Health Care and the Horse Race
With Americans pegging health care reform as the top domestic priority, the candidates are unveiling their plans. Some are better than others, but none include the changes necessary to take on the twin scourges of the health care system: insurance providers and Big Pharma.
Considering the fundamental failings of the U.S. health care system—which is overpriced for all Americans, inadequate for many, and deadly for some—it comes as no surprise that health care ranked second only to Iraq in a recent Gallup poll on top priorities for the president and Congress and was first among domestic priorities. Another poll, commissioned by SEIU, the health care workers' union, found that 82 percent of likely voters in the first four caucus and primary states agree that "everyone has a right to quality, affordable health care coverage." (This included 92 percent of Democratic voters and, more surprisingly, 72 percent of Republicans.)
The more complex question, of course, is just how to reform the system and, of late, many of the presidential candidates have entered the debate, unveiling health care plans that offer varying degrees of specificity. While the Republican candidates' platforms are decidedly short on content—most believe the "power of the market" can heal a sick system—the leading Democrats have provided fairly detailed proposals, all of them promising what the polls say Americans want, "quality, affordable health care" for everyone.
"Universal health care" has become the grand Democratic mantra, found on every campaign web site and repeated in every stump speech and debate. But the phrase itself is misleading—most often, it actually means "universal health insurance." While the plans do outline some modest and not altogether meaningless reforms, especially when it comes to care for children, most are designed to preserve—and even benefit—the twin scourges of the U.S. health care system: the insurance companies and the pharmaceutical industry. With the exception of the acknowledged mavericks Dennis Kucinich (D-Ohio) and Mike Gravel, no one has suggested anything resembling a single-payer national health care system (that is, one that is managed and administered by the federal government), which would boot out the rapacious middlemen of the insurance industry and reign in Big Pharma—the primary obstacles to quality, affordable health care in this country.
On the Democratic side, many of the candidates are proposing to subsidize private insurance purchases for the uninsured. Most likely, this would actually wind up bringing the insurance companies billions in new income, while in some cases failing to serve the neediest individuals. As Steffie Woolhandler, the Harvard doctor who has compiled voluminous data on the structure of the industry points out, tax credits, medical savings plans, and other subsidies are next to meaningless to people without jobs or money. What good is an income tax credit if you don't have an income? And why, for that matter, is universal health insurance presented as such a bright shining promise, when, more and more, people who do have insurance continually have to jump through hoops to get the coverage they pay for?
The most effective weapon against the pharmaceutical industry and health insurance companies would of course be a single-payer system, which would give the government clout in negotiating prices with the drug companies, and render the insurance providers obsolete.
Here, in brief, are the meager pickings the candidates offer. First the Democrats:
Hillary Clinton (D-N.Y.), the Democratic frontrunner who as First Lady tried and failed to reform the health care system, has made universal health care a centerpiece of her platform. If elected, she has promised to achieve this by the end of her second term and in the meantime proposes giving federal aid to states in order to expand health coverage for uninsured children. Clinton would also require insurers to cover everyone, regardless of pre-existing conditions, and stop price gouging, ostensibly through some form of government regulation.
Barack Obama (D-Ill.) aims for universal health insurance coverage by 2012, taking various steps leading up to it, beginning by making coverage for children mandatory. The Illinois senator proposes creating a national health plan that's similar to the one that's currently available to federal employees and a "National Health Insurance Exchange," which would regulate the industry and provide subsidies to people who can't afford insurance. (They can then decide whether to buy in to the national plan or a private one.) His plan would also require employers that don't provide "meaningful" coverage for their employees to contribute to the national plan.
John Edwards, the former North Carolina senator, says he wants to "achieve universal coverage as quickly as possible" and proposes a three-fold plan to do so. First, he would require employers to either cover their workers outright or at least help to finance their insurance. Second, he advocates subsidizing the uninsured through tax credits, while also expanding existing entitlement programs such as Medicaid and the State Children's Health Insurance Program. Last, he would create what he calls "health markets," state-run "purchasing pools" that allow people to choose between competing plans, private as well as public.
At this point, Joe Biden's (D-Del.) health care plan remains pretty vague (taking up all of three paragraphs on his campaign web site), but the senator says he wants to make the health care system more efficient and less costly by modernizing and simplifying the system. He also proposes expanding coverage for children and relieving "families and businesses of the burden of expensive catastrophic cases." As yet, he has no specific plan of how to do so.
