On health, a clear choice between Bush, Kerry
October 17, 2004
The health care crisis is back. It’s a lively topic in the presidential campaign.
Eleven years after the Clintons introduced their super-complex plan to revamp health care, the problems of rising costs and increasing numbers of uninsured have only gotten worse.
More than 43 million citizens under the age of 65 do not have health insurance – up from 38 million a decade ago. And fewer employers provide health insurance plans at all. Four years ago, 65 percent of employers offered health plans. Today it’s 61 percent.
In addition, health care costs continue to skyrocket – well beyond the rate of inflation. Since 2001, premiums for family coverage have risen 59 percent, according to a recent Kaiser Family Foundation survey. That’s five times the rate of inflation and well above the increase in income for the average worker. For employers, it adds to the cost of doing business and discourages hiring new employees.
And the trends are ominous. Spending on health care now accounts for almost 15 percent of the nation’s gross domestic product – and rising. Japan and Great Britain spend 8 percent. And the United States has fallen behind other nations in significant measures of health. For instance, the infant mortality rate for black Americans is double the rate for whites and four times that for babies in Japan.
The health care proposals by President George W. Bush and his Democratic challenger, Sen. John Kerry, are dramatically different in type and scale.
While Kerry’s plan is far short of the scope of the Clinton administration’s proposal – and not a Big Government plan as Bush charges – it is ambitious and expensive. Kerry wants to cover 95 percent of the population; he estimates it would cost $653 billion over nine years. He would pay for it by rolling back the tax cuts for people earning more than $200,000 a year.
Kerry’s plan includes tax credits to small businesses to enroll in the federal employees health care system – a group of private plans. He would lower premiums by having the government re-insure for catastrophic coverage – the fastest growing aspect of health insurance. And he would extend government coverage to all children not covered.
Bush’s plan is far less ambitious. It basically involves offering health savings accounts that would allow individuals to deduct the costs of health insurance from their taxes. The major problem with his scheme is that middle-income and working-class families might not be able to afford to pay into the accounts.
It would certainly benefit the wealthy. And the Kaiser foundation estimates it would only reduce the uncovered rolls by 1.8 million.
Bush says Kerry’s plan would cost three times what Kerry estimates and require a tax increase. Maybe so. And the Kerry plan would be more effective in providing additional coverage than reducing medical costs. But Bush’s plan doesn’t meet the challenge of either rising costs or lack of coverage.
Inevitably, reducing costs will involve tough moral and ethical questions, the kind that politicians running for office aren’t willing to deal with. The nation has developed more medical technology than it can afford. The key issue in controlling costs will be: who gets what type of care, and when. That does imply rationing.
This much is clear: The next president will have to step up to these issues. In our view, the Kerry plan offers more hope for making progress.