DES MOINES, Iowa - Democratic presidential candidate Hillary Rodham Clinton on Monday offered a sweeping health care reform plan to ensure coverage for all Americans with federal assistance to help defray the cost.
Thirteen years after her first effort was abandoned -- but saying she still bore the scars from that failure, Clinton described her new plan as necessary to address the crisis of some 47 million uninsured.
"I believe everyone -- every man, woman and child -- should have quality, affordable health care in America," the New York senator told an audience in Iowa. She vowed to accomplish the goal in her first term.
Her original plan was an unprecedented initiative for a first lady. This time, she is offering a $110 billion a year program as a candidate for the presidency, in the leadoff state that is her toughest battleground. The health care plan came late in her primary campaign, after several rivals had already described their visions.
"Perhaps more than anybody else I know just how hard this fight will be," Clinton said.
Dismissing the inevitable Republican criticism, Clinton admonished the crowd. "I know my Republican opponents will try to equate health care for all Americans with government-run health care. Don't let them fool us again. This is not government-run."
Clinton says she has learned from the 1990s experience, which almost derailed Bill Clinton's presidency and helped put Republicans in control of Congress for years to come. Aides say she has jettisoned the complexity and uncertainty of the last effort in favor of a plan that stresses simplicity, cost control and consumer choice.
The centerpiece of Clinton's "American Health Choices Plan" is the so-called "individual mandate," requiring everyone to have health insurance -- just as most states require drivers to purchase auto insurance. Rival John Edwards has also offered a plan that includes an individual mandate, while the proposal outlined by Barack Obama does not.
The Democratic presidential contenders have been united in advocating universal coverage. They have parted ways on certain specifics, including the individual mandate, which has detractors from both ends of the political spectrum.
Republican skeptics say it would be too invasive and would restrict personal freedom and choice. Liberal Democrats have expressed concern that such a mandate would be too financially burdensome for lower-income individuals and families -- a concern shared by Obama, who has said individuals cannot be forced to purchase insurance until the cost of coverage is substantially reduced.
Aides said Clinton believes that an individual mandate is the only way to achieve health care for all. A key component of her plan would be a federal tax subsidy to help individuals pay for coverage.
Clinton's plan builds on the existing employer-based system of coverage. People who receive insurance through the workplace could continue to do so; businesses, in turn, would be required to offer insurance to employees, or contribute to a government-run pool that would help pay for those not covered. Clinton would also offer a tax subsidy to small businesses to help them afford the cost of providing coverage to their workers.
For individuals and families who are not covered by employers or whose employer-based coverage is inadequate, Clinton would offer expanded versions of two existing government programs: Medicare, and the health insurance plan currently offered to federal employees. Consumers could choose between either government-run program, but aides stress that no new federal bureaucracy would be created under the Clinton plan.
Clinton proposed several specific measures to pay for her plan, including an end to some of the Bush-era tax cuts for people making more than $250,000 per year. Edwards has vowed to completely repeal the tax cuts for high earners to pay for the cost of his plan, estimated at $90 billion-$120 billion per year, while Obama would pay for his plan in part by letting the tax cuts expire in 2010.
In response, Obama said Clinton's plan is similar to one he proposed in the spring, "though my universal health care plan would go further in reducing the punishing cost of health care than any other proposal that's been offered in this campaign."
He took another swipe at the Clinton administration's closed-door sessions on health care in the 1990s, saying "the real key to passing any health care reform is the ability to bring people together in an open, transparent process that builds a broad consensus for change."
Other Democratic rivals were swift in their criticism.
Delaware Sen. Joe Biden said, "If universal health care plans could have gotten us health care, we would have gotten it a long time ago," while Connecticut Sen. Chris Dodd said, "To ensure all Americans have affordable health care will take more than leadership that simply knows how to fight."
Added John Edwards: "If you're going to negotiate universal health care with the same powerful interests that defeated it before, your proposal isn't a plan, it's a starting point." Edwards said on his first day in office he will submit legislation that would pull health insurance for the president, members of Congress and all political appointees unless they pass universal health care within six months.
Republican Mitt Romney, in New York City for a fundraising stop, criticized Clinton's proposal, saying, "'Hillary care' continues to be bad medicine ... in her plan, we have Washington-managed health care. Fundamentally, she takes her inspiration from European bureaucracies."
The plan that Romney helped institute while governor of Massachusetts requires the same individual insurance mandate as Clinton's and uses state subsidies to help reduce the cost of private coverage. Since then, Romney has said he would leave it up to the states to decide whether they supported such a mandate.
Said Republican Rudy Giuliani's campaign: "Senator Clinton's latest health scheme includes more government mandates, expensive federal subsidies and more big bureaucracy -- in short, prescription for an increase in wait times, a decrease in patient care and tax hikes to pay for it all."
