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A Project of The Annenberg Public Policy Center

Harry & Louise Again?

Obama mailer on Clinton health care plan lacks context.


An Obama mailer stretches the differences between the candidates on health care. Specifically:

  • It touts measures included in Obama’s plan to help low-income individuals buy insurance but fails to mention that Clinton would provide similar financial assistance.
  • It says Obama’s plan would save the average family $2,500 per year – an estimate provided by experts at the campaign’s request – but doesn’t say that Clinton estimates hers will save $2,200 per year.
  • It also neglects to point out that Clinton’s plan isn’t the only one that would have an enforcement mechanism for those who failed to purchase insurance. Obama’s plan, which would require that children be insured, would need one as well, though it would affect fewer persons.

The Clinton campaign objected to the mailer on grounds that its image of a middle-class white couple is reminiscent of the "Harry and Louise" TV spots that the health insurance industry used to attack the 1993 Clinton health care plan. We see the resemblance, but fail to see the relevancy.


Barack Obama said at the Jan. 31 debate in Los Angeles that his health care plan has "about 95 percent" in common with Democratic rival Hillary Clinton’s. Nevertheless, his campaign sent out a piece of direct mail that lacks a good amount of context and could mislead those who are not familiar with Clinton’s plan. The mail piece drew an angry protest from the Clinton campaign, which compared it to the well-known "Harry and Louise" TV spots by the Health Insurance Association of America that attacked the 1993 Clinton health care plan.

[TET ]

Obama for America Mailer

Hillary’s health care plan forces everyone to buy insurance, even if you can’t afford it. Is that the best we can do for families struggling with high health care costs?

Hillary’s health care plan forces everyone to buy insurance, even if you can’t afford it… and you pay a penalty if you don’t.

The way Hillary Clinton’s health care plan covers everyone is to have the government force uninsured people to buy insurance, even if they can’t afford it.

"…forcing those who cannot afford health insurance to buy it through mandates…punishing those who don’t fall in line with fines."
– The Daily Iowan, December 21, 2007

Punishing families who can’t afford health care to begin with just doesn’t make sense.

Barack Obama believes that it’s not that people don’t want health care, it’s that they can’t afford it.

Barack Obama believes Americans who don’t have health care coverage desperately want it; they just can’t afford to pay for it. That’s why the Obama plan covers every American by reducing costs more than Hillary Clinton’s, saving the typical family up to $2,500 per year.

Bill Clinton’s own Secretary of Labor, Robert Reich, wrote, "I’ve compared the two plans in detail…But in my view Obama’s would insure more people, not fewer, than HRC’s." – Robert Reich, December 3, 2007

The Obama Health Care Plan:

  • Offers health care coverage for all Americans similar to that of members of Congress, and subsidies to help those who cannot afford it.
  • Reduces insurance costs more than Hillary’s plan, including capping insurance company profits in places where they have taken advantage of people.
  • Saves the typical family up to $2,500 per year.

Read the entire plan at BarackObama.com.

Barack Obama. Health care we can afford. Change we can believe in.[/TET]

The mailer focuses on the primary difference between the two candidates’ proposals: whether they would require everyone to obtain coverage. Clinton’s plan would require all Americans to get insurance, though she hasn’t said what will happen if they don’t. Obama’s plan would require insurance for all children but not for adults. Both plans would help consumers with the cost of getting coverage – although you wouldn’t know it from reading Obama’s mailer.

 Affordability for All?

The mailer opens with the claim that "Hillary’s health care plan forces everyone to buy insurance, even if you can’t afford it." Clinton’s plan does require everyone to have health insurance, and there will be some kind of penalty for those who don’t comply. The mailer is correct on that point. But the Obama mailer leaves out any information on cost-reduction measures and low-income help that Clinton’s plan offers, while it touts such measures found in his plan – some of which very closely mirror Clinton’s.

For instance, the mailer says Obama’s plan will save the average family $2,500 per year. That estimate comes from several Harvard professors who examined the plan at the Obama campaign’s request. But Clinton says the Business Roundtable, an association of CEOs, estimates her plan would do nearly as well, saving about $2,200 per year per family.

