Remembering Obama's campaign health-care plan

"Though the American left and right don't agree on much," wrote Frank Rich over the weekend, "they are both now coalescing around the suspicion that Obama's brilliant presidential campaign was as hollow as Tiger's public image."

It's hard to imagine why. The health-care bill that looks likely to clear the Senate this week is not very close to the health-care bill most liberals want. But it is very close to the health-care bill that Barack Obama promised.

Thanks to the magic of Google, it's easy enough to revisit the plan (pdf) Obama campaigned on in light of the plan that seems likely to pass. And there are, to be sure, some differences. The public option did not survive the Senate. The individual mandate, which Obama campaigned against, was added after key members of Congress and the administration realized that the plan wouldn't function in its absence. Drug reimportation was defeated, and a vague effort to have government pick up some catastrophic costs was never really mentioned.

But the basic structure of the proposal is remarkably similar. Here's how it was described in the campaign's white paper:

The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.

We don't know what the employer mandate will look like once the House and the Senate merge their bills, and the exchanges look likelier to be run by states or regions than by the government (though there will also be a national exchange overseen by the Office of Personnel Management), but those are really the only differences. And it's not even clear they're differences.

Nor were there aggressive cost controls outlined in Obama's white paper but abandoned amid the legislative process. The Senate bill is quite a bit stronger on controlling costs than the campaign paper, which makes no mention of prudential purchasing or the excise tax on high-cost health insurance or the Medicare Commission or specific delivery-system reforms. The paper promises investments in comparative effectiveness research and health information technology, and the Obama administration delivered on both in the stimulus.

But whether you love the Senate bill or loathe it, whether you're impressed by Obama's effort or disappointed, it is very hard to argue that the bill Congress looks likely to pass is fundamentally different from the approach Obama initially advocated. "The Obama-Biden plan both builds on and improves our current insurance system," the campaign promised, and on that, for better or for worse, they've delivered. You can debate whether Obama should have lashed himself to such an incremental and status-quo oriented approach, but you cannot argue that he kept it a secret.

Photo credit: AP Photo/Gerald Herbert.