INDIANOLA, Iowa — Hillary Clinton is set to unveil her health care plan on Monday, one that would force private insurance companies to cover even the sickest Americans, and that would group citizens into large “purchasing pools” to lower costs.
Despite some sharp jabs between presidential contenders over the hot-button issue, Clinton and her rivals seem to differ more on tactics than substance.
Like former Sen. John Edwards’ scheme and like the plan Republican former Governor Mitt Romney signed into law in Massachusetts — but unlike the plan of Illinois Senator Barack Obama — Clinton’s is expected to require all Americans to buy health insurance.
She set the stage for Monday's announcement with some strong rhetoric in Iowa on Sunday.
“I understand that the special interests don’t want change. They’re willing to just keep dragging us further and further into the ditch,” Clinton said at Senator Tom Harkin’s annual Steak Fry here.
“When I’m president, we’re going to get it done — we’re going to have universal health care.”
Despite those occasional flares of confrontational language, Clinton's plan — like the other Democrats' proposals — attempts to split the difference between the demands of party activists and hard-headed political calculation.
The Democrats all seem to sense that major health care reform, handled carefully, could be within reach for a Democratic president backed by a Democratic Congress in 2009, but all aim to avoid a repeat of the tactical mistakes of the Clinton Administration’s drive for universal health care in 1994.
And so Clinton and the other candidates, like the voters gathered Sunday in Indianola, are engaged largely in a debate about tactics.
Clinton was asked directly about the relative modesty of her approach in a revealing, unpublicized New York talk in April, in which a board member of the Community Service Society of New York, Jonathan Greenberg, asked her why she “continue[s] to see the solution” as private insurance, rather than a single-payer national system.
“Well, I didn’t say that,” Clinton responded, to the audience’s apparent surprise.
But she added that "for the short term, it’ll probably have to build on the employer-based system, but with a lot of changes in how it operates and what the insurance companies are expected to do."
She also proposed providing "options to people to buy into government health care.”
A far broader program known as “Medicare for All,” she said, “would be something to be considered” if Democrats can win at least 55 seats in the Senate.
“I just feel it’s unfair to tell people we can do something politically when we don’t yet have the votes to do it.”
Clinton isn’t the only one hinting at a two-stage conversion to a national health care system.
Edwards, whose health care plan includes a public alternative competing against private plans, appears to hold out a similar hope.
“I set up this system so that if Americans choose, there will be health markets, everybody in this room can choose a private plan or a government plan, which is basically Medicare plus,” Edwards said of his own plan on New Hampshire Public Radio in June.
“If the American people start gravitating toward the government plan, then this thing could very easily become single payer and that would be perfectly fine with me.”
Despite their similar plans, Edwards continues to attempt to draw a contrast with Clinton on the question of how best to pass a plan into law.
At a labor union forum in Chicago Monday, an aide said, he plans to say Clinton is too much part of the status quo to change it, and also to lay out his own strategy for passing his proposal into law.
Romney, who has said e “loves” the Massachusetts model but hasn’t endorsed it on a national level, also planned to deliver a response to Clinton Monday morning.
Many Democratic voters favor the simpler option of a single-payer plan, among them Susan Ridenour, a legal secretary in Des Moines, who said she asked Obama about why he had proposed a more modest change during an event at the Des Moines Public Library earlier this year.
“He said he was interested in getting everyone covered,” she said. “He said [single-payer] could be the ultimate goal.
“At first that was a big issue for me,” said Ridenour, but said she subsequently came around to Obama’s point of view: “It is too big a thing to just do.”
Supporters of the other candidates tended to agree that the plans were similar, and to argue about who was the best to get it done.
“I don’t think [Edwards] is going to be intimidated by the insurance industry and the pharmaceutical corporations,” said Jim Ferguson, a retired school administrator from Des Moines, of his favored candidate.
“Hillary has the heart for it. If anybody can get it done, she can,” said Lou Ann Parker, a court reporter who was sitting with a friend, Vicki Stewart, a retired court reporter and fellow Hillary supporter. She nodded as Stewart expressed her own fondest hope for the plan Clinton rolls out Monday.
“I hope it’s something that is realistically do-able,” she said.