Also, the mailer says Obama’s proposal "offers health care coverage for all Americans similar to that of members of Congress, and subsidies to help those who cannot afford it." It leaves out the fact that Clinton, too, proposes allowing Americans to "choose from dozens of the same plans available to members of Congress," as her Web site states. Instead of direct federal subsidies, Clinton would rely on tax credits that hold premiums to a set percentage of income:

Clinton Plan: This credit will ensure that securing quality health care is never a crushing burden for any working family. This guarantee will be achieved through a premium affordability tax credit that ensures that health premiums never rise above a certain percentage of family income. The tax credit will be indexed over time, and designed to maintain consumer price consciousness in choosing health plans, even for those who reach the percentage of income limit.

The Clinton plan doesn’t specify what "a certain percentage" will be, and whether health care is perceived as a "crushing burden" will probably depend on the family. Obama’s plan is similarly vague, promising "income-related federal subsidies" for those who "need assistance" but not specifying amount or eligibility requirements.

Student Judgments

The mailer also includes a quote from The Daily Iowan:

Obama Mailer: “forcing those who cannot afford health insurance to buy it through mandates … punishing those who don’t fall in line with fines.”

This snippet is from an opinion column in The Daily Iowan. Obama doesn’t tell readers that this is a college newspaper written and edited by University of Iowa students. That’s not to say it’s wrong, but a student newspaper carries less authority than a professionally written and edited major U.S. daily. The full quote reads, "Rather than forcing those who cannot afford health insurance to buy it through mandates and punishing those who don’t fall in line with fines, Obama’s approach to ensuring total coverage of all Americans aims to lower costs by pinning the pressure on insurance and pharmaceutical companies."

The Obama campaign is trying to shift the focus to some unspecified "punishment" that Clinton’s plan would mete out for those who didn’t obtain coverage. It’s true that a "mandate" implies penalties for noncompliance, and Clinton’s campaign has yet to outline what those would be. But Obama’s plan, which would mandate coverage for children, would presumably also have some enforcement mechanism, and he doesn’t make explicit what that would be, either, at least as his plan is laid out on his Web site.

"Harry and Louise"

According to news reports, the Clinton campaign lashed out at the use of the mailer in a conference call with selected reporters, complaining that the mail piece bears a resemblance to the "Harry and Louise" TV spots of 1993 and 1994 (pictured here).

One person on the call emotionally said the Obama mail piece was "outrageous as having Nazis march through Skokie, Illinois." That outburst was quickly disavowed during the call by Clinton spokesman Howard Wolfson, who said it is "not a comparison that [the campaign] would make." The unpaid health care adviser who made the remark, Len Nichols of the New America Foundation, later apologized. He sent an e-mail to reporters saying, "My passions overwhelmed me. I chose an analogy that was wholly inappropriate."

We agree that there is a resemblance between the photo on the Obama mailer and the TV spots. In those ads actors portraying a white, middle-class couple expressed grave concerns about how the Clinton administration’s health care plan would affect them. The ads were part of a $17 million campaign by the insurance industry that was widely credited – rightly or wrongly – with contributing to the defeat of the Clinton plan, and the ads still anger many advocates of broader government efforts to provide health insurance. But so far as we can see, Obama’s choice of images in his mailer has nothing whatever to do with the accuracy of the claims it makes, or the accuracy of what "Harry and Louise" said, for that matter.

— by Jess Henig


Obama, Barack. "Plan for a Healthy America," 29 May 2007.

Clinton, Hillary. "American Health Choices Plan," 17 Sept. 2007.

Blumenthal, David and David Cutler and Jeffrey Liebman. "Final Costs Memo," 29 May 2007.

"Caucus 2008: Our Endorsements." Editorial. The Daily Iowan, 21 Dec. 2007.

Thrush, Glenn. "Clinton adviser apologizes for remarks on Obama ad." Newsday, 2 Feb. 2008.

Scarlett, Thomas. "Killing health care reform." Campaigns & Elections, Oct-Nov 1994.