Where’s the beef?

American presidential elections are about personalities and policies. To date media coverage of the US primary elections has focused principally on the backgrounds and personal attributes of the leading candidates.

This is hardly surprising given that for the first time ever an African-American or a woman (and former First Lady) will be one of the nominees. To boot, the Republican side is set to elect a candidate whose personal biography includes five and a half years spent being brutalised and tortured in a Vietnamese prisoner of war camp. However, as important as the character test is for running for the American presidency, it does not tell us everything about a politician: we also need to know about their policy plans and record.

Foremost among domestic issues in the 2008 campaign - particularly in the Democratic Party race - has been the beleaguered American health care system.

Healthcare American-style is founded on laissez-faire economics and individuals’ responsibility to obtain private insurance (unless you are on solo-parents’ benefit, disabled or elderly). The system, although failing to cover approximately 47 million people, is per capita one of the most expensive in the OECD. Insurance costs often place a heavy burden on individuals and companies; soaring costs are now responsible for half of all personal bankruptcies in the US.

If either Hillary Clinton or Barack Obama takes the White House this year, a public insurance scheme will be set up modelled on that available to members of congress, aimed at meeting the needs of the uninsured and the millions more saddled with prohibitive insurance premiums.

Significantly both candidates pledge to end the industry practice of denying equal coverage for people with pre-existing conditions or illness. Clinton’s proposal remains the most ambitious however, aiming to provide universal and compulsory healthcare. Her offer of tax credits to families and businesses to ensure affordability establishes “shared responsibility”, placing an onus on individuals to obtain insurance or be penalised for not doing so.

Obama has criticised the harsh implications of this proposal, but will nevertheless mandate compulsory coverage for children. The onus will however remain on Clinton to deliver, after her highly publicised failure to reform healthcare in 1993 while First Lady.

In contrast McCain will take an explicitly conservative approach, privileging the freedom of individuals and families to control healthcare over government imposed universal healthcare. In particular McCain rejects employer provided health insurance, noting that General Motors now spends more on employee’s healthcare than the steel in its vehicles. Affordability will be improved through the market, with tax credits for everyone who has obtained health insurance, and reforms to introduce greater national competition between health insurance providers.

Economists are increasingly in agreement that the United States has entered a period of recession, as they were in 1992 when Bill Clinton informed George Bush Snr that it was “the economy stupid”.

Seizing this issue Hillary Clinton quips that it will take another Clinton “to clean up after the second Bush”.

She proposes dramatic steps to tackle the sub-prime mortgage crisis, including a three-month moratorium on foreclosures and a five-year freeze on interest rates for affected owner-occupiers.

Obama contends that the policy will merely pass higher rates onto new homebuyers, preferring a more conventional approach of tax breaks combined with some direct relief for fraud victims.