Health Care 2005: How Do the Policies of President Bush and Senator Kerry Compare?

In 1991, in a Resolution on Christian Responsibility and a National Medical Plan 1, the 203rd Presbyterian Church (U.S.A.) General Assembly noted that it "decries our nation's failure to establish an equitable, efficient, and universally accessible medical plan. It asks the nation's legislative leadership, with help from religious, health care, insurance, and other organizations or industries, to break the impasse for the purpose of establishing a National Medical Plan. It returns to the roots of healing found in our faith and speaks forthrightly for health care services guided by theological vision. It calls upon the Presbyterian family to step into the fray, advocating access to health care for all."

Further, the Assembly "simply recognizes that most Americans desire an equitable and accessible health care system. The current system is neither; it fails the American dream of compassion and justice. Corporate society is squeezed by its high costs. Morally sensitive individuals are scandalized by its inequity. A growing number of individuals are suffering and dying because of lack of access to health care. Increasing numbers of people are becoming impoverished by health care costs. Reformation is required."

The Assembly called upon "the president of the United States and his administration to provide moral and political leadership so that an equitable, efficient, and universally accessible health plan, which includes a National Medical Plan defined by the elements and principles noted in the background, will be established" and called on "Presbyterians who are active in party politics to seek candidates for office, especially for their party's presidential nomination, who will place high priority on the establishment of an equitable, efficient, and universally accessible health plan, which includes a National Medical Plan."

In the 13 years since that call, our nation is still faced with extraordinary challenges in terms of health care. According to the Kaiser Commission on Medicaid and the Uninsured, 43.3 million were uninsured in 2002, over 80% of whom came from working families. The U.S. also leads the world in health care costs, spending nearly $1.6 trillion on health care in 2002 — 14.9% of the U.S. Gross Domestic Product (GDP) — nearly double the amount spent in 1992. Yet, in several indicators, U.S. health outcomes still lag behind other industrialized countries that spend less on health care. As the Presidential campaign season heats up, what are the two major candidates, President George W. Bush, and Senator John F. Kerry (D-MA), proposing regarding health care issues — particularly regarding the uninsured and health care costs? 2

While their plans for health care are very different, both candidates "support refundable tax credits for individuals who purchase their own health insurance," noted Ceci Connolly in the Washington Post. She added that they "also propose opening up larger purchasing pools to individuals and small businesses to help take advantage of group discounts." 3

President George W. Bush

In the State of the Union in January 2004, Mr. Bush said, "Our goal is to ensure that Americans can choose and afford private health care coverage that best fits their individual needs." His health care proposal 4, calls for the following to make health care more affordable:

• Association Health Plans (AHPs), which he says "will help small businesses provide affordable health insurance coverage to their workers,"
• Health Savings Accounts (HSAs), tax-exempt, portable accounts, to help individuals pay for health expenses,
• New health insurance deductions for individuals who establish HSAs,
• Refundable tax credits for lower-income Americans, of up to $1,000 for individuals and $3,000 for families, to buy health insurance coverage, and
• Medical liability reform to "help improve health care quality and slow the rise in health care costs."

The Kaiser Commission noted that Mr. Bush's general approach is "individual tax incentives to purchase coverage and restructuring Medicaid into a block grant."5 Mr. Bush has also called for increased funding (of approximately $169 million) for community health centers and giving states the option to block grant their Medicaid programs, increasing federal funding to states who accept the block grant through fiscal year 2010, and decreasing federal funds from that year through fiscal year 2013. The block grant proposal met with resistance from states in the 108th Congress. 6

At a recent meeting of the National Coalition on Health Care, Megan Hauck, a representative of Mr. Bush's campaign, said that his plan would expand health coverage to 2.5 million uninsured people at a cost of approximately $90 billion.

