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).

Editorials

• Anchorage Daily News: The McCain health care proposal would "make an inefficient and expensive system even worse," according to a Daily News editorial. Under the proposal, "you can pretty much count on losing your health coverage at your job," the editorial states. In addition, the proposal would "leave you with less purchasing power while throwing you to the mercy of dealing with health insurance companies" and would require "workers with expensive pre-existing conditions, or high-risk health histories" to "pay a lot more -- if they can even get coverage at all," according to the editorial. The editorial states, "No question, there's lots of room for improvement in the U.S. health care system. But McCain's proposal -- giving more money and clout to health insurance companies -- moves the country 180 degrees in the wrong direction" (Anchorage Daily News, 5/2).
• Boston Globe: "A robust government role ... is a precondition to extend coverage to the 47 million Americans who are without it," a move that the "market alone cannot achieve," despite claims by McCain that health insurance is "something that could be relegated to the marketplace and individual choice," according to a Globe editorial. According to the editorial, under the McCain proposal, many "people would have to pay higher taxes to get the insurance they want." Clinton and Obama "have suggested stronger government intervention and more tax money to cover the uninsured," which is "a better way to reach McCain's laudable intention," the editorial states (Boston Globe, 5/5).
• Orlando Sentinel: "If the next president doesn't chart a more fiscally responsible course, benefits for retired baby boomers and rising health care costs will push deficits into the stratosphere," a Sentinel editorial states. The editorial states, "Goals such as improving health care and education and making the tax system more competitive are worth pursuing, but not if there's no money to pay for them," adding, "We can only hope that the three presidential candidates' tax and spending plans represent campaign pandering instead of serious fiscal blueprints" (Orlando Sentinel, 5/5).
• Washington Times: "To say that John McCain has a health care 'plan' is to suggest that the presumptive Republican nominee has huddled with a bunch of experts and 'stakeholders' to come up with a solution that guarantees something for everybody," a Times editorial states. However, "McCain's approach to health care reform is similar to Ronald Reagan's view