Healthcare and the Election – Candidate Positions on Key Issues (Part II of III)
Coverage and Affordability : 4 to 5 million people have lost their health insurance since 2001 for a total of 45 million Americans. This is a tragic figure for the richest country in the world, yet has no real meaning unless it is you or your family that do not have coverage.
President Bush: Bush offers tax credits for high deductible, tax-free health savings accounts which allow someone to direct those funds for use in healthcare expenditures, especially catastrophic care. This helps the wealthier and healthier individual, leaving sicker and less well-off patients in traditional plans that eventually would need to raise premiums further to cover costs. Bush proposes tax credits up to $3000 to allow purchase of healthcare policies. He would allow small businesses to form “Association Health Plans” to collectively bargain for lower rates. Bush also wants to cap malpractice awards to reduce frivolous cases.
Senator Kerry: Kerry would create an option to allow people to join a group plan similar to the Federal Employee Health Benefits Program, which is the plan that insures Congressmen and Senators. He would expand the State Children's' Health Insurance Plan (SCHIP) to cover all uninsured children. Senator Kerry also proposes pooling catastrophic cases to lower the cost of the risk pool, and then reimburse employer-based plans for their costs through a federally funded “reinsurance” plan. Companies would not have to bear the cost of the most expensive cases. The savings would be converted into lower premiums that would cover all workers. Small businesses and people between jobs would get tax credits to help them purchase insurance. Senator Kerry will reduce frivolous cases by requiring malpractice certification of merit by outside experts before cases are allowed to proceed. The filing attorney is subject to a “three strikes (frivolous cases) and out” rule, i.e., not allowed to file another case.
Outside analysts estimate Bush's approach would cover about 4 to 7 million individuals and cost $90-130 billion, and Kerry's approach would cover up to 27 million individuals and cost $650 billion, each over 10 years. Rolling back tax cuts on those making more than $200,000 per year, plus improved efficiency by using healthcare technology funds Kerry's plan.
Neither of these approaches represent a government “take-over” of healthcare, but neither plan completely mitigates the daunting problem of covering the uninsured which has driven up healthcare costs for those with insurance, and has prompted the closing of trauma units, emergency rooms and entire hospitals. I will discuss these issues in Part III.
Medicare :
President Bush: As part of the Medicare Reform Act of 2003, Bush is funding demonstration projects in 19 states to explore privatization of Medicare by subsidizing premiums to allow managed care plans to compete with Medicare. If successful, managed care plans (like PPOs and HMOs) would play larger roles in caring for Medicare patients.
Senator Kerry: Kerry opposed the prescription drug benefit because he objected to the “doughnut” (see below) that leaves a large coverage gap. He favors a more comprehensive prescription drug benefit. He would increase federal support for Medicare, and implement information technology and disease management to improve efficiency of care and improve quality and outcome.
Picking a candidate on this issue depends on how one feels about private health plans, i.e., managed care plans like HMO's, getting control of your Medicare plan. If one thinks that private plans can provide better care for your money, then President Bush should get your vote. If you have doubts that private managed care plans should control your retirement health plan, then Senator Kerry is your man.
Pharmaceutical costs :
President Bush: The Medicare Prescription Drug Act covers some prescription medications beginning in 2006. The partial coverage goes up to $2251, then stops until out-of-pocket costs reach $5100, leaving the notorious “gap” or “doughnut hole” that the patient is responsible for before Medicare resumes coverage. Bush is opposed to reimportation of drugs due to alleged safety concerns, which is the drug companies' position. Senate Majority Leader Bill Frist has blocked (many think at the request of the White House) the Senate bill that would allow a drug reimportation vote (already passed by the House in 2003).
Senator Kerry: Kerry would allow reimportation of certifiably safe medications from countries like Canada (cost savings approximately 50-70%). Additionally, he would allow Medicare to negotiate with pharmaceutical companies with the clout of its 41 million Medicare members, not just smaller plans which the pharmaceutical industry favors. With more members speaking with a single voice, there is greater leverage to negotiate more favorable prices. The Veterans Administration system already bulk purchases drugs as a single entity.
Certainly counterfeit and unsafe medications are rampant on the Internet. Technological tracking with methods like radio frequency identification tags (RFID) can go a long way to ensure safety. The powerful pharmaceutical industry lobby is against any reimportation. I will address this issue again in Part III of this series.
Stem cell research :
President Bush: Bush signed an executive order allowing federal funding of stem research, but only on the approximately 60 existing cell lines at the time of the order. Only 22 of the embryonic stem cell lines have been viable for research, which scientists feel significantly restrict potential breakthroughs.
Senator Kerry: Kerry has said he will lift the restrictions on stem cell research lines and allow federal funding. Guidelines for ethical stem cell research would be implemented.
How one feels about religious and political constraints on scientific endeavors, no matter the potential benefit, should influence candidate choice based on this issue.
In Part III, I will outline a proposed roadmap to provide necessary care for everyone.