Sept. 17, 2004 – President George W. Bush and his Democratic challenger, Senator John Kerry, have both made health care a primary issue in their election campaigns, saying their plan will best provide access to care for the poor, seniors and all Americans.
There are currently about 45 million Americans without health insurance, a disproportionate number of them people of color, and the number is rising. Add to that tens of millions more who are underinsured, with plans that cover only emergency services or mandate high co-payments, deductibles and other obstacles which put needed care out of reach.
Bushâ€™s proposals emphasize tax-free personal health savings accounts and Medicare reform including continuation of the controversial "prescription drug benefit" for seniors, which was launched this year and will take full effect in 2006.
Kerry, on the other hand, advocates greatly increasing the number of Americans who are insured through a program to cover all children, tax credits toward insurance premiums and at least a $1,000 reduction in all yearly premiums. He also advocates making prescription drugs more affordable by allowing states to purchase them in bulk, permitting importation from Canada and covering drugs under Medicare.
Meanwhile, third party candidates Ralph Nader and David Cobb advocate a national health care "single payer" system in which services would be provided by private institutions but funded by the federal government. Under this system, people could choose their care providers.
Physicians for a National Health Program and other similar groups argue that some form of a universal coverage system is necessary to avoid the system collapsing under a weight of uninsured and underinsured people with emergency care needs, especially as the Baby Boomer generation ages.
So how do these proposals stack up, and do they really offer solutions to the spiraling health care crisis?
Bushâ€™s plan calls for greatly increasing the use of health savings accounts (HSAs) in which people deposit their own money, tax-free, to spend on health care and private insurance plans. Bush proposes subsidizing low-income families by putting several thousand dollars in their HSAs.
Dr. Quentin Young, a practicing physician since 1952 and head of the group Physicians for a National Health Program, fears that the health savings accounts will encourage people to forego care as much as possible in order to save money. He added that neglecting medical care increases costs since problems that could have been avoided or treated more easily in the beginning stages become serious and expensive without early treatment.
"Studies show that people delay care if they are uninsured or underinsured, then they end up in emergency rooms, which is the most expensive way of all," Young said.
Bushâ€™s Medicare reform plans would lead the program down the road to privatization. The prescription drug benefit passed as part of the Medicare prescription drug bill in December 2003 is part of this trend. While it gives low-income seniors a $600-a-year grant and discounts on specified drugs, it prohibits the government from negotiating lower prices with drug companies, like the Veterans Administration already does, and forbids buying drugs from Canada.
"The Medicare drug bill is an attempt to privatize and destroy our Medicare system, which currently is a wonderful system despite the obstacles that opponents have inflicted on it," Young said. "They want to herd senior citizens into â€˜choosingâ€™ the drug benefit because theyâ€™re really desperate and have no choice. To call Bushâ€™s plan a â€˜planâ€™ is a euphemism. Itâ€™s an abomination."
Almost all proponents of universal health care are highly critical of Bushâ€™s proposals and record. The number of uninsured people climbed by about four million during his first term, and his major promises did not pan out.
During the 2000 campaign Bush said the Medicare Modernization Act, which includes the prescription drug plan, would cost about $158 billion over ten years, but when Congress passed the bill in an extremely close and contentious vote, the Congressional Budget Office estimated it would cost about $395 billion. Unknown to lawmakers or the American public, officials at the administrationâ€™s Centers for Medicare and Medicaid Services put the price tag at about $100 billion more, based on higher assumptions about how many seniors would take advantage of the benefit.
Congressional investigators are asking the former Medicare administrator, Thomas Scully, to return his government salary because of allegations he intentionally tried to prevent Congress from learning about higher estimates for the drug planâ€™s cost.
Critics point to massive contributions from drug companies to the Republican Party as one of the reasons Bush and lawmakers were so eager to pass the drug benefit plan. Bushâ€™s campaign received a total of $1.2 million from the pharmaceutical and health products industry compared to $350,000 for Kerry.
