Do the Democrats have a solution?

IT'S THE deadly calculus of health care in America: Billions of dollars are spent in the name of caring for the sick, yet millions go without the health care they need.

Widespread recognition of this fact has pushed health care reform to the center stage of the battle over who will be the Democratic Party presidential nominee. Hillary Clinton accuses Barack Obama's plan of "leaving out" 15 million people from "universal coverage," and Obama charges that by mandating that everyone have insurance, Clinton's plan penalizes those who can't afford it.

Angry rhetoric aside--"Shame on you, Barack Obama!" Clinton chastised after Obama supposedly misrepresented her plan in campaign literature--both Democratic candidates are far from proposing the kind of changes necessary to guarantee people the health care they need.

In fact, in important ways, the two Democrats' plans could make matters worse for people desperate to get quality health coverage, but left with no alternative but a private insurance industry bent on making more profits.

But in the meantime, the debate between Obama and Clinton has created an opportunity for opponents of health care business-as-usual to put their case forward--for a truly universal, single-payer health care plan.

OBAMA'S AND Clinton's plans do share some long-needed and welcome proposals, including bans on insurance companies using the excuse of "pre-existing conditions" to keep people from obtaining insurance, and requirements for insurance companies to charge the same premiums, regardless of clients' age or health.

Beyond these, however, Obama and Clinton disagree on who will be insured and how.

Clinton promises a federal mandate that would require everyone to have insurance, but it is unclear about how the mandate would work. Clinton says there would be some sort of help, likely a tax credit, for people who make too much money to apply for Medicaid, but can't afford high insurance costs. Beyond that, her proposal has been vague on the details.

Though she denies it, Clinton's plan resembles the 2006 health care law passed by Massachusetts that requires everyone in the state get insurance.

Under the law, people who make up to three times the poverty line--$30,630 for individuals and $41,880 for couples--get a subsidy to help them with purchasing insurance. More than that, and they pay the full price of insurance--which can be anywhere from $1,464 a year for young adults to $9,600 a year for those over 55.

It's no wonder that, despite the threat of fines that are set to increase to $2,000 in 2008, only 7 percent of the 244,000 people who are uninsured in Massachusetts had bought insurance by December 1, 2007.

In response, the Obama campaign has argued that Clinton's universal mandate will penalize the middle class. His plan limits mandated insurance to coverage for children alone.

"The only difference between Sen. Clinton's plan and mine is that she thinks the problem for people without health care is that nobody has forced them to get health care," Obama said at a Democratic debate in Las Vegas last year. "What I see are people who would love to have health care and can't afford it."

But if Obama wanted everyone to have access to affordable health care, he'd support a national single-payer health care plan that covers everyone. Five years ago, he said he supported such a plan.

In 2003, Obama told an audience at an AFL-CIO conference: "I happen to be a proponent of a single-payer health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care, cannot provide basic health insurance to everybody...

"[E]verybody in, nobody out--a single-payer health care plan, a universal health care plan. That's what I'd like to see. But as all of you know, we may not get there immediately. Because, first we've got to take back the White House, and we've got to take back the Senate, and we've got to take back the House."

Now, however, Obama claims he would only support single-payer if he were "starting from scratch"--and, as he told the New Yorker in May 2007, "We may need a system that's not so disruptive that people feel like suddenly what they've known for most of their lives is thrown by the wayside."

Obama's talks like he's ready for substantive change, but the truth is that he's holding it back.

"Obama references two papers by PNHP co-founders Dr. David Himmelstein and Dr. Steffie Woolhandler: Their seminal paper on medical bills as a contributor to bankruptcy (Health Affairs, 2005) and their groundbreaking study on the 31 percent administrative overhead in the U.S. health system (New England Journal of Medicine, 2003)," Physicians for a National Health Program (PNHP) Executive Director Dr. Ida Hellander wrote last May.

"Unfortunately, he doesn't show any understanding of the implications of either.

"For example, he continues to rely on private health insurance (75 percent of people bankrupted by medical bills had insurance) and insists (like Hillary Clinton) that computers can reduce administrative burdens in the health system (only a single payer can do that, as demonstrated in their research)."

