Where Do the Candidates Stand on Health Care? Conclusions
For the past couple of months, I've been writing about the candidates' health care plans. I've written about the Democrats -- Hillary Clinton and Barack Obama -- the Republicans -- Rudy Giuliani, Mike Huckabee, John McCain, and Mitt Romney -- and even a couple of the candidates that have already dropped out of the race -- Dennis Kucinich, Fred Thompson, and most recently John Edwards. And after reading through various proposals, websites, and searching for information, I've come to a few health care conclusions of my own.
I'll start with the good stuff first. On the Democratic side, the health care plans of Clinton, Obama, and Edwards have a lot of quality proposals. And even the fact that they exist is noteworthy -- in a time when media coverage tends to focus on the horserace of the primary season and the dramas and spats among the candidates, these three candidates have laid out detailed plans on how they would fix America's health care crisis. It seems politicians are finally listening to what polls have been saying for a while -- that there is actual demand for universal health care in this country. Nine out of ten Americans think the health care system needs fundamental changes, and nearly eight in ten people say they would like universal health care even if it means extending Bush's tax cuts on wealthy Americans. And even some of the Republicans are listening to the demand for better health coverage. Although their plans are largely less detailed (and less universal) than the Democrats, at least health care has become part of the political conversation. Given that 47 million Americans are uninsured, and four out of five of the 90 million people under 65 who were uninsured for part of 2005 and 2006 are from working families, it's clearly time for a health plan that benefits the current and aspiring middle class.
Not only do the Democrats health care plans exist, but moreover, they're GOOD. Both Clinton's and Obama's (and Edwards' -- although he dropped out he certainly made a substantial contribution to policy discussions) plans use similar means to provide affordable insurance for all, and take measures to prevent insurers from discriminating against people who are older and sicker. Although there are some differences -- the big one is that Clinton and Edwards have a mandate, whereas Obama only mandates that children have insurance -- any of these plans would be a huge step forward from where we are today.
So, in no particular order, here are some of the things I've learned:
Lawsuits aren't all bad. In his State of the Union address on Monday, Bush said that we need to "confront the epidemic of junk medical lawsuits." However, medical malpractice lawsuits aren't junk, but a way of insuring that Americans receive high quality care. Malpractice lawsuits are a way for hospitals and doctors to be held accountable to their patients. As DMI's State of the Union analysis says of medical malpractice suits,
"Capping malpractice liability limits the amount of money patients can receive when injured by medical negligence and can effectively grant hospitals immunity from the consequences of their malpractice. As a result, capping liability for lawsuits is actually likely to increase the amount of medical errors that contribute to the cost of healthcare."
Many of the candidates -- such as Mitt Romney -- have suggested that implementing medical malpractice caps is likely to cut costs and improve health care quality, but the reverse is more likely to be the case.
The free market and universal health care can co-exist. The Democrats' plans have been criticized for their tendencies towards "socialized medicine," but their plans -- especially Edwards' and Clinton's -- have a nifty bit of free market competition built right in. Edwards' plan reads,
"Health Care Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."
By forcing the government and the private sector to compete against each other, Edwards basically puts himself in a win-win situation. If the private insurers win, then they've been forced to cut costs and improve efficiency. If the government wins, then we're one step closer to a single-payer system. Clinton's plan operates in a similar way, although she is less explicit about the competition.
Health Savings Accounts aren't all they're chalked up to be. Many of the candidates -- including McCain and Giuliani -- really talk up the accounts, billing them as a surefire solution to health care affordability. But Health Savings Accounts (HSAs) won't cut costs, only shift the costs from business and the government onto America's already strained current and aspiring middle class. Insurance is around for a reason: to spread risk within a pool of individuals so that no one person is left with huge expenses or without access to care. HSA's shift the burden of care and risk of unknown medical expenses onto the individual. Although the tax breaks associated with HSAs would likely help the rich, they would hurt lower-income people who pay little income tax in the first place.
Government health care works. The health care legislation that dominated the news this past year has been SCHIP, or the bill to provide funding for the State Children's Health Insurance program. The bill, which went through various versions in both the House and Senate and was vetoed twice by the President, provides health insurance to 6 million children who would otherwise go uninsured. The program has been overwhelmingly successful, but lack of government funding will prevent the program from continuing to function in the future. According to the Congressional Budget Office, if the bill had passed 3.8 million children would have health coverage by 2012 who would otherwise be uninsured.
When looking at the candidates' health care plans, I've noticed how they discuss current government programs and how they plan to modify these programs in the future. Mitt Romney called SCHIP a "flawed approach" and concluded that these children were better off with private insurance, although he never explained how that would occur. Obama, on the other hand, says he will "expand eligibility for the Medicaid and SCHIP programs," giving more of the 47 million uninsured people in this country access to care. Clinton also plans to expand both programs, to give the "most vulnerable populations" access to care.
The health care system needs more technology. All the candidates -- and even Bush in his State of the Union speech on Monday -- agree on at least one health care reform: that it's time to update the U.S. health care system with technology, especially electronic record keeping. "We must call on Congress...to promote health information technology," Bush said in his address. According to Clinton's plan, "The RAND Corporation estimates net savings from the use of information technology to be $77 billion per year." Huckabee recommends "adopting electronic record keeping" and Obama "will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT." Which leads to the perhaps a bit-too-obvious question: if every presidential candidate, and even the President, agree on the need for better technology, why haven't we done anything about it?
When I started writing about these health care plans, I expected to find a lot of bad policies and a lack of solutions to solve the current health care crisis. But while I certainly did find lots of inefficient or just plain bad ways to reform the health care system, I also found hope that the system is likely to improve in the future. Although no candidate has a perfect plan, at least a few of the current candidates have plans that are a giant step in the right direction.