HEALTH CARE POLITICS 2008 HARVARD SCHOOL OF HEALTH, NEJM 1/14/08Both republican and democratic parties are showing different visions on how the voters health care should look. It is a top issue with both parties in the primaries. Employer sponsored insurance has sponsored the general health care system since the 1940s. Over 160 million non elderly americans are now covered. Will the intensity become the same as when President Clinton was first elected?
A survey in November by the Harvard School of Health showed:
DEMOCRATSThe democrats mainly complain about the quality and the cost of their health care. Half of the respondents felt the system was not bad enough to rebuild, and even 20% said it was excellent.
Democrats want universal health coverage and tax incentives to make it affordable. They want their employers or the government to pay for their health coverage. They also want more coverage and more benefits..
It is the number one problem to democrats and they feel the government should make it work. They would even pay more tax to get more insurance coverage. They want everyone to have health care with the government to help. They would like costs controlled and more health insurance coverage available.
REPUBLICANSRepublicans seem satisfied with the cost and quality of health care and are not worried about paying more or losing their coverage. They consider the war, economy, and immigration to be greater issues than health care.
They also would like the cost of health care reduced, but don’t want the government involved. They prefer the individual to purchase his own coverage.
High deductibles are fine. They want catastrophic coverage and like health savings accounts. It is the individual’s responsibility expect the private health insurance companies to give good coverage.
THE DEMOCRATIC PLAN
The aim is to finance minimal coverage by play or play employer mandates requiring businesses to offer workers insurance or pay a tax. Small businesses would be exempt and those that offered insurance would get a tax credit.
Private insurance issuers would be tightly regulated to allow everyone access to insurance. There would be new purchasing pools where individuals and businesses could buy insurance from any number of private plans. Government would subsidize individuals with low income. Medicare would not change. Medicaid would cover more low income americans.
The plans avoid details of budgeting the health care spending and centralized government cost controls. The plans mention cost saving measures as electronic medical records and focusing on preventive medicine. All this would be funded by canceling Bush's tax cut and a tax reform.
Hilary Clinton's plan requires all Americans to have insurance. Sen. Obama's plan mandates coverage only for children but does not rule out other changes.
People who can afford insurance must purchase coverage or pay a penalty. Health care becomes a responsibility not simply a right. Healthy persons must join insurance pools to share the risk and ensure coverage for all.
Since health care is unaffordable to many Americans, this plan depends an enforcement mechanism, the price of insurance, and generous government subsidies.
THE REPUBLICAN PLAN
Senator McCain has not release a detailed health plan but favors incremental expansion of insurance coverage and a change in tax policy so there could be more access and more control. It would shift enrollment form employer sponsored insurance to the individual. McCain offers a tax credit for Americans buying health insurance from an employer ore employer sponsored insurance, since these contributions are tax exempt. He pushes for more generic drugs and to coordinate how health providers are paid. He woulde decentralize market oriented reforms rather than universal coverage. This plan is not likely to increase coverage nor control costs.
THE BALANCE OF POWERIn the end, the values and beliefs of the candidate are most important. How committed is the candidate and can he or she deliver health change? Experience, stands on issues, leadership ability, character, and like-ability all are factors. Does the candidate share the voter’s views, values, and beliefs on issues most important to the voter? How health care should look like depends on how satisfied every voter is with his health care situation. in the end we can't take the candidates literally. The next president will have a different plan than what is proposed in the primaries. After all, the congress passes the laws.
THE KEY: OVER 1/3 OF AMERICANS ARE INDEPENDENT VOTERS WILL IT BOIL DOWN TO WHAT THEY THINK? Your comments always appreciated.
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