The Presidential Candidates on Health Care
Farhana Hossain
The New York Times
Presidential candidates in both parties are promising to overhaul the nation’s health care system and cover more - if not all - of the nation’s uninsured. In 2005, 44.8 million people - 15.3 percent of the population - were without health insurance, according to estimates released by the Census Bureau in March. The leading Democrats are competing among themselves over who has the better plan to control costs and approach universal coverage. The Republicans, for the most part, are promising to expand coverage without increasing the role of the federal government, and reduce cost through tax incentives. Most of the candidates have not presented a detailed outline of their health care plans, but here is what they have said so far.
Read Dr. Don McCanne’s Quote of the Day Comment on Sen. Hillary Clinton’s Health reform proposal.
Democrat
PROPOSAL TO EXPAND COVERAGE
IMMEDIATELY INSURE EVERYONE UNDER 18
“I would move immediately to insure all children under age 18, modernize medical records and provide catastrophic health insurance to lift the burden on the 46 million people who can’t afford coverage.”
— Las Vegas Sun, March 23, 2007
WORK WITH STATES TO MOVE TOWARDS UNIVERSAL COVERAGE
“I think the thing that will get us to total health coverage - health insurance for everybody the quickest - is to do what we did on welfare reform. What we did was we allowed the states considerable flexibility and leeway in reorganizing the system and we underwrote the cost of the poor states in doing it to get work programs going. Do the same exact thing with health care. You have a dozen states, including big ones, that are now passing legislation requiring universal insurance, just like liability insurance. Once you get to a critical mass of 30 to 35 states, you’ve established a national consensus. Cherry-pick those elements of the plans. Maybe even give them localized flavor rather than one simple standard that exists that require that there be total complete coverage across the board.”
— In New Hampshire, April 14, 2007
PAYING FOR ADDITIONAL COSTS
END WAR IN IRAQ; ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR THE HIGHEST EARNERS
“The first two things we could do and we could do it without having to fundamentally change anything other than the president’s unneeded tax cut for people making an average of $1.43 million dollars a year in the top one percent.”
— In Nevada, April 2007
“Eliminate the break for investment on dividends, which is $195 billion. For $26 billion a year, I can insure every single solitary child under the age of 18 in the United States. You need start-up dollars. The place I’d start off with is somewhere over $220 billion a year by the tax cuts and ending the war.”
— On NBC’s “Meet the Press,” April 2007
Democrat
PROPOSAL TO EXPAND COVERAGE
REQUIRE EVERYONE TO GET INSURANCE, SUBSIDIZED BY EMPLOYERS AND THE GOVERNMENT
“I call my plan, the American Health Choices plan. … If you have private insurance you like, nothing changes … you can keep that insurance. … If, however, you don’t have health insurance or you don’t like the insurance you have, you can choose from the same wide variety of private plans that members of Congress choose from. … You will have access to a public plan that will provide a stable, competitive alternative to private insurance if that is your choice.”
“While I will be requiring all Americans to have health care, I will be calling on employers to do their part as well. … Under my plan, large companies will be required to help pay for their employees’ health care. Those that do so can simply maintain their current policy that they choose. Those that don’t, will need to contribute towards the cost of covering their employees on a sliding scale based on their size and average wages. … We won’t require small businesses to cover employees. Instead we will provide tax credits to ensure that many of them do. … The government will provide tax-credits to insure that every single American can afford health insurance.”
— In Des Moines, Sept. 17, 2007
PAYING FOR ADDITIONAL COSTS
ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR PEOPLE EARNING OVER $250,000 AND BY SAVINGS IN THE EXISTING HEALTH CARE SYSTEM
“I won’t pay for it by pouring money into a broken system. I won’t pay for it by raising taxes on middle class families who are already struggling with rising costs and stagnant wages. Instead, I’ll pay for part of it by implementing the cost saving measures I outlined in May. And I will pay for some of it by rolling back part of President Bush’s fiscally irresponsible tax breaks for the highest income Americans. And I’ll pay for some of it by limiting the tax breaks for people making over $250,000 a year to the same level that ordinary, middle class Americans get.”