Obama said one thing when faced with a trade union audience in favor of single-payer health care. Now, on the presidential campaign trail, he says he'd do another.

Without pressure forcing him to take up single-payer, Obama is bound to opt for what is seen by the Democratic Party establishment as the more reasonable, "not-so-disruptive" solution.

THAT DYNAMIC should be familiar to followers of Hillary Clinton. During her campaign, she regularly invokes her record of fighting for health care reform during the administration of her husband, Bill Clinton.

Hillary Clinton claims she learned a valuable Washington lesson at the time about tempering her demands for reform. However, health care activists who met with her learned a different lesson--the old bait and switch.

In early 1993, Hillary Clinton met with health care rights activists like the PNHP's Quentin Young and David Himmelstein. They were told outright that a single-payer plan didn't have a prayer with the Clinton White House. The eventual proposal from the White House trumpeted toothless "universal" coverage, but even that was too much to get past the health care industry and its mouthpieces in Congress.

In the end, the feeble "Health Security Act," centered largely on private health maintenance organizations (HMOs), withered and died before even coming to a vote in Congress. Thus, even in the context of widespread public expectations that the Clintons would win health care coverage for every working and poor American, the administration covered for the health care industry's bottom line instead.

For this reason, a better way to figure out how committed the candidates are to far-reaching change in health care would be to follow the trail of campaign contributors.

According to the Center for Responsive Politics (CRP), Clinton so far tops the list of presidential candidates to receive donations from the health care industry with $3.9 million. But Obama isn't far behind with $3.2 million. John McCain came in at $1.2 million--but former Republican candidates Mitt Romney and Rudolph Giuliani each attracted almost twice as much as McCain.

Even more telling is the fact that campaign money from the health sector is going to Democrats ahead of Republicans this year--donations to Democrats are beating out Republicans by about $4 million. This is in contrast to previous election years, when the Republicans roundly beat Democrats.

Among the top 10 health-sector donors is Pfizer Pharmaceuticals, which lobbied fiercely against prescription drugs benefits coming under Medicare and opposed attempts to get more generic drugs on the market. So far this election cycle, Pfizer has split its money evenly between Democrats and Republicans--a big departure from its typical heavy lean toward the Republicans.

Figures for the drug giants Eli Lilly and GlaxoSmithKline are similar. Meanwhile, among Obama's campaign team is Moses Mercado, a lobbyist with Ogilvy Government Relations, whose client list includes Pfizer and United Health Group, a managed health care company.

MEANWHILE, ORDINARY people continue to suffer the consequences of a for-profit health care system. Some 47 million people--roughly one in every six Americans--goes without health insurance. According to the U.S. Census Bureau, 2.2 million people were added to ranks of the uninsured in 2006 alone.

Last year, Michael Moore's film Sicko corroborated what so many people experience firsthand--that even if you have insurance, it doesn't mean that you are guaranteed health care.

The reality of the "health insurance plan" in the U.S. is that it is none of these things--it isn't healthy, no one is actually ensured care, and there doesn't appear to be a plan.

In the long run, Clinton and Obama's health care plans share more than the candidates would like us to think. Both leave out undocumented immigrants, whether they are children or adults. Neither requires insurance companies to cover abortion or a range of other reproductive health issues for women.

Both plans rely primarily on employers to provide insurance to their workers, which too few actually offer--and when they do, employees usually have to pay a significant amount, and the coverage is a far cry from complete.

While their plans may offer some coverage for people to buy if they aren't covered at work, it will be based on the private, for-profit insurance industry. The heads of these giant companies will still call the shots, and undoubtedly, millions of people will remain unable to afford medical care, and will therefore go without.

Rather than representing an incremental step toward winning affordable health care for everyone, these plans go in the opposite direction.

"The leading Democrats' health care plans, if enacted, are a prescription for failure by giving the private insurance industry another bonanza: a carte blanche opportunity to sell more limited-benefit policies to healthy people and prevent a structural health care fix," Dr. John Geyman wrote in Tikkun magazine.

"They would further raise costs, increase bureaucracy, enrich market stakeholders at the expense of patients, families and taxpayers, and perpetuate markets treating health care as just another commodity to be bought and sold. Wall Street would prosper as Main Street hurts."