Bush and Kerry on the Health Care Crisis

“If there’s a senior citizen somewhere who can't pay for her prescription and has to choose between medicine and the rent, that makes my life poorer, even if it's not my grandmother…it’s that fundamental belief - I am my brother’s keeper, I am my sister’s keeper - that makes this country work.” - Barack Obama, Illinois State Senator, 7-27-04

Forty-five million people have no coverage and tens of millions more have inadequate insurance. Employers are cutting back on coverage or hiring part-timers with no benefits as the annual cost for family coverage has more than doubled in the past six years Total healthcare costs have gone up 50% since 2000. Co-pays and prescription drug costs are exploding and the powerful pharmaceutical companies engage in price gouging. The Medicare prescription drug bill won’t permit the government to negotiate lower prices. The pressure is on for presidential candidates to come up with answers on how to deal with the healthcare crisis.

How would the Republican and Democratic candidates respond? Ms. Kate Sullivan Hare, speaking for the Chamber of Commerce commented that, “neither presidential candidate is really talking about government policies to control health care inflation.”

So what are they saying?

The Republican Proposal

President Bush describes health care as an “individual responsibility” as part of what he calls the “ownership society.” Everyone would own their own health plan and a piece of their own retirement. They’d shoulder the economic risk of investing their health care benefits in the stock market. This might benefit the healthy and wealthy, but it’s not wise policy.

The President’s health plan revolves around Health Savings Accounts (HSA). Rather than offer health benefits, employers would give workers a limited amount of money to invest in HSAs, a dramatic departure from the basic concept of health insurance with the risk spread among the large pool of people who pay in. In turn, health care is available when they need it.

As for lowering the cost of health care, the President relies on tort reform, limiting financial liability for providers and insurers. It also limits the right of patients to sue for fair compensation in the event they are harmed by poor care. Lawsuits account for only 4% of total health care costs so it would have very little effect on healthcare expense.

Republican talking points on health care and HSAs include:

· Tax credits will be given for investing money in HSAs - instead of having actual health insurance.
· HSAs would be portable as employment changes.
· Direct help would be provided to help low-income Americans purchase HSAs.
· Every poor county will have a rural or community health center.

What Bush doesn’t mention:
· HSAs would radically restructure the provision of health care by moving away from relatively comprehensive insurance, including catastrophic coverage.
· HSAs really mean universal under-insurance. There is absolutely no guarantee that accounts will be large enough to cover actual health care costs. Annual tax credits or “direct help” of $3,000 don’t come even close to current insurance premiums when the annual family coverage averages more than $9,000.
· HSAs would cherry-pick the healthy and the well off. Sick people would have the choice of higher costs or no health care at all. This would shift costs to society as a whole.

· Rural or community health centers provide primary care - not hospital care or care by specialists.
· Insurance and pharmaceutical companies, managed care programs and HMOs are a major part of the problem but aren’t even mentioned!
· Over the past 4 years Medicaid was defunded, SCHIP reduced for the first time, Veterans Affairs funding cut, and the social insurance model of Medicare undermined by encouraging privatization.

Democrats Sound the Alarm on Health Care

Twelve years ago, Bill Clinton ran for President saying that health care is a right. Now John Kerry says, “Health care is not a privilege for the wealthy, the connected, and the elected - it is a right for all Americans.”

Quality, affordable health coverage for all Americans to keep our families healthy, our business competitive and our country strong was the theme running through the Democratic National Convention. They condemned policies that divide our system between the healthy and wealthy people and the elderly or sick. At the same time, the broad middle class and small companies can’t afford to maintain their current coverage.

What the Democrats said on health care:
· The American people deserve the same health care as their elected leaders.
· Don’t send Medicare to the marketplace and into hands of HMOs.
· Our seniors need a real drug benefit - one that uses the government's purchasing power to lower costs and ensure access to new therapies for illness.
· Stop giving huge profits to drug companies and HMOs at the expense of affordable health care for more Americans.

What they didn’t say:
· What a decent, affordable system would look like;
· the solution requires more than just cracking down on waste and greed;
· there is already enough money in the system to cover everybody if we use the money better.
· the current direction of US health policy is actively destroying Medicare and Medicaid and undermining employer-based insurance.
· How to deal with the negative impact of the federal deficit on state and local health care budgets.

How should the health care justice movement respond? We should refine our focus. After the 1992 Clinton proposals, things got bogged down with a thousand pages of policy.  The big picture was lost and so was the health care battle.

We can and must say what the candidates have not focused on so far. All the American people, not just the wealthy, deserve access to affordable, comprehensive health care. We must reject bare bones coverage for some and full coverage only for those who can pay for it. We need to keep in mind that the current system costs more and provides less than a comprehensive national program. We must demand that candidates will both undo the damage already done and work to preserve the foundations of these programs. Stop the destructive attacks on Medicare and Medicaid! We must oppose any federal proposal that makes health coverage an individual responsibility or limits states’ ability to expand coverage. We must make clear that catastrophic coverage as the national health insurance standard would be catastrophic for America’s health. Affordable health care for all is possible, but primarily “individual” solutions will fail. Health care for all requires a societal approach, a commitment to design a system that includes everyone whatever the means of health care delivery.

- Molly Rush, PUSH (Pennsylvanians United for Single-payer Healthcare)