— In Des Moines, Sept. 17, 2007
HAS OUTLINED A SEVEN-POINT PLAN TO CONTROL COST
- Ensure better preventative care
- Modernize record-keeping
- Streamline care for the chronically ill
- Create large insurance pools
- Start a “Best Practices Institute” to finance research
- Control prescription drug costs
- Revise medical malpractice system
— At George Washington University, May 24, 2007
Democrat
PROPOSAL TO EXPAND COVERAGE
HAS PLEDGED UNIVERSAL HEALTH CARE, SUBSIDIZED BY EMPLOYERS AND THE GOVERNMENT
“Everyone participates, everyone benefits. All the stakeholders — individuals, employers, the government — are involved in coming up with a system here that would make it possible to reduce those numbers of 47 million of our fellow citizens who have no health care to make sure they’ll be included.
- Second is prevention alone. Minimum we try to do is see to it to reduce the cost by stopping people from getting ill in the first place.
- Thirdly is building upon the good things we’ve done already: Forty years of Medicaid and Medicare. I would extend Medicaid to poorer families, 100 percent of poverty; the ones with children, 300 percent of poverty.
- Last is the fourth principle, dealing with technology. Some $80 or $90 billion could be saved, not to mention the morbidity rates by doing a far better job and utilizing the technology that exists today.”
— Presidential Forum on Health Care, March 27, 2007
PAYING FOR ADDITIONAL COSTS
END WAR IN IRAQ; ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR THE HIGHEST EARNERS
“If you get rid of these permanent tax cuts to the top one percent of income earners, get the war ended in Iraq that we’re spending $2 million a week, $8 million a month, we can provide the resources to really move in this direction. So I would make it a top priority in my administration. I wouldn’t want to put a time frame on it because I think it’s too important, but for us to get there as soon as possible.”
— Presidential Forum on Health Care, March 27, 2007
Democrat
PROPOSAL TO EXPAND COVERAGE
REQUIRE EVERYONE TO GET INSURANCE, SUBSIDIZED BY EMPLOYERS AND THE GOVERNMENT
“What we’re going to do is cover every single American, including the 47 million who don’t have coverage. We’re going to bring down costs for everybody. And for most Americans, we’re going to help them pay the cost. It’s based on a concept of shared responsibility. In the case of employers, we’re going to ask them to do more to either insure all their employees or to contribute to their being insured. The government will help subsidize the health care and create health care markets so we have more competition and deal with issues like preventative care, mental health care, to make sure those kind of things — chronic care — are, in fact, being done. And then, finally, for individuals, we’re going to make sure they have insurance. They have to have insurance so that everybody has health insurance.”
— On NBC’s “Meet the Press,” Feb. 4, 2007
PAYING FOR ADDITIONAL COSTS
ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR THE HIGHEST EARNERS
“The tax cuts that George Bush gave to people who make over $200,000 a year will have to go away to pay for my health care plan. My universal health care plan costs 90- to $120 billion a year. I do not believe, having spent a lot of time on this, that you can achieve universal health care without—without finding a revenue source, and that’s my revenue source.”
— Face the Nation, Feb.25, 2007
Democrat
PROPOSAL TO EXPAND COVERAGE
ISSUE VOUCHERS TO EVERYONE BASED ON THEIR PROJECTED NEEDS
“Under the plan we would issue vouchers to every single American. And the vouchers, you don’t pay for them, they’re issued to you. You sign up every year for them. And the vouchers will have a very modest co-pay, a very modest deductible, but that’s it. Everybody gets the same product universally in the United States of America. And then if you want more than the product you got, you pay for it.
The vouchers are set up for risk on an individual basis, not on a collective this fits all, because if you’re young, you probably don’t have a cost of more than $3,000. When you’re my age, it could be $150,000-$180,000 in one year. One of the facets of the plan would be to keep in place Medicare and Medicaid and phase them out over time. Because plans to put everybody on Medicare aren’t going to fly financially and just can’t be met.”
— Presidential Forum on Health Care, March 24, 2007
PAYING FOR ADDITIONAL COSTS
FEDERAL GOVERNMENT WITH TAXPAYER‘S MONEY; CONTROL COST BY MODERNIZING RECORDS
“All Americans pay for it regardless of the system you have now but the system you’re going to get, single-payer Health Care Voucher plan. There’s no magic in this whole process. Somebody is going to pay. You know who pays, it’s the average American, one way or the other, particularly under our present system. And so to want to trash the business community and trash our tax system, which is already corrupt, with greater corruption as a way to solve the problem is a nonstarter. The way the plan is designed, it won’t raise costs, because the 30 percent that they’re talking about is paper cost. If you took that and put it into some real costs in health care, we’d cover everybody without raising any costs.”
