Clark Offers Health-Care Plan

Mostly blending ideas already embraced by other Democratic presidential candidates, retired Gen. Wesley K. Clark on Tuesday proposed to provide health care for all children and millions of uninsured adults through a sweeping expansion of public programs and generous new tax credits.

Although Clark stressed preventive care more than some of his opponents, the plan fits squarely in the mainstream of the emerging debate among the Democrats on health care.

When fully phased in, Clark’s proposal would cost about as much each year and cover a comparable number of people -- almost 32 million of the nearly 44 million Americans without health insurance -- as plans from former Vermont Gov. Howard Dean and Sens. Joe Lieberman of Connecticut and John F. Kerry of Massachusetts, according to Emory University professor Kenneth E. Thorpe, who has studied the plans.

A main element of Clark’s plan -- a requirement that all parents provide insurance for their children -- replicates a recent proposal by Sen. John Edwards of North Carolina.

As with many of his policy proposals, Clark linked his call for health care reform to his experience in the military -- particularly his recovery from combat wounds in Vietnam. “It seems to me that just as our soldiers can’t do their jobs without adequate health care, our families shouldn’t be expected to do their best jobs without adequate health care, either,” he said in a speech in Portsmouth, N.H.

The most distinctive element of Clark’s plan is his call for creating a federal commission that would attempt to slow the surge in health-care premiums, which have jumped by more than 10% in each of the last three years.

Clark says the commission would annually identify cutting-edge methods of preventing and managing disease and use the buying power of federal health insurance programs, such as Medicare, to encourage more providers and private health insurance plans to adopt them. At the same time, he would significantly expand Medicare coverage of preventive techniques.

“If we better covered and used diagnostic and prevention services

To reduce the number of uninsured, Clark’s plan relies on several principal initiatives.

Like Edwards, Clark would require every parent to purchase insurance for their children through age 22, while providing them with substantial federal assistance. Under the plan, children in families earning up to 150% of the poverty level (about $27,000 for a family of four) would enroll in Medicaid or the Children’s Health Insurance Program (known as CHIPs) at no cost. Both programs are state-federal partnerships, but Clark said his proposal would have Washington assume all the cost of the expansion.

For families earning up to about $90,000 a year, the plan would provide federal tax credits to cover much of the cost for insuring children who are not now covered. Families that now receive coverage for their children through their employer would be eligible for a smaller tax credit that would offset part of the cost of their premiums.

“In return for this assistance,” Clark said, “it would become the responsibility -- indeed, the requirement -- of young adults and parents to enroll their children in a responsible health insurance plan.”

He also would expand coverage for low-income adults without insurance. He would enroll uninsured adults earning up to about $13,775 annually in Medicaid or CHIPs, again without requiring states to contribute.

He would provide tax subsidies to pay for most of the cost of purchasing coverage for uninsured adults earning up to about $25,000 a year. Clark’s plan would finance well over half the cost of purchasing insurance for those adults, a much larger share than President Bush would subsidize through tax credits he has proposed, according to Thorpe’s calculations. And Clark would provide the subsidy to a larger pool of low-income workers than most of his competitors: Dean, for instance, would only subsidize health insurance for single adults earning less than $17,000.

Clark wouldn’t provide uninsured adults earning more than $25,000 any subsidy, but like most of his rivals he would allow them to buy into the Federal Employees Health Benefits Program, which provides coverage for members of Congress.

In all, Clark’s plan eventually would provide coverage for 31.8 million of the 43.6 million uninsured Americans, according to the analysis by Thorpe.

That would be roughly the same level of coverage as the plans offered by Dean and Rep. Richard A. Gephardt of Missouri, about 5 million more than Kerry’s, and roughly 10 million more than Edwards’.

Over the next 10 years, Thorpe calculated, Clark’s plan would cost $772 billion. That’s more than Edwards’ (nearly $600 billion) and Lieberman’s ($747 billion), but less than Kerry’s and Dean’s (both around $900 billion).

Among the major candidates, Gephardt has offered the most expensive plan, proposing generous tax subsidies for employers to cover their workers at a cost of about $2.5 trillion over 10 years, according to Thorpe.

But those comparisons are somewhat misleading because Clark wouldn’t launch his plan until 2006 or fully phase it in until 2008, later than some of his rivals’ proposals. By Thorpe’s calculations, the Clark plan’s annual cost in 2011 would be just over $122 billion a year, nearly as much as Dean’s ($125 billion) and Kerry’s ($127 billion), more than Lieberman’s ($111 billion), considerably more than Edwards’ ($90.2 billion), and much less than Gephardt’s (about $300 billion a year by then.)

Longshot Rep. Dennis J. Kucinich of Ohio is promoting a single-payer government-run plan that would cover all of the uninsured at an estimated annual cost of about $600 billion.

Thorpe said that aside from Gephardt and Kucinich, the plans offered by the Democratic candidates “are using the same basic tools, so on the basis of each newly insured person, the cost should be pretty similar.”

Clark’s aides, though, said they believe the cost-control elements in his proposal -- particularly the commission to study prevention and disease management -- could produce savings of $125 billion over the next decade, reducing his plan’s overall cost below that of almost all of his rivals.