Clinton v.s. Obama: On Health Care

In the latest debate among the Democrats, Sens. Hillary Clinton and Barack Obama sparred over their plans for health care and Social Security. We found both presidential candidates guilty of exaggerations and questionable claims:

• Clinton said that Obama's health care plan would leave 15 million Americans without insurance, while her plan provided universal coverage. Obama countered that his proposal would cover everyone in the country. Clinton's plan will likely cover more people than Obama's, but it's doubtful the difference between their very similar proposals would be as high as the figure Clinton cites.
  
  Update: Three months after we wrote this article, we revisited this issue and found that health care experts agreed that the difference between the two plans could be as high as Clinton claimed, if not higher.
  
  
• Clinton implied that firefighters would be affected by Obama's proposal to raise the income limit for Social Security taxes above $97,000 a year. Obama implied that his proposal would tax only the "upper class." We found both claims misleading.
  

Obama also said an employer has a greater chance of being struck by lightning than of being prosecuted for employing an immigrant who's in the U.S. illegally. That turns out to be pretty close to the truth.

Similar Plans

It's true that Clinton’s plan would likely lead to somewhat higher levels of coverage than Obama’s, according to the research we've seen. But the difference in outcomes may not amount to much. The main distinction: Clinton calls for a mandate that would require all individuals to have health insurance; Obama requires only that children have coverage and that dependents be covered under their parents' insurance up to age 25. Of the estimated 46.5 million uninsured in the U.S., 9.4 million are children and 37 million are adults, according to an analysis of Census data by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute. But neither candidate has provided enough detail for analysts to predict confidently how many might be left uninsured under either plan.

• Sara Collins, an assistant vice president at The Commonwealth Fund, a private foundation that calls for higher quality and accessibility in health care, says that the Obama and Clinton plans (as well as Edwards') are “very, very similar in structure.” Studies show that mandates make a difference, but Collins says the “15 million” seems like too big a number based on past analyses.
  
  
• Kenneth E. Thorpe, a professor of health policy at Emory University who worked in President Clinton’s administration and who has evaluated several presidential candidates’ health plans, also says that “it’s hard to come up with precise numbers” without knowing the details on the federal subsidies these plans would include. “Whether it’s 15, 20 or 10,” he says, that estimate makes “an assumption on the subsidies that the campaign hasn’t put out.”
  
  
• Robert Blendon, director of the Harvard Program on Public Opinion and Health and Social Policy, estimates Obama’s plan would end up covering 5 percent to 10 percent fewer individuals than Clinton’s. But that’s assuming that it’s possible for Clinton to require everyone to purchase insurance. Blendon suspects that it isn’t. “At the end of the day,” he tells FactCheck.org, “it’s not going to be everybody. We have no idea what the actual falloff would be.”
  

Among the unknown factors is what sort of insurance would turn out to be available under either plan. Preliminary data from Massachusetts, which implemented a sweeping health insurance plan last year, is showing that many people would rather remain uninsured than purchase a stripped-down plan. “People always say having some insurance is better than no insurance,” Blendon says. “It turns out, in some of the focus groups in Massachusetts, people don’t believe that.”

A Trillion-Dollar Tax Increase

Clinton called Obama's proposal to raise Social Security taxes on earnings over $97,500 per year, the current upper limit on which any tax is levied, a trillion-dollar increase on "middle class families."

Clinton: I do not want to fix the problems of Social Security on the backs of middle class families and seniors. (Applause.) If you lift the cap completely, that is a $1 trillion tax increase. I don't think we need to do that.

Taxing all earnings would indeed amount to a $1.3 trillion increase over the next 10 years alone, according to estimates by Cato Institute Social Security expert Michael Tanner, who says he drew his figures from projections by the Social Security Administration staff. A similar estimate comes from Citizens for Tax Justice, which figures the measure would bring in $124 billion per year.

Obama defended his proposal by saying it would fall only on the "upper class."

Obama: I've heard you say this is a trillion dollar tax cut on the middle class by adjusting the cap. Understand that only 6 percent of Americans make more than $97,000 — (cheers, applause) — so 6 percent is not the middle class — it's the upper class.

Clinton responded by saying that some of her New York constituents would still find the increase burdensome. "I represent firefighters. I represent school supervisors," she said.

"Upper Class" Firefighters?

It's hard to say who's being more misleading here. The base pay of a New York City firefighter is $68,475 after five years on the job, and even with overtime, holiday pay and other differentials the total pay is $86,518, well below the level affected by Obama's proposal. So Clinton is being misleading to suggest that a rank-and-file firefighter would be affected.

On the other hand, FDNY captains make $140,173 with overtime, according to the department. For them, Obama's proposal could amount to a $2,646 tax increase, not counting what the city would have to pay for the employer's share of the added payroll tax. As for school administrators, in New York state there are few that make less than $100,000 a year, and some superintendents make more than twice that, according to the New York State Education Department. Are fire captains and high-school principals considered "upper class" financially? If so, it would be news to us.

Obama may be correct to say that only the top 6.5 percent of earners would be affected. That's based on that same analysis by Citizens for Tax Justice that we mentioned earlier. But we judge that Obama is being misleading to say that his proposal would tax only the "upper class."

An Unsure Cure

It is also worth noting that Obama's proposed tax increase wouldn't necessarily cure the system's financial ills.

It's true that taxing all earnings could bring in barely enough to make the Social Security system solvent for the next 75 years. Actuarial experts at the Social Security Administration estimated in 2006 that lifting the cap entirely would keep the trust fund going until 2081. That could be pushed out longer if Congress took the drastic step of denying upper-income workers any benefit for the added taxes they would pay, not giving them credit for the taxes when calculating their eventual retirement benefits. But as we've noted, Obama has only proposed raising the cap, without saying how much, or whether he'd also deny pension credit for the increased taxes.

However, Obama isn't necessarily endorsing taxation of all earnings. He's for raising the cap but hasn't specified how far. What he has endorsed, according to a fact sheet on his Web site, is "increasing the maximum amount of earnings covered," and he says he'd "work with Congress and the American people" on the details. Still, he has been more specific than Clinton, who will say only that she'll ask a bipartisan commission to come up with solutions after she's elected.

Source: factcheck.org