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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.

| Tue Jun. 12, 2007 2:00 AM EDT

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.

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