Bedside manner / How Clinton and Obama truly differ on health care

sfgate_get_fprefs();

Despite visual aspects to the contrary, the recent oil of vitriol between Sens. Edmund Hillary Rodham Bill Clinton and Barack Obama masks some echt differences between the Democratic candidates.

One particularly of import difference affects wellness care. The difference, however, is not so much 1 of policy. It is really a differentiation of process.

On substantial grounds, their wellness programs are very similar. Both would keep the employer-based system of private coverage while introducing a public coverage option for consumers. Both would put important new ordinances on private insurers, forbidding them from denying insurance or charging higher rates to those with "pre-existing conditions."

But there is one major distinction: Clinton's program includes a governmental authorization that every individual have wellness coverage, and Obama's doesn't.

Clinton reasons that without a mandate, healthy people will not purchase coverage and will seek wellness attention only when they acquire sick. This could raise costs for everyone else and endanger the viability of any reformed wellness attention system. Obama reasons that the job is not that people don't desire wellness coverage; it's that they cannot afford it.

Much of the rhetoric between the campaigners have muddled the issue: Is the ultimate end of wellness reform an individual authorization or expanded coverage? One is an intermediate step; the other is the policy aim itself. Indeed, Obama is not opposed to the conception of mandates; his program includes one for children, and he have repeatedly said he would see one for grownups if needed. Mandates aren't the issue - cosmopolitan insurance is.

Or is it? Some have got suggested that Obama's program would go forth more than people uninsured than Clinton's. As a result, Obama no longer depicts his program as "universal." Clinton, however, still does. This lone adds to the confusion. "Mandating" is not "providing" - just because the authorities necessitates something makes not do it so.

The lone truly "universal" system would be a single-payer model, in which the authorities automatically sees everyone. Neither campaigner currently recommends such as a system, or anything else that is really "universal." Rightly or wrongly, both Bill Clinton and Obama are champs of the "near-universal."

But presume that authorizations really are indispensable. In a wellness system still dependent on private insurance companies (as both Bill Clinton and Obama propose), the clearest donees of an individual authorization would be private insurers. The authorization stands for a bargain: The authorities acquires tighter ordinance of the coverage industry, and private insurance companies have billions of bonded new clients in return. Clinton's plan, with its expressed mandate, professes this trade up front. Obama's plan, without a mandate, makes not. He simply begins from a stronger negotiating place than Clinton.

The wellness attention argument foregrounds a far more than of import differentiation between Bill Clinton and Obama, 1 that travels beyond the differences in their policy aims to whether either one could actually accomplish them as president.

Throughout their careers, Bill Clinton and Obama have got earned and deliberately nurtured distinct political personas. Bill Clinton is the policy swot and political street fighter, a tough subsister who looks to bask the fighting as much as the outcome. She spearheaded the failing attempt to reform wellness attention in 1993-94 - an effort stymied by secrecy, complexness and an unwillingness to see outside ideas.

Obama is the community organiser - more than than results-oriented than ideological, more likely to see possible allies than certain enemies, and equipt with a acute sense of powerfulness human relationships and negotiating strategy. His political calling have been marked by pragmatism and a committedness to do authorities more crystalline and accountable.

Essentially, Clinton's character is divisive, while Obama's is inclusive. This have been reflected on the political campaign trail, where Bill Clinton have relied upon a core of Democratic zealots and Obama have depended on a broader alkali of people new to politics. These alliances will impact the public presentation of either campaigner in the general election. But they also will find each candidate's effectivity as president, where good administration is nil without principled, successful alliance building.

Indeed, the top difference between Bill Clinton and Obama is not over policy, but over process. Bill Clinton and Obama may share similar policy destinations, but they would take very different ways to acquire there.

Despite the heated up candidacy of recent weeks, no 1 should doubt the core rules of either Bill Clinton or Obama. Both campaigners have got demonstrated their committedness to meaningful wellness attention reform. The inquiry is who is more than likely to bring forth results, on wellness attention and other issues. On that footing alone, the differentiation is clear.

Daniel Widome is a San Francisco author and policy analyst.

Denmark Hospital Delays Spur Quadrupling of Insurance (Update1)

, Lego A/S and Novo
Nordisk A/S are offering private wellness coverage for workers
tired of waiting for publicly funded treatment.

More than 600,000 of Denmark's 5.5 million occupants now
have coverage that enables them to jump months-long waiting
lists at public infirmaries for non-emergency medical care. The
average clip Danes were forced to wait for a scope of 18
operations was 21 hebdomads in 2006 because of a deficiency of
specialists.

As the U.S. seeks to travel away from a trust on employer-
provided wellness coverage so the uninsured tin acquire care,
countries like Kingdom Of Denmark with a long history of government-funded
medical systems are moving toward the U.S. model. The figure of
privately insured Danes quadrupled since 2002, when the
government responded to holds in publicly provided treatment by
giving companies a taxation interruption on insurance premiums and making the policies
tax-free for workers.

