Understanding the Issues 2008: Health Care

With the Presidential election just a few months away I thought it would be a good idea if every few weeks we took a look at one of the key issues and broke down each of the major candidate's stance on it. So we did this a few months ago with Iraq, and now we're going to follow up with Health Care. Initially I wasn't going to identify the candidates just to avoid any bias, but I found that to be too complicated.

Ok, well vote and discuss. Hopefully, this can spark some good debate that will either reinforce your view or make you reconsider.

Hillary Clinton
-Require everyone to get health insurance, subsidized by employers and the government
-Pay for it by rolling back tax cuts for households earning over $250,000 and savings in the existing system.
-Require large employers to provide insurance or contribute to the cost.
-Provide tax credits to small businesses and subsidies for low-income people.
-Create a pool of private plans similar to the program for federal workers and one public plan similar to Medicare.
-Plans are portable from job to job. Expand Medicaid, State Children’s Health Insurance Program.

HillaryClinton.com - American's Health Choices Plan (http://www.hillaryclinton.com/feature/healthcareplan/)

John Edwards
-Require everyone to get health insurance, subsidized by employers and the government
-Pay for it by rolling back tax cuts for households earning over $200,000.
-Require employers to provide insurance or contribute to cost, with subsidies for low-income people.
-Create regional nonprofit pools that offer private plans and at least one public plan like Medicare.
-Expand Medicaid and State Children’s Health Insurance Program to serve adults below the poverty line and children and parents below 250 percent of the line.

John Edwards for President-Health Care (http://johnedwards.com/issues/health-care/)

Barack Obama
-Require that all children have health insurance
-Pay for it by rolling back tax cuts for households earning over $250,000; aims for universal coverage.
-Require employers to provide insurance or contribute to the cost. Exempt smallest businesses.
-Reimburse employers for catastrophic health costs.
-Provide subsidies for low-income people. Create purchasing pool with choice of competing private plans and one public plan like Medicare.
-Expand Medicaid, State Children’s Health Insurance Program.

Barack Obama | Change We Can Believe In | Health Care (http://www.barackobama.com/issues/healthcare/)

Rudy Giuliani
-Free market, consumer based system
-Opposes mandate requiring everyone obtain health insurance
-Tax deductions for health care expenses: $7,500 for individuals and $15,000 for families. Provide additional tax deductions to low-income households.
-Allow people to buy insurance across state lines.
-Expand health savings accounts by simplifying the rules and regulations to participate in them.

JoinRudy2008 :: Issues (http://www.joinrudy2008.com/issues/view/11)

Mike Huckabee
-Free market, consumer based system
-Opposes mandate requiring everyone obtain health insurance
-Use stats as "laboratories for new market-based approaches"
-Tax credits for low-income households
-Make plans portable from one job to another

Mike Huckabee for President - Issues (http://www.mikehuckabee.com/?FuseAction=Issues.View&Issue_id=8)

John McCain
-Free market, consumer based system
-Opposes mandate requiring everyone obtain health insurance
-Make plans portable and accessible across state lines.
-Provide $2,500 tax credits ($5,000 for families)
-Move to compensate medical providers based on the quality of their work
-Bring greater competition to drug markets by safe reimportation of drugs and streamlining the process for introducing generic drugs.

John McCain 2008 - John McCain for President (http://www.johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm)

Mitt Romney
-Free market, consumer based system
-Opposes mandate requiring everyone obtain health insurance
-Give states flexibility to create programs and deregulate their insurance markets
-Make all health care expenses deductible
-Give tax credits for insurance not provided by an employer.

Health Care (http://www.mittromney.com/Issues/healthcare)

I like Obama's mainly because he's trying to make it required that all children have health care coverage. I'm really politically dumb to all these terms but. Being that I'm a democrat, I tend to like all the dem's views. Sigh. So hard to choose.

I think that as time goes on we should move more and more towards a government health system. I will go with Hillary on this, but she will most likely not get my vote.

im not for forcing people to have health care. the universal health care i would like to see is like the one that is in place over seas. you have health issues you go to the doctor. ALL doctors charge the same fees for the same procedures. it is a govt run program. rolling back the tax breaks would be one way to pay for it. the main problem with health care in this day and age is the sky rocketing cost. this would be one way to control it. not to hijack, but i love Edwards plan on how to replenish social security

John McCain's is by far the best. Though for my employer, the biggest provider of free and underreimbursed care in Pennsylvania, a Democrat would be the best for our financials. But John McCain is the only candidate who addresses the root causes for why healthcare is so expensive.

All of the Democrats are simply trying to find a way to get everybody in the US coverage. A noble cause, but it does nothing to address the factors driving the high growth in health care costs.

First, making plans portable across state lines increases competition amongst hospitals. All of a sudden Cooper University Hospital in South Jersey has to compete with places like the Hospital of University of Pennsylvania, and Jefferson University Hospital for patients. Plus, HMOs now have increased competition from each other as consumers can opt for plans from other states.

