Newspapers examine issues related to health care proposals of Presidential candidates

Several newspapers recently published articles that examined the health care proposals of presidential candidates Sens. Hillary Rodham Clinton (D-N.Y), Barack Obama (D-Ill.) and John McCain (R-Ariz.). Summaries appear below.

• Debate: The "sharply contrasting health care visions" of the Democratic and Republican presidential candidates "offer the promise of a grand campaign debate -- if the candidates find room on a crowded agenda," Reuters/Washington Post reports. McCain has criticized the Clinton and Obama health care proposals as "big-government" plans that will reduce choices for consumers, and the Democratic candidates have said that the McCain proposal would reduce incentives for employers to offer health insurance. Drew Altman, president and CEO of the Kaiser Family Foundation, said, "There is no question there are fundamental, Grand Canyon-like differences on health care between the two parties," but "it's an open question whether it will be a hot issue in the campaign." He added, "I now believe the biggest obstacle to health care reform is this ideological divide -- is there any way to bridge these differences?" Paul Ginsburg, president of the Center for Studying Health System Change, said, "I would expect to see the Democratic approach resonate more with voters" because Democrats are "very clearly telling voters you are going to be eligible for a public program" (Whitesides, Reuters/Washington Post, 5/4).
• Differences: The Democratic and Republican presidential candidates offer voters "clear choices" on health care, the Los Angeles Times reports. Clinton and Obama have proposed to expand public health insurance programs to provide coverage to more U.S. residents, and McCain has proposed incentives for individuals and families to purchase private coverage. According to the Los Angeles Times, the Democratic candidates consider lack of health insurance the main problem with the health care system, and McCain considers cost the main problem. Robert Blendon of the Harvard School of Public Health said, "The Democrats are emphasizing that people need employers and government to create large pools so that they can get group rates for much less than as individuals," and McCain "emphasizes a vision where individuals get more choices in the marketplace and are less reliant on employers and government" (Alonso-Zaldivar, Los Angeles Times, 5/5).
• Entitlement programs: None of the "three White House contenders has offered a comprehensive solution" to the expected "fraying of the safety net" of Medicare and Social Security as the U.S. population ages, but each "has suggested some intriguing fixes that, while differing in the details, all seek to alleviate the entitlement problem by stimulating individual savings," Roger Lowenstein writes in the New York Times Magazine. McCain would replace the tax exemption for employer-provided health care with tax credits for those purchasing their own insurance. According to Lowenstein, at the "very least, if campaign politics preclude speaking harsh truths, the age of tinkering with the framework ... is under way" (Lowenstein, New York Times Magazine, 5/4). NPR's "Weekend Edition Sunday" reported on concern about the financial solvency of Medicare as baby boomers reach retirement age. The segment includes comments from HHS Secretary Mike Leavitt and Jonathan Oberlander, a professor of health policy at the University of North Carolina-Chapel Hill (Rovner, "Weekend Edition Sunday," NPR, 5/3).
• Health insurance mandate: A mandate that all residents obtain health insurance, the "one major difference" in the Clinton and Obama health care proposals, has "received more attention than it deserves," according to experts, the New York Times reports as part of a broader story on the candidates' economic policies. Clinton supports such a mandate, but Obama would require only that children have health insurance. According to the New York Times, economists "generally favor" the Clinton proposal because the plan could make the health care system more efficient, but health care analysts "say the Clinton campaign has falsely suggested the Obama plan would exclude people who wanted to sign up for health insurance." Health care policy experts "praise both candidates for an unusually substantive primary campaign," as both have "come forward with detailed plans" to address the "decline of company-provided health insurance" and other issues, the New York Times reports (Leonhardt, New York Times, 5/4).
• Single-payer system: McCain has indicated that the Clinton and Obama health care proposals would establish a single-payer or nationalized health care system similar to those in Canada and Britain, but the "suggestion is incorrect," the New York Times reports. Neither candidate has proposed a single-payer system, as Canada has, or a nationalized system, as Britain has, and both would expand public health insurance programs but allow residents to retain employer-sponsored coverage, with subsidies provided to those who qualify to help cover the cost of premiums. According to Blendon, the criticism from McCain is the latest example of the use of such language to characterize health care proposals. He said, "McCain tries to appeal to ... a general antigovernment feeling ... a value that may or may not relate to the policies being discussed by either candidate." McCain spokesperson Tucker Bounds said that, although the Clinton and Obama proposals do not "outline" such a single-payer or nationalized system to the "finite extent, they clearly suggest that the movement toward a single-payer system is in their overall interests" (Cooper/Bosman, New York Times, 5/3).

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