Corinne Ramey
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.
Corinne Ramey: Author Bio | Other Posts
Posted at 6:44 AM, Jan 31, 2008 in The Candidates on Health Care
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Comments
Check out peoplepowergranny.blogspot.com and read how I understand each candidate's position on health care reform in the USA. Would love your opinion and invite you to vote in my poll.
Posted by: People Power Granny | January 31, 2008 09:47 PM
Will you please GET IT!!! I don't want the government running, providing, messing with, or touching, or anything, with my health care. I want them to butt out! Do you get it? Please GET IT!!!! Butt out of my life. Get back to the Constitution. Live and let live. We have always been able to take much better care of ourselves than the government ever could. I have the right to take care of my own health care. I even have the right to have NO health care. Don't you get it? If the government is in charge of your health care, then it is the government who will decide what care you get to have. Wouldn't YOU rather be the one who decides that? Now do you get it?
Posted by: marjay | February 1, 2008 11:20 AM
Hey Marjay,
Do you get it. You have the right to make stupid decisions, but not the right to make me pay when your idiocy falls through. I shouldn't have to bail you out of your mortgage that you couldn't afford in the first place, I shouldn't have to foot the bill when you show up in the emergency room because you didn't have the health care to see a nurse practicioner when your problem was treatable, and I shouldn't have to pay to clean up my drinking water you polluted.
The idiots who rail against socialized medicine don't get it. We already HAVE socialized medicine...if you are poor. Who do you think pays when the millions of poor people end up in the emergency room. Not the poor, we do. The only ones in this country that DON'T ALREADY get free medical care are the middle class. Do you get it yet! The poor go to see doctors at the emergency room when they have a severe cold-the most expensive option possible. The people with insurance pay for this at the same time we are going to see a nurse for our own care. Do you GET IT that this system is a failure and only gets worse over time. Get this, we already have socialized medicine. Stop fighting against getting something we already have and start fighting to make the WAY we pay for health care better for those who actually pay, and the AMOUNT we pay for the poor less. Do you get it now?
Posted by: Adam | February 1, 2008 11:57 AM
Now that I addressed Marjays rant, let me address something from the much more intelligent article above.
"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?"
Two reasons that really boil down to one. Cost and resistance from the insurance companies. Resistance from insurance companies really boils down to cost. Savings noted above by Rand corporation and Obama are real, but require an investment of money first and are only recovered over time and accross all insurers. A big part of the savings is in being able to move information efficiently among insurer and between govt. programs like medicare and private insurers. This provides little benefit for individual insurers to make the upfront investments.
Oh yeah, actually there is a third reason. Idiot neo-cons, the scurge of the Republican party, scream socialized medicine every time a reasonable plan is advanced.
Posted by: adam | February 1, 2008 12:38 PM
I believe mandated health care is disrespectful of individual rights and unenforceable. Just what are you going to do if someone opts out on mandatory health insurance? Are you going to arrest them? Oh, yes, you are going to garnishee their wages,effectively stealing from their ability to feed their family or pay the rent. Do you make them pay as they go when they show up in the emergency room? What are you going to do if they refuse to pay or can't pay? Do you turn them away? I think the telling factor is the mandatory cost and how it compares with the costs resulting from Obama's plan. Like Obama,I believe that if health care is made truly affordable, people will pay.
Posted by: BobW | February 1, 2008 10:04 PM
Personally, I think we need to take a slightly more capitalist approach... supply hospitals filled with staff and the needed equipment. Give the people a choice privatized hospital and paid-for-by-taxes (government) and let the people decide.
www.yeswecansong.com
Posted by: christian | February 2, 2008 12:18 AM
Although mandates may not be the perfect solution, Bob, I think they would work much better than you suggested. Mandates would not keep people from being able to "feed their family or pay their rent" because health care would be heavily subsidized for low-income people, and made more affordable for everyone. Additionally, according to this Times article, "20 percent of the uninsured have household incomes of $75,000 or more, according to the Census Bureau," so mandates wouldn't only affect low-income people.
For more on mandates, check out Paul Krugman's editorial from Monday, where he sites a study by Jonathan Gruber showing that a plan with mandates would cover twice as many of the uninsured as a plan without.
Krugman writes,
Posted by: Corinne Ramey | February 5, 2008 12:02 PM
i am a single parent with two boys in high school. i have degrees from rutgers and columbia, and i am one of the "working poor". i live in a small town and make a small wage. my boss would love to give me health insurance, as well as a raise, but it is a small business and she would go out of business. i receive medicare, and for that i am very grateful. the "health care savings account" scares the hell out of me. oh, i guess i'll just shovel all that cash i have into the account. or maybe they will cut my taxes and I'll use that money. let's see, that comes to about 43.50.
adam is right, we already have socialized health care, so let's make smart decisions and make it work for everyone. the way medicare works now, if i get a raise, i will no longer be eligible for medicare, but still won't be able to afford to pay for an unexpected trip to the dr. and why even bother trying to save money, if i save more than 2000, then i am no longer eligible for medicare. there has to be a way to provide adequate medical treatment for people who need it. period. other countries can do it, oh yeah, but they probably don't spend as much on war.
oh and BobW, please disrespect me and stitch up that nasty gash i got on my head after i fell over laughing while reading your comment.
Posted by: d. | February 6, 2008 05:14 PM
I agree that there are some serious problems with health savings accounts. You can read more about problems with the accounts here.
And yes, many of the issues you mentioned are reasons why health insurance tied to employers is problematic. Both Obama and Clinton have measures in their plans to make insurance both portable (your insurance stays the same even when you switch employers) and available from non-employer sources for lower costs. So maybe by 2009 your health insurance will improve...
Posted by: Corinne Ramey | February 7, 2008 10:18 AM
You had said that you feel the democrats health plans are good. They may seem good, but they are actually not a good idea at all. These plans would drive up our taxes and our right to choose is being violated. We should have the options to choose our providers, our doctors etc. Government health care is available for those who qualify however its not for everyone.
Posted by: Affordable Health Insurance | April 1, 2008 03:52 PM
Dear "Affordable Health Insurance",
I just think it's so cute that you are commenting on this policy blog specifically to advertise a website that sells health insurance. Threatened by change much? So, I appreciate your attempt at advertising your product on our blog but this isn't really the venue for that.
So lets try to cut down on the amount of false advertising in the comments threads for advertisers? It fits in better on late night tv infomercials anyway.
Posted by: Elana | April 2, 2008 10:04 AM
Everyone has their favorite way of using the internet. Many of us search to find what we want, click in to a specific website, read what's available and click out. That's not necessarily a bad thing because it's efficient. We learn to tune out things we don't need and go straight for what's essential.
www.onlineuniversalwork.com
Posted by: charlesbrooks | February 4, 2010 01:43 AM
Influence can be defined as the power exerted over the minds and behavior of others. A power that can affect, persuade and cause changes to someone or something. In order to influence people, you first need to discover what is already influencing them. What makes them tick? What do they care about? We need some leverage to work with when we're trying to change how people think and behave.
www.onlineuniversalwork.com
Posted by: charlesbrooks | February 4, 2010 01:46 AM
Influence can be defined as the power exerted over the minds and behavior of others. A power that can affect, persuade and cause changes to someone or something. In order to influence people, you first need to discover what is already influencing them. What makes them tick? What do they care about? We need some leverage to work with when we're trying to change how people think and behave.
www.onlineuniversalwork.com
Posted by: charlesbrooks | February 4, 2010 01:48 AM