Compensating providers based on quality is a movement already taking place in the commercial insurance world. Independence Blue Cross and Aetna here in Philadelphia are already driving pay-for-performance. In other words, if your hospital shows above average mortality rates, rates of unplanned-return-to-surgery, and other quality metrics, then you get a bigger rate increase from the insurers. McCain is the ONLY CANDIDATE that wants to put this in place for government payers Medicare and Medicaid. Keep in mind, Medicare and Medicaid are responsible for a huge portion of payments to providers, so until they begin using pay-for-performance, the healthcare industry will not take quality seriously.

And one of the biggest reasons why healthcare costs have been increasing so rapidly in this counrty is the increase in pharmaceuticals. There are more drugs than ever before, and they all come with patents. McCain is suggesting to make it easier for generics to compete with patented drugs, and increasing price competition through importation. Without these moves, there will be no market factors in place to stop the momentum behind the unstoppable growth in drug prices.

I work in the Financial Planning department of a major metropolitan academic healthcare center. We treat a TON of medicaid patients. A democrat would definitely be best for my employer (they'd essentially just boost payments to us), McCain is by far the best for the country. He's the only candidate who truly rolls up his sleeves, gets his hands dirty, and digs into the issues to truly understand them.

Giuliani or McCain. In the spirit of common sense, I can't support a health care plan that deems it a legal necessity to have one. I would support government assistance for those who cannot afford it themselves, but are trying.

Allowing people to buy across states (Giuliani/McCain) would really open up the market.

And one of the biggest reasons why healthcare costs have been increasing so rapidly in this counrty is the increase in pharmaceuticals. There are more drugs than ever before, and they all come with patents. McCain is suggesting to make it easier for generics to compete with patented drugs, and increasing price competition through importation. Without these moves, there will be no market factors in place to stop the momentum behind the unstoppable growth in drug prices.

I agree with much of what you say but on drugs we might disagree. The incentive for companies to research and formulate new drugs is all in the profit. I think we can agree that drug companies need to maintain the highest level of motivation and increasing their exposure to generics would seem to drive profits down to me. I am not sure what the answer here is.

schneed, its funny you mention the companies blue cross and aetna. from 1999 until 2006, i had blue cross, that was company provided. last year our company switched to aetna. i never thought that much about it until i got a phone call from my brother. he said aetna is the worst. refuses to pay on just about everything. this year our company switched back. one of the big wheels wives got really sick. and aetna fought them tooth and nail over everything. thus the switch. you talk about compensating providers based on quality. in theory, this is a great idea. in reality, who makes this call? or is this another way for some one to make a ton of money for giving good marks to some providers that don't really deserve it? if its someone involved in the insurance industry that will be doing the grading, it definitely isn't going to work

schneed, its funny you mention the companies blue cross and aetna. from 1999 until 2006, i had blue cross, that was company provided. last year our company switched to aetna. i never thought that much about it until i got a phone call from my brother. he said aetna is the worst. refuses to pay on just about everything. this year our company switched back. one of the big wheels wives got really sick. and aetna fought them tooth and nail over everything. thus the switch. you talk about compensating providers based on quality. in theory, this is a great idea. in reality, who makes this call? or is this another way for some one to make a ton of money for giving good marks to some providers that don't really deserve it? if its someone involved in the insurance industry that will be doing the grading, it definitely isn't going to work

Dmek, with all due respect, you apparently know nothing on how pay for performance works. Quality is not "judged" or "graded" by someone who comes in and peeks under the hood of your hospital. It is judged by hard numbers standardized within the industry:

- % of people dying compared to the expected death rate
- % of patients receiving unplanned return to surgery
- % of patients discharged within a predetermined time frame appropriate for their illness

You either meet those numbers or you don't, it's not subjective. If you meet them, IBC and Aetna give you a 5% increase on your reimbursement rates next year. If you fail, they only give you a 2% increase. Cut and dry. It's widely regarded as one of the best innovations to come about in healthcare reimbursement recently.

I agree with much of what you say but on drugs we might disagree. The incentive for companies to research and formulate new drugs is all in the profit. I think we can agree that drug companies need to maintain the highest level of motivation and increasing their exposure to generics would seem to drive profits down to me. I am not sure what the answer here is.

I disagree here. If you shorten the amount of time a patent can last, you open the drug companies up to generics sooner. This puts more pressure on the drug companies to come up with new drugs faster. If patents expire more quickly, it becomes imperative to cycle new drugs into the market faster and faster, else you end up with a slew of products exposed to competition from generics.

It will push margins down, yes. But if the drug company sits idle and brings no new drugs to market, they'll go out of business. Their only option will be to bring more new drugs, with patents, to market. If the patents don't last as long, you need more drugs in the market, or you dry up.