''It volition sabotage the public health-care system and all
of us in the stop will end up paying for it,'' Per Clausen, a
legislator who is the chief spokesman on wellness attention for The Red-
Green Alliance, one of Denmark's Socialist parties. ''Insurance
shouldn't be necessary to acquire good, fast treatment and it
shouldn't be financed with taxes.''

Offering Insurance

A 2007 study by the
showed that three-fourths of members offered insurance to at
least some employees. Private coverage may be increasing
because companies utilize it to lure workers as Denmark's
unemployment charge per unit stays near the last degree in three
decades.

''It is a cardinal displacement in how wellness attention is delivered
to the Danish population,'' said St Martin Standberg-Larsen, lead
author of a published
this calendar month by the World Health Organization.

Annual taxation interruptions totaling as much as 400 million kroner
($83.6 million) monetary fund faster attention for somes choice group, contrary to
Denmark's law establishing equal entree and equal quality, said
Standberg-Larsen, a research worker at the University of Copenhagen's
Institute of Populace Health.

The holds in non-emergency treatment were the consequence of a
government determination to cut instruction disbursement in the mid-1990s
to ease a budget deficit. Kingdom Of Denmark necessitates an further 1,500
nurses and 1,000 doctors, especially specialists, to handle
demand, the country's medical and nursing association said.

Health-Care Spending

Denmark passes 7.6 percentage of gross domestic merchandise on
public wellness care, surpassed by lone France, Republic Of Iceland and
Germany among 23 states surveyed in 2005, the Organization
for Economic Cooperation and Development said in a study this
month.

The government, like its opposite numbers in the U.K. and
Germany, is trying to ran into rising demand for taxpayer-provided
health services while keeping costs under control. The country's
health-care disbursement is rising about 2.8 percentage a twelvemonth per
resident, the OECD said. Primary wellness attention and emergency
treatment are provided without fees, while Danes do co-
payments for other care.

To ran into demand and pushing populace infirmaries to be more
efficient, Kingdom Of Denmark in 2002 began paying private installations and
doctors to handle anyone forced to wait more than than than two months. The
time bounds was cut to one calendar month in October.

''Patients don't care whether their knee joint is fixed by a
private or public doctor,'' Health Curate
said in an interview. ''They attention that it acquires done and that it
gets done well.''

Back Pain

Warehouse worker Suzanne Joergensen spent four months
receiving therapy under the public system that did nil to
ease her , before asking her physician if she could see a
rheumatologist using her private insurance. Three years later she
had an appointment.

''My jaw dropped,'' said the 35-year-old Joergensen from
her infirmary bed in Copenhagen's . ''I
was expecting a month.'' Doctors operated on her slipped disc a
month after her request, while patients typically wait 15 weeks
to acquire the operation under the public system.

Under public care, ''I would still be waiting to see the
rheumatologist,'' she said. ''The waiting lines are just
horrible.''

There are only about 100 docs who work exclusively
outside the public system, according to the Association of
Private Hospitals and Private Clinics. The private hospitals
rely instead on doctors who desire to gain other money in
addition to their 37.5-hour-a-week occupations in the public system. A
specialist devising between 800,000 and 1 million kroner in the
public system can gain 20 percentage more per hr moonlighting,
the grouping said.

Jobless Rate

Denmark's drop to 2.1 percentage in January, the
lowest degree since 1974, the country's statistics agency
reported. To pull and throw onto workers, employers have
offered computers, mobile telephones and ranks to athletic
facilities. About one in five of the United Federation of Danish
Workers' 352,000 members now have got wellness insurance, the
country's biggest labor union said last month. Some unions
representing public-sector workers also have got gained coverage.

''It's Associate in Nursing first-class perk,'' said police force military officer Henrik
Jensen from his infirmary bed at PrivatHospitalet Danmark. The
48-year-old was about to experience back surgery.

Insurance Premiums

Annual insurance premiums scope from 1,000 kroner to 2,000 kroner. The terms is low as it's calm a relatively new merchandise but as
usage additions the cost may rise, said Lisbeth Kristensen, head
of wellness coverage merchandises for , the Nordic
region's second-largest property and casualty insurer.

Carlsberg and insulin shaper necessitate workers to
pay portion of the premium, while toymaker Lego and cobbler Ecco
A/S choice up the full tab. Workers don't have got to pay taxations on
the value of the insurance, unlike such as fringe benefits as the telephones and
club memberships.

''That's what people are looking at when they take an
employer,'' said Seth Thomas Kolber, frailty president of human
resources for domestic trading operations of Valby, Denmark-based
, Scandinavia's greatest brewer.

The tax-savings are attractive in Denmark, where about 40
percent of full-time workers are hit with a 63 percentage taxation rate
assessed on income over 327,200 kroner. The taxations pay for a
social social welfare system that includes subsidized day-care and
stipends for college students.

Insured Workers

The figure of insured workers climbed to 612,000 in 2006
from 141,000 four old age earlier, with insurance premiums totaling 690
million kroner, the said. The
number will climb up to 1 million in 2010, or almost half the
country's full-time workers, the grouping estimates.