Senator John F. Kerry

The presumptive Democratic nominee, Mr. Kerry of Massachusetts, has developed a health care proposal, available in its entirety through the Kaiser Election Web site. In a speech in Florida in May, Mr. Kerry noted, "'It is long-since time that we stopped being the only industrial nation on the planet that doesn't understand that health care is not a privilege for the wealthy and the connected and the elected, it's a right for all Americans." 7 The Kaiser Commission described his general approach as "FEHBP (Federal Employees Health Benefits Program) buy-in, available to all Americans and small businesses, combined with a federal reinsurance pool and a 'swap' of federal and state Medicaid responsibilities to expand public coverage."8

Mr. Kerry's plan includes:

• Medicaid and the State Children's Health Insurance Program (SCHIP) Expansion, to cover more lower-income children and adults,
• Allowing individuals and businesses the option to join the Federal Employees Health Benefits Program (FEHBP),
• Providing private insurers help in handling the most expensive medical cases by having the federal government pay for 75% of the cost of catastrophic cases (once individual care reached $50,000), in return requiring companies who accept federal help to pay for health insurance for all employees, and
• Encouraging technological innovation to reduce medical errors.

At a recent meeting of the National Coalition on Health Care, Sarah Bianchi, National Policy Director for the Kerry Campaign, noted that Kerry's plan would cost $653 billion over 10 years, would cover 27 million uninsured people, and would be paid for by rolling back tax cuts for the wealthy that were passed during the Bush Administration.

What You Can Do

In the 1991 General Assembly resolution mentioned above, the Assembly encouraged "all members of the PC(USA) to engage in advocacy for universal access to health as a normative part of their devotional life and stewardship commitment." In 2002, the General Assembly reiterated past calls for advocacy on behalf of the uninsured, calling on the Presbyterian Washington Office to "encourage members of the Congress to recognize the importance of Universal Health Care — that is, equal, accessible, affordable, and high-quality health care for all persons residing in our nation."

In this election year, remind candidates at all levels of government that health care is important to you.

• Review Presbyterian General Assembly policies in the Christian and Citizen Election Year Resource.
• Read more about the candidates' statements on health care issues. Go to Kaiser Network's In-Depth Coverage of Health Issues in the 2004 Campaign.
• Send a letter to the editor of your local paper. Find the contact information of your local paper.
• Attend candidate forums and ask questions about candidate positions on health care.
• Consider how your congregation can be active in educating yourselves and your community in this election season. Review "Do's and Don'ts for Congregations during Election Times."
• VOTE!

Excerpts from "The Health-Care System Needs Strong Medicine" by Robert Kuttner (BusinessWeek, May 24, 2004, p. 30)

Neither candidate quite comes to grips with the underlying forces driving health costs higher. Expenses are inexorably rising for three basic reasons. First, people are living longer, and oldsters consume more health dollars. Second, medical technology keeps finding ways to keep us alive. Third, health care can't get major productivity gains because it is a labor intensive enterprise*.But absent more fundamental reform, the most likely source of cost reduction for employers, insurers, and government alike will be shifting the burden to individuals. Employer-provided insurance is already shifting costs at an alarming rate. As the Medicare and Medicaid budgets come under increased stress, fiscal pressure will mount to cap the government's costs, too.

In reality, most people who lack adequate health coverage can't afford it at prevailing prices. Bush's proposed health tax credit would cover only $1,000 of the cost of a decent family policy ($6,000 to $9,000), just as his Medicare drug program leaves very sick people paying about 50 percent to 75 percent of the cost of their medications. His health savings account requires insurance plans with high deductibles, which undermines the goal of preventive care. These "market incentives" aren't much help. Indeed, marketization can exacerbate the problem if it encourages insurers to fragment the risk pool and maximize profits by discriminating against people likely to get sick.

Kerry would actually deliver some expansion of coverage. Even so, allowing people on modest incomes access to the excellent Federal Employees plan isn't much use to families that can't afford the premiums. Absent stronger medicine (such as mandatory employer coverage or a universal, single-payer system), government incentives to employers or tax credits to individuals won't solve the problem. Advocates of universal coverage contend that only by putting everyone in the same risk pool — and reducing the hundreds of billions of dollars that go to marketing, claims processing, and profit — can we afford both to contain costs and cover the entire population. At the same time, however, society just can't afford to give every patient every possible treatment. That's a reality that no one wants to face. [Robert Kuttner is co-editor of The American Prospect and author of Everything for Sale.]