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Once the Democratic presidential race narrowed to a two-person contest, the campaign became a debate mostly over style and personality rather than substance and policy differences.
But health care is one issue where Sens. Barack Obama (Ill.) and Hillary Rodham Clinton (N.Y.) are offering two distinct visions of the policy course they would follow.
Although Clintons 1993 single-payer proposal is off the table, she still offers a more expansive health care plan than Obama. Both candidates want to create a government insurance plan available to all and ban insurance companies from denying anyone coverage. But Clinton mandates that every American have some form of health insurance. Obamas plan mandates only that children get covered.
In debates, Clinton has charged that Obamas lack of mandates would leave 15 million Americans uninsured. Obama responds that his opponent would garnish wages from poor workers who cant afford health care.
Barack Obama believes that the reason people dont have health care is that they cant afford it, not that they need to be forced to buy it, Obamas campaign said in a written response to questions, echoing a line the candidate uses on the campaign trail.
Clinton counters that insuring everyone is the best way to reduce costs because it creates a shared pool of risk and guarantees that people dont game the system by waiting until they get sick to apply for insurance.
The only way you get universal coverage is to have a mandate, Clinton policy director Neera Tanden said in an interview. Every health care expert will say the best way to maximize cost reductions is to get everyone in the system.
Asked whether Obama would prefer mandates but thinks his plan is more palatable to the American people and more likely to gain Congressional approval, his campaign responded: Obama strongly believes that meaningful cost reduction measures must take effect before a federal individual health insurance mandate can be considered.
The Clinton campaign believes Obama has miscalculated if he believes hes found a middle ground that would insulate him from Republican attacks that he is pushing too large a government role in health care, according to Tanden.