Nine out of 10 insured Danes are covered through their
companies. Employers state they desire the coverage to assist keep
workers healthy and on the job.

''We hope to take away some of the uncertainness when you
become sick and you have got to wait and wait to happen out what is
wrong,'' said Niels Erik Tulstrup, labour dealings specializer at
, Denmark's biggest telephone company. ''If we have got got success
with that, you will have fewer ill absences,''

The figure of private wellness installations have climbed to 191
from about 60 in 2002. In October, Nielsen said the private
hospitals received only 447 million kroner of the 58.2 billion
kroner the authorities spent on wellness care.

''We should utilize the money to better the quality and the
quantity of attention in the public system,'' said Clausen, the
socialist legislator. ''It's not too late.''

To reach the newsman on this story:
in Kobenhavn at
.

2008 VOTERS GUIDE / THE ROAD TO THE PRESIDENCY / HEALTH CARE: Insurance funding

sfgate_get_fprefs();

With wellness attention emerging as a head domestic issue in the 2008 presidential race, the assorted campaigners are pitching numerous chopine designed to cut down costs and broaden coverage.

But Republicans and Democrats markedly differ in their attacks to wellness attention reform. Noting the importance of individual pick and duty in shaping wellness care, the proposals of Republican campaigners trust on taxation credits or taxation tax deductions and promote private coverage to offer a wide, fiscally competitory array of options. Republican chopine generally keep that people should be able to purchase programs based on their ain perceived needs.

By contrast, the proposals of Democratic campaigners name for cosmopolitan insurance - there are an estimated 47 million uninsured people in the United States. The Democratic campaigners would also outlaw the sale of coverage that lets hazard evaluations based on wellness status.

"Everyone in the state holds there is a heath attention crisis, but the visions of the two political parties are very different," said Henry Martin Robert Blendon, a professor of wellness attention and political analysis at the Harvard University School of Populace Health. "They reflect the positions and values of the people in each of the parties. Republicans are not interested in a campaigner who desires to cover everyone and make a new disbursement program. They are more than than likely to believe that people have got got more of a duty to have their ain insurance coverage.

"But what is incredibly of import to Democrats is that everybody be covered, they experience it's in the national interest."

HILLARY RODHAM Clinton

Proposes cosmopolitan coverage through both public and private insurance; people would be required to have got wellness insurance coverage; income-related taxation subsidies would do insurance more affordable; big employers would be required to supply or lend to coverage, while lower-income little concerns would be given tax credits to promote them to offer insurance to employees; would make a Health Choices Menu operated in concurrence with the Federal Soldier Employee Health Benefits Program - it would be offered to all Americans.

BARACK OBAMA

Proposes low-cost cosmopolitan insurance via a premix of private and more than expansive populace coverage; would make the National Health Insurance Exchange, into which little concerns and people with no entree to other word forms of insurance could enroll; all children would be required to have got wellness insurance; employers would be required to offer "meaningful" insurance or lend to support the new populace program. Obama would spread out Medicaid and the State Children's Health Insurance Program.

JOHN Edwards Calls for low-cost cosmopolitan insurance by 2012 through a blend of private and populace insurance that would necessitate people to have got insurance and employers to supply it or assist wage for it, with low-income people gaining coverage through expanded public insurance; would make regional Health Markets, non-profit-making buying pools that would offer portable, fiscally competing coverage, both public and private; would give middle-class households refundable taxation credits on a sliding scale of measurement to assist wage for coverage.

RUDY GIULIANI

Wants to utilize free-market incentives to cut down costs and better the quality of wellness insurance; those lacking insurance through their employers would have a wellness coverage taxation taxation deduction of up to $15,000 to assist subsidise coverage insurance premiums - taxpayers could set extra finances into wellness nest egg business relationships to pay for medical expenses; lower-income families would acquire a refundable tax credit; opposes authorities authorizations requiring coverage.

MIKE HUCKABEE

Urges the creative activity of a market-based system and would utilize taxation taxation deductions and credits to assist people purchase private insurance; low-income taxpayers would acquire a tax credit. Huckabee would do wellness nest egg business relationships more widely available, and wellness coverage more portable.

JOHN MCCAIN

Would get rid of advantageous taxations for employer-sponsored insurance while giving taxation credits to people and families; would advance competition between bearers and seek to change payments to suppliers and novice legal reforms to incorporate wellness costs. McCain would let veteran soldiers to utilize Veterans Administration benefits to pay for attention through other providers.

RON Paul

Wants to advance free-market competition among wellness coverage providers. Under his proposal, taxpayers could subtract all wellness attention costs, including premiums, from their taxes. The law currently restricts tax deductions for unreimbursed medical disbursals in extra of 7 1/2 percentage of their adjusted gross income.

MITT ROMNEY

Proposes the deregulating and enlargement of the private wellness coverage market; would give states more flexibleness on Medicaid by changing administrative requirements; would redirect federal and state subsidies that support unsalaried care, channeling the finances to supply subsidies to low-income uninsured families.

This narrative was based in portion on information provided by the Kaiser Family Foundation. E-mail Elizabeth Ii Fernandez at .