Meanwhile Bush has claimed his proposed health program would extend health care to an additional ten million people at a cost of $102 billion over the next decade. But according to an analysis by the Washington Post, that consulted Congressional Budget Office and Treasury Department projections as well as independent analysts, the plan would actually extend coverage to between two and six million people.
Additionally Bushâ€™s plan, as outlined on his re-election web site, includes a focus on abstinence-only sex education -- which leaves out crucial HIV and STD prevention efforts -- and drug testing of teenagers, which is not widely seen as an effective method of preventing drug use.
Michael Cannon, director of health policy studies at the libertarian Cato Institute, said that "on balance, Bushâ€™s agenda is preferable to Kerryâ€™s, but neither is perfect."
"Bushâ€™s includes more regulation, when regulation should have been kept at the state level," Cannon said. "We want to beat back attempts to expand government control over the health care system. We want to return control over patientsâ€™ dollars to patients, not to the government. What that means is preserving and strengthening health savings."
But under this plan people who just do not make enough to cover the care they need will be left out in the cold.
Proponents of universal health care look more favorably on Kerryâ€™s platform. Stating that "it is morally wrong to leave so many Americans uninsured," Kerry promises the government will pay the full cost for insuring twenty million children under Medicaid and make sure all children are insured. He also says he will make employee coverage more affordable for small businesses through tax credits, extend tax credits of 25 and 75 percent of premiums to moderate- and low-income people, cover drugs under Medicare and allow drug importation from Canada. He also supports investment in prevention and wellness as a way to reduce Medicare costs.
Kerryâ€™s voting record on health care issues supports his claims. He voted yes on allowing drug imports from Canada, yes on allowing patients to sue HMOs, no on Bushâ€™s Medicare drug prescription benefit and yes on covering drugs under Medicare. He introduced the Nurse Reinvestment Act to subsidize training more nurses and the budget allocation to increase HIV/AIDS funding.
But Kerryâ€™s fairly ambitious plans come with a big price tag -- his proposals would cover an estimated 27 million currently uninsured people at a cost of $653 billion to $1 trillion over ten years, depending on the cost effectiveness of his proposed preventative medicine plans. The estimated price is so high because rather than controlling costs, the government would be paying for care for a greater number of people but at high and rising market rates.
Many health care advocates also question the validity of tax credits, proposed by Bush as well as Kerry, as a meaningful way to increase access to health care. Many low-income and immigrant families who work in the informal economy do not even file tax returns, and those who do so on their own without the aid of an accountant may not know how to file for the tax credit. Even if they do, expenses would not be reimbursed until months later.
Independent candidate Ralph Nader and Green Party candidate advocate universal health care with a single payer plan that removes the private health industry. This is the same approach endorsed by Physicians for a National Health Program, the American Nurses Association and many other groups.
As quoted on Naderâ€™s campaign website, the plan would mean "the government finances health care, but keeps the delivery of health care to private non-profits, and allows free choice of doctors and hospitals for patients." The plan would also mandate full and universal access to preventative programs, mental health services, home care for the elderly or infirm, dental services and other life-long needs.
Physicians for a National Health Program and other similar groups have published papers outlining their positions on the candidates and their vision for the US health system. They argue that some form of a universal coverage system is necessary to avoid the system collapsing under a weight of uninsured and underinsured people with emergency care needs, especially as the Baby Boomer generation ages.
A universal system is plenty feasible, say advocates, judging from other countriesâ€™ experience.
"Weâ€™re spending $6,200 per person [annually], the highest in the world, yet weâ€™re only ranked 27th in life expectancy -- behind Barbados," Young said. "France and Switzerland spend half what we do. Canada spends about a third what we do, and they have better records in the indicators like life expectancy, infant mortality and immunization rates. We have the money. We have the facilities. We have the doctors. We just stubbornly refuse to organize all these resources into a national system."