work: If you have private insurance, nothing changes. You keep that insurance. If you like your doctor you have, you keep him.

But if you don't have health insurance or if you don't like the insurance you have, you can choose from the same wide variety of private plans that members of Congress get to choose from.

SUSAN DENTZER: Clinton said the new menu of options that people could pick from would include a public plan like Medicare. We asked her about that.

A lot of your critics say including a public plan in that approach is really single-payer through the back door, that it would create a new federal bureaucracy, it would saddle taxpayers with huge new costs, and probably produce overwhelming pressure to clamp down on health care prices.

SEN. HILLARY CLINTON: Well, that's a either misunderstanding or misrepresentation of what I've proposed. I've included the public plan option because a lot of Americans want it. I believe in choice and competition. You know, let's see what happens.

For all those people who believe that, you know, the private system is by far the best, they're going to have more than 250 options to choose from. And for those people who like the fact that Medicare, which ensures private choice, only has a 3 percent administrative cost, they'll get to make that choice.

SUSAN DENTZER: Responding to David Muir of ABC News, Edwards said he had proposed an almost identical plan several months before Clinton proposed hers.

DAVID MUIR, ABC News: Even your wife said, "It's John Edwards' plan as presented by Hillary Clinton," or along those lines. Can you help the people at home who are watching this know what the key differences are then between your plan and Senator Clinton's plan?

JOHN EDWARDS: Yes, they're in the weeds. There are some differences, but they're not significant. I should be flattered, I guess. But I think for America this is a good thing, that we're having a debate about health care and universal health care. And the differences between the major candidates are fairly nuanced.

SUSAN DENTZER: One of those nuanced differences was over who would be compelled to contribute to coverage, in other words, mandates. These could include requirements on employers to contribute a certain percentage of payroll to workers' health coverage and a mandate on individuals that they purchase health insurance.

Edwards, Clinton and Richardson agreed that both types of mandates were needed. They all said the individual mandate would be coupled with subsidies for people who could not otherwise afford coverage.

JOHN EDWARDS: In the weeds that a mandate is necessary is because you cannot have universal health care without it. It does not exist, and anyone who pretends it is, is not being straight.

Biden and Obama drop mandates

SUSAN DENTZER: Taking a different tack, Senator Joe Biden of Delaware said he had deliberately omitted any mandates from his plan.

SEN. JOE BIDEN (D), Delaware: One word the Americans don't like, "mandate." I don't want to make this hard. I want to make this simple and not susceptible to what some of the insurance companies and the right wing will argue this is: a mandated socialistic system.

SUSAN DENTZER: Instead, Biden proposed having government pay all health care bills for any individual that top $50,000 a year, a so-called reinsurance program. He said that would make coverage cheaper and more attractive to both employers and individuals alike.

SEN. JOE BIDEN: So that's the incentive to keep them in. And I do not believe that it is instinctive instinct of American people that, given affordable access to health care, they're going to deny it. Now, if it turns out I'm wrong and it becomes a problem -- and I don't believe it is -- then I would adjust it.

SUSAN DENTZER: Senator Barack Obama of Illinois turned down our invitation to participate in the forum, but on the campaign trail in New Hampshire he defended his decision to omit an individual mandate from his plan, even though he would impose a mandate on large employers and would also require parents to obtain coverage for their children.

SEN. BARACK OBAMA (D), Illinois: In terms of this debate about the mandate, look, this is a manufactured issue. I have committed that I will make sure that every single American in this country has health care they can count on.

I think the problem -- and the reason people don't have health care is not because they're running away to avoid getting health care. It's because they can't afford it. If we make it affordable, which my plan does, more effectively than any other plan out there, then I'm confident that people will buy it.

SUSAN DENTZER: With the exception of Kucinich, who'd replace private health coverage with a public system, all the Democrats said that private insurance companies would have to operate under new national rules.

SEN. HILLARY CLINTON: Whatever you choose, you will have the following guarantees. First, you will never be denied coverage because of pre-existing conditions or risk factors. Second, your coverage will be guaranteed. Third, your coverage will be affordable. Fourth, you will always have an option that is fully portable.

Saving up to fund care

SUSAN DENTZER: The Democrats also said their plans would all require $80 billion to $110 billion a year in additional federal spending and proposed similar ways to come up with the money.

Julie Rovner of National Public Radio pressed Senator Clinton on that.

JULIE ROVNER, National Public Radio: Can you give us some more clear idea of how much more in federal outlays you'd be willing to put on the table for this?

SEN. HILLARY CLINTON: I have put forth a list of savings and spendings that add up to about $110 billion. And about half of that would come from not continuing the high-end tax cuts for the wealthiest of Americans, returning to a pre-Bush administration level, back in the 1990s. And the other half comes from savings that every expert I have talked to believes we can realize.

SUSAN DENTZER: As for savings, the candidates agreed that there were real ways to cut health costs or at least to get better value for the dollars spent, especially for chronic disease.

GOV. BILL RICHARDSON: Chronic diseases like heart disease, diabetes and cancer account for at least 75 percent of our health care costs. We have got to start taking better care of ourselves as a nation.

JOHN EDWARDS: Our chronic care is a mess, because there's no medical home that is responsible for the coordination of chronic care, so that you don't have overlapping care, that you don't have unnecessary care.

But if you are 75 years old and you have a serious chronic health care condition, a serious heart ailment or diabetes, you have one health care provider that you know you can go to who will coordinate your care among other health care providers.

SUSAN DENTZER: All said they were looking forward to debating the Republican presidential candidates on health reform, and if elected, would steel themselves for a long battle ahead.

SEN. HILLARY CLINTON: I'm looking forward to debating whomever they nominate on health care. We can continue with the dysfunctional, expensive, unequal system that lacks quality, or we can begin to say, "Look, we are a smart country, and we can figure this out." And I'm betting that's what we'll do.

JOHN EDWARDS: There will be millions and millions of dollars spent on television and newspapers, on radio, to try to defeat health care reform. And it will never change unless we as a nation join together and stand up to them.

SUSAN DENTZER: Videos of all the forums and full transcripts are available online at All Republican candidates were also invited to participate in the forums, but so far only one, Arizona Senator John McCain, has done so.