 Leading presidential candidates propose ways to improve cost, quality By Michelle Austein November 07, 2007
The United States is expected to spend about $2.3 trillion on health care in 2007, or about 16 percent of the country's gross domestic product -- significantly more per capita than any other nation. It is the only industrialized country that does not mandate access to health insurance for all citizens. Most Americans receive health insurance at a subsidized cost through their employers, and polls show most are happy with the insurance they have through this system. The U.S. government provides assistance through Medicare for those 65 and older and Medicaid for those with low incomes. "A big concern on the part of Americans is the cost of health care, the cost of insurance," said Alwyn Cassil, director of public affairs for the Center for Studying Health System Change, a nonpartisan research organization. About 47 million Americans do not have health insurance, and most of them are poor. Many small companies do not provide insurance for their employees, and insurance purchased independently can be significantly more costly to individuals than that provided by their employer. CANDIDATES' VISIONS Almost all the major presidential candidates have outlined their visions for expanded health care coverage and improved quality of care in the United States. Candidates have discussed their plans on the campaign trail and on their Web sites. Historically, Democratic voters have been more interested in health care than Republicans, so Democratic candidates tend to be more vocal about it during the primary season. Democratic candidates have released more detailed plans than their Republican counterparts. Even so, Cassil said, it is not an issue on which Democratic candidates are differentiating themselves during the primaries. Hillary Clinton, Barack Obama and John Edwards, the top three Democratic candidates, have similar proposals, Cassil said. Their proposals call for universal coverage for all citizens. Clinton and Edwards would require all people to have health insurance and provide both private and government insurance plans to choose from. Obama's plan would mandate that all children be insured. The candidates' plans would lower costs through tax credits and create financial incentives for health care providers to improve their quality of care. Cassil said that the three leading Democratic candidates have proposals similar to the system currently used in Massachusetts, which requires all its residents to have insurance, either through private insurance companies or through the state. This plan was spearheaded by then Governor Mitt Romney. As a Republican candidate for president, Romney has not called for universal coverage, but, instead, has said that states should determine how best to use federal funds to provide coverage for uninsured residents. John McCain and Rudy Giuliani have called for tax incentives that would enable more people to purchase private insurance if they cannot or do not want to purchase it through their employers. Technology is the key to improving health care quality, according to Romney, Giuliani and Fred Thompson. McCain aims to improve quality by better publicizing various treatment options, their costs and likely outcomes. CHALLENGES OF HEALTH CARE REFORM Both Republican and Democratic candidates realize that an important way to lower health care costs is to encourage Americans to live healthier lifestyles. At a recent forum hosted by the publication Congressional Quarterly at George Washington University, presidential campaign representatives discussed the importance of encouraging Americans to eat healthier foods, exercise more and quit smoking. Candidates have suggested different ways to promote healthier lifestyles, including offering healthier food in school cafeterias, providing incentives for companies to offer smoking cessation programs or running advertising campaigns to remind Americans of the importance of exercising and eating right. Health care is not likely to play a significant role in the primary campaigns, Cassil said, but added it "will play a bigger role once the nominees are selected" and predicted, "Health care will be an area where there will be significant difference between whoever the Republican nominee is and whoever the Democratic nominee is." To change the U.S. health care system, a president would have to work with Congress. Therefore, as Cassil explained, "the real debate about health care in this country is not going to be in the 2008 election, it is going to be in the 2009 congressional session." The shape of that debate, she said, "is going to depend on who controls Congress and the White House."
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