— Presidential Forum on Health Care, March 24, 2007
Democrat
PROPOSAL TO EXPAND COVERAGE
ESTABLISH MEDICARE FOR ALL
“A not-for-profit health care system is not only possible, but H.R. 676, a bill that I introduced, and a number of Congressmen, the Conyers-Kucinich bill, actually establishes Medicare for all, a single-payer system and it’s a not-for-profit system. It’s time we ended this thought that health care is a privilege. It is a basic right, and it’s time to end this control that insurance companies have not only over health care but over our political system. I’m talking about a real deal for the American people, a universal single-payer not-for-profit Medicare for all.”
— Presidential Forum on Health Care, March 24, 2007
PAYING FOR ADDITIONAL COSTS
REMOVE COSTS RELATED TO PRIVATE INSURERS
“At least 30% of the $3.2 trillion spent annually for health care in the United States goes to the for-profit system, while 50 million Americans, many of them working, are without health insurance. About $660 billion goes for corporate profits, executive salaries, stock options, advertising, marketing, and the cost of paperwork. If we took all that money and we put it into a public health system, a national health care plan, we would have enough money to cover everything for everyone.”
— House floor, July 12, 2006
IMPLEMENT TAXES FOR THE HIGHEST EARNERS AND A PAYROLL TAX
“B). Increasing personal income taxes on the top 5 percent income earners.
C). Instituting a modest and progressive excise tax on payroll and self-employment income.
D). Instituting a small tax on stock and bond transactions.”
— H.R. 676
Democrat
PROPOSAL TO EXPAND COVERAGE
REQUIRE CHILDREN TO GET INSURANCE; AIMS FOR UNIVERSAL COVERAGE
“The main disagreement with John [Edwards] and I is John believes that we have to have mandatory insurance for everyone in order to have universal health care. My belief is that most families want health care but they can’t afford it. And so my emphasis is on driving down the costs, taking on the insurance companies, making sure that they are limited in the ability to extract profits and deny coverage — that we make sure the drug companies have to do what’s right by their patients instead of simply hoarding their profits. If we do those things then I believe that we can drive down the costs for families. In fact, we’ve got very conservative, credible estimates that say we can save families that do have health insurance about a thousand dollars a year, and we can also make sure that we provide coverage for everybody else. And we do provide mandatory health care for children.”
— CNN debate for Democratic candidates, June 3, 2007
PAYING FOR ADDITIONAL COSTS
ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR PEOPLE EARNING OVER $250,000
To help pay for all this, we will ask all but the smallest businesses who don’t make a meaningful contribution today to the health care coverage of their employees to do so by supporting this new plan. And we’ll also allow the temporary Bush tax cuts for the wealthiest Americans to expire.
— University of Iowa, May 29, 2007
Democrat
PROPOSAL TO EXPAND COVERAGE
REQUIRE EVERYONE TO GET INSURANCE, SUBSIDIZED BY EMPLOYERS AND THE GOVERNMENT
“No. 1, my plan is mandatory. You do have everybody sharing — the employer, the employee, you have the state and the federal government. Secondly, I believe that we can have a plan where if you were satisfied with your health care plan, you can keep it. No new bureaucracy. But in addition to that, you focus on prevention. You allow everybody to get the Congressional plan that every member here has.You bring Medicare 55 and over.”
— CNN debate for Democratic candidates, June 3, 2007
“Our main responsibility should be to insure all children under five. We’ve done that in New Mexico and we should do that nationally. Secondly, we should insure all working adults, all working families. The third phase would be the chronically unemployed. The way you do that is by improving efficiencies and costs. The way you do that is not have Medicare and Medicaid covering seniors and disabled, it should be one. We should expand the S-Chip [State Children’s Health Insurance Program] to cover children.”
— A.F.S.C.M.E. forum, Feb. 21, 2007
PAYING FOR ADDITIONAL COSTS
FORM PARTNERSHIP WITH HEALTH CARE COMMUNITY
“I would not increase taxes. I believe that, if anything, Democrats have been viewed - our solution is always to increase taxes, and we shouldn’t. I don’t think the solution of the Democratic Party should always be to either spend more or tax more. I believe if we have partnerships between hospitals, between communities, between the state, the federal government, and you give flexibility to the states, we can have universal health care.”
— A.F.S.C.M.E. forum, Feb. 21, 2007
Republican
DETAILS OF THEIR PLANS
ADVOCATES MARKET-BASED HEALTH CARE; MAKE PRIVATE INSURANCE AFFORDABLE THROUGH TAX DEDUCTIONS
“I believe we can reduce costs and improve the quality of care by increasing competition. We can do it through tax cuts, not tax hikes. We can do it by empowering patients and their doctors, not government bureaucrats.”