Senator Christopher Dodd (D-Conn.) would build on Medicaid and Medicare to achieve a form of universal health care. Under his plan, employers would either cover workers or contribute to a federal "Health Care General Fund." People who are uninsured would be required to buy insurance from this fund at a price that's based on income.
New Mexico Governor Bill Richardson would expand existing health care programs, making Medicare available to anyone over the age of 55; open the Federal Employee Health Benefits plan to working families and small businesses; and offer tax credits to defray health care costs. Under his plan, lower income individuals and families would be insured through Medicaid and the State Children's Health Insurance Program.
Dennis Kucinich supports a single-payer, national health-care system (which he dubs "Medicare for All") to be phased in over a ten-year period. He advocates a publicly financed system that would eliminate the role of private insurers.
Former Alaska senator Mike Gravel is promoting a single-payer system in which the federal government would issue annual health care vouchers to all Americans based on their projected needs.
And on the Republican side:
Rudolph Giuliani has yet to offer a specific plan, but wants to shift from employer and government-based plans to a market-based system, in which individuals are responsible for choosing and purchasing their own insurance. "What I would do is change the whole model that we have for health insurance in this country," he said last week. "The problem with our health insurance is it's government and employer-dominated. People don't make individual choices. It's your health; you should own your health insurance." The former New York mayor proposes relaxing laws that regulate the industry and giving families a $15,000 tax credit to buy insurance outside of employer-based plans.
Senator John McCain (R-Ariz.) has yet to articulate a plan, but in the past he has backed full health care for veterans, expanded insurance programs for children, tax breaks for health insurance purchases, and more prescription drug support for seniors. He told an interviewer last weekend that one of the main obstacles to universal coverage is that "there's a lot of healthy Americans that say I just don't want health insurance."
While serving as governor of Massachusetts, Mitt Romney brought a form of universal health care to his state, requiring, among other things, that most companies provide insurance to their employees or face penalties. The plan also mandates that uninsured individuals purchase coverage, with the state picking up the slack for people who can't afford the full cost of insurance. Though he barely mentions his health care views on the campaign trail, he has said he believes in extending health care to all Americans through a market-based approach, not through taxes or government reforms, and would organize a system for the uninsured based on state-run insurance pools.
Without offering much in the way of specifics, Senator Sam Brownback (R-Kan.), like the rest of his Republican rivals, is for a market-based approach, arguing, "Our healthcare system will thrive with increased consumer choice, consumer control, and real competition."
Mike Huckabee, who famously dropped more than 100 pounds after being diagnosed with diabetes, places an emphasis on preventive care rather than universal coverage as a means of fixing the health care system. The former Arkansas governor wants the states to guide future policy and has proposed making health insurance tax deductible for individuals and families (as it currently is for businesses) and offering tax credits to low income families. He has said, "We don't need universal health care mandated by federal edict."
Tommy Thompson, the former secretary of the Department of Health and Human Services, wants to cut coverage costs through preventative care and the use of technology ("our doctors use the latest technology to cure your illnesses, but manila folders to keep track what's wrong with you"). In order to provide health care for all Americans, he proposes requiring states to organize "purchasing pools" for the uninsured.
Ron Paul (R-Tex.), a medical doctor, says America's health care system has been ruined by red tape, "government mandates," and malpractice suits. To solve this last problem, he favors tax credits for "negative outcomes insurance" (a form of coverage that could be purchased prior to undergoing a serious medical procedure), which he believes would reduce the number of lawsuits that are driving up insurance premiums for doctors.
Tom Tancredo (R-Colo.) has no plan, but says many of the health care system's problems "stem from regulations imposed by the federal government." Along with creating red tape and waste, he says, government involvement, and entitlement programs in particular, may actually be making us sicker: "Because it's true that government today heavily subsidizes medical treatment, might Americans have greater incentives to eat and exercise properly if this subsidization were reduced?"
Former Virginia governor Jim Gilmore and Duncan Hunter (R-Calif.) do not include health care among their stated campaign issues, but Hunter's votes in Congress consistently support the drug industry. And, if it's any indication of the health care policies he might favor, when Hunter served as the chair of the Armed Services Committee he blocked a provision to open the military's TRICARE health care program to reservists and the National Guard.
James Ridgeway is the Washington Correspondent for Mother Jones.
© 2007 Mother Jones