Policy analysis frameworks and applications

Policy Analysis

Barack Obama on the future of American health care

One of the greatest concerns of Democratic voters this primary season was that of the need for healthcare reform. The weight given to this issue in the minds of voters was often second only to that of the war in Iraq and the overall state of the U.S. economy. It was also one area where the frontrunner Democratic Illinois Senator Barack Obama was perceived as exhibiting a potential weakness in relation to his rival, New York Democratic Senator Hillary Clinton. Clinton had extensive experience researching the issue during her work chairing a commission on one of the nations first, albeit failed, national health care initiatives.

Brief overview of the issue

America spends more on healthcare than any other nation, yet it is facing a healthcare crisis that has escalated since the beginning of the 21st century. The number of uninsured Americans increased by 6 million people between the years of 2000 and 2004 largely because more and more employers refused to cover their employees. More Americans were also forced to work part-time jobs without benefits to make a living. There was a shift in employment patterns from industries that historically had had high rates of coverage like manufacturing industries to service-based industries that did not offer benefits. Fewer individuals were employed by large firms that offered comprehensive coverage. Instead, more Americans worked for small firms that did not offer coverage or became self-employed (Holahan & Cook 2005).

Policy Goals

Barack Obama's policy goal is to provide high-quality, more affordable and portable health care coverage for all Americans through a mix of public and private channels (Obama 2008). His stated intent is to provide healthcare to all Americans and to alleviate the financial burden of providing healthcare currently placed upon employers.

Benefits and Services

Barack Obama hopes to offer a new national health plan similar to the plan already available to members of Congress with guaranteed eligibility for all Americans. It will offer comprehensive coverage to all uninsured Americans regardless of any preexisting health conditions they might have. A National Health Insurance Exchange will act as a watchdog group and reform the private insurance market to make coverage more affordable and accessible for individuals using private insurance plans (Obama 2008).

Eligibility Rules

No one will be denied coverage according to the rules of Obama's national health insurance plan. All children will and must be covered. Medicare and Medicaid assistance, along with existing state health insurance plans will be built upon and expanded (Obama 2008).

Service delivery system

Insurance will be provided through a combination of public and private channels, using existing programs as well as introducing new programs.

Financing

Obama's failure to mandate that every adult American must participate in some form of health insurance plan has drawn criticism from Hillary Clinton and her supporters. Also, even nonpartisan industry analysts note that his plan may not solve the systemic problems generated by uninsured Americans of all ages: "Millions of children qualify for coverage through S-CHIP (State Children's Health Insurance Program), but parents don't always buy coverage for their children. Some can't afford it, while others have no idea it exists. Voluntary programs always leave people behind, even when they include subsidies like those in Obama's plan. In fact, the Urban Institute notes that no study has ever shown better than a two-thirds rate of participation in a voluntary program. This means Obama's plan would leave about 15 million people without coverage, at least. This is an improvement over the 47 million without insurance now, but public health care costs could still stay high. Those 15 million would still need health care in case of an emergency -- yes, that means visiting the local emergency room. Who pays for that? If they can't afford the visit, then the rest of us pay it in subsidies through higher taxes" (Sage 2008). Also, if people opt out voluntarily and do not pay into the system, there simply may not be enough money to sustain the national health insurance plan for the uninsured, much less fund the other aspects of the Obama plan.