— Boston Globe op-ed, Aug. 3, 2007
No estimate of cost. He proposes an income tax credit of up to $7,500 for individuals and $15,000 for families, allowing that money to be directed toward the purchase of health insurance and other medical spending. He also said he opposed any government mandates that would require people or businesses to buy insurance. He criticized Democrats’ plans, saying they should leave the important decision of choosing insurance to individuals, not the government. He did not promise that all the uninsured would be covered under his proposal. He would expand health savings accounts by simplifying the rules and regulations to participate in them. He wants to increase the efficiency of the evaluation process for new drugs. He said the current process is too heavily regulated.
PAYING FOR ADDITIONAL COSTS
HAS NOT ADDRESSED HOW HE WOULD PAY FOR THE TAX DEDUCTIONS; HAS SAID THAT A FREE-MARKET WOULD BRING DOWN COSTS
“He said competition among insurers for customers would lead them to reduce the costs of their policies, estimating that only 20 million to 30 million of the 120 million who currently get their insurance through an employer would need to sign up for individual insurance plans for that to happen. “You have to start bringing the price down before you can figure out how many people can you include. It can’t be done with a magic wand all at once.”
— Rochester, N.H., July 30, 2007
Republican
DETAILS OF THEIR PLANS
ADVOCATES MARKET-BASED HEALTH CARE; MAKE PRIVATE INSURANCE AFFORDABLE THROUGH TAX DEDUCTIONS AND COST CONTROL MEASURES
“We don’t need universal health care mandated by federal edict or funded through ever-higher taxes. We do need to get serious about preventive health care instead of chasing more and more dollars to treat chronic disease, which currently gobbles up 80% of our health care costs, and yet is often avoidable. The result is that we’ll be able to deliver better care where and when it’s needed.
I advocate policies that will encourage the private sector to seek innovative ways to bring down costs and improve the free market for health care services. I also value the states’ role as laboratories for new market-based approaches, and I will encourage those efforts. “
PAYING FOR ADDITIONAL COSTS
IMPLEMENT COST CONTROL MEASURES
“We can make health care more affordable by reforming medical liability; adopting electronic record keeping; making health insurance more portable from one job to another; expanding health savings accounts to everyone, not just those with high deductibles; and making health insurance tax deductible for individuals and families as it now is for businesses. Low-income families would get tax credits instead of deductions.”
— Campaign Web site
Republican
DETAILS OF THEIR PLANS
ADVOCATES MARKET-BASED HEALTH CARE; OPPOSED TO GOVERNMENT-SUBSIDIZED UNIVERSAL HEALTH CARE
“I am not for universal health care. If everything is paid for by the government, you’ll have companies trying to get in and trying to overcharge. And you’ll lose what I call a consumer interest, in keeping the cost of health care down.”
— WMUR-TV, April 13, 2007
LET AMERICANS SHOP FOR INSURANCE ACROSS STATE LINES
“We need to be able to buy our health care insurance across state lines. Right now the same single policy that can be purchased in Long Beach for $73 costs $334 in New Jersey. The states lock up the insurance industry. They won’t let Americans buy across state lines just like they do everything else. If we’re able to do that, we’re going to bring down the cost of health insurance.”
— CNN debate for Republican candidates, June 5, 2007
PAYING FOR ADDITIONAL COSTS
NOT AVAILABLE
Republican
DETAILS OF THEIR PLANS
HAS PLEDGED AFFORDABLE HEALTH CARE FOR EVERY AMERICAN WITHOUT A FEDERAL MANDATE
“The biggest problem with the American health care system is that it costs too much. … Businesses and families pay more and more every year to get what they often consider to be inadequate attention or poor care.”
— Des Moines, Oct. 11, 2007
No estimate of cost. He would provide $2,500 refundable tax credits for individuals, and $5,000 tax credits to families, if they have health insurance. He opposes universal health care mandates. He said he believed in limited government intervention, and wanted to give individuals freedom to choose their own health care. He would allow people to have portable insurance that could be purchased across state lines. He wants to bring greater competition to drug markets by safe reimportation of drugs and streamlining the process for introducing generic drugs.
PAYING FOR ADDITIONAL COSTS
SAYS UNIVERSAL HEALTH CARE IS POSSIBLE WITHOUT A TAX INCREASE
“I’m certainly not interested in raising people’s taxes, as many of the Democrats are interested in doing. I’m absolutely opposed to that.”
— On ABC’s “This Week,” June 10, 2007
Employers would no longer be allowed to deduct health care costs from their taxes under his plan.
Republican
DETAILS OF THEIR PLANS
ADVOCATES MARKET-BASED HEALTH CARE; OPPOSED TO FEDERAL MANDATE
“It’s time to rethink the whole system. The rise of HMOs has created a harmful collusion between politicians, drug companies, and organized medicine that raises the price of health care by stifling competition between providers. And all this in favor of moving us towards universal health care! I believe strongly that patients are better served by having an element of choice in the matter, which is why I support letting the free-market determine health care costs. This won’t happen, however, until we unravel the HMO web and change the tax code to allow individuals to fully deduct health care costs from their taxes, as employers can.”
— Muckraker Report, June 28, 2007
PAYING FOR ADDITIONAL COSTS
WANTS TO MAKE HEALTH CARE MORE AFFORDABLE WITHOUT TAX INCREASE
“Congress needs to craft innovative legislation that makes health care more affordable without raising taxes or increasing the deficit. It also needs to repeal bad laws that keep health care costs higher than necessary.”
— LewRockwell.com, August 23, 2006
Republican
DETAILS OF THEIR PLANS
ENCOURAGE STATES TO DEVELOP MARKET-BASED HEALTH CARE PROGRAMS; OPPOSED TO A NATIONAL VERSION OF THE PLAN HE SUPPORTED FOR MASSACHUSSETS AS GOVERNOR OF THE STATE, REQUIRING EVERYONE TO GET INSURANCE
“The way we improve something is not by putting more government into it. … Instead, the right way for us to go is to bring in place the kind of market dynamics that make the rest of the economy so successful.”
— Republican Debate, Dearborn, Mich., Oct. 9, 2007
The cost would depend on what kinds of plans states propose. He wants to allow people who buy their own health insurance to be able to deduct premiums, deductibles and co-payments from their income. He is against individual or employer health care mandates, but said he wanted to get everybody “in the system” by driving down costs with market reforms. His plan would assist low-income Americans in buying private health insurance plans of their choice. He has not specified a way to change the current process of regulating drugs.
PAYING FOR ADDITIONAL COSTS
USE FEDERAL MONEY NOW BEING USED TO HELP STATES COVER THE COST OF MEDICAL CARE FOR THE UNINSURED
“It’s a conservative idea insisting that individuals have responsibility for their own health care. I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase.”
— USA Today, July 5, 2005
Republican
DETAILS OF THEIR PLANS
ADVOCATES MARKET-BASED HEALTH CARE; WOULD NOT RULE OUT FEDERAL SUBSIDIES FOR THE NEEDY
“As for the uninsured: as many as 25 percent of them are illegal aliens and should be deported or encouraged to leave. For citizens and legal residents who are employed by businesses which cannot afford coverage, I favor association health plans which band small businesses together to access lower-cost insurance. For those out of work, state governments should be the primary source of relief, although I would not rule out federal incentives or limited subsidies to make sure families who have fallen on hard times are not without coverage.”
PAYING FOR ADDITIONAL COSTS
PROPOSES IMMIGRATION REFORM TO CURB COST
“The two major problems are the high cost of care and the number of uninsured. Tort reform and immigration enforcement would save the system billions and drive down costs. In California alone, illegal immigrants cost the system $800 million annually and have forced 84 hospitals to close.
As for the uninsured: as many as 25 percent of them are illegal aliens and should be deported or encouraged to leave.”
— Campaign Web site
Republican
DETAILS OF THEIR PLANS
ADVOCATES MARKET-BASED HEALTH CARE, OPPOSES FEDERAL MANDATE
“The best way to improve the best health care in the world, which is what we get right here in the United States, is to expand choice—not punishment.”
— Orlando, September 2007
“Those who propose a one-size-fits-all Washington-controlled program ignore the cost, inefficiency, and inadequate care that such a system offers.”
— Campaign Web site
PAYING FOR ADDITIONAL COSTS
IMPLEMENT MEASURES TO CONTROL COSTS AND SAVE MONEY
Access to affordable, portable health care can be made available for all Americans without imposing new mandates or raising taxes. Current government programs must also be streamlined and improved so that those who truly need help can get the health care they need.
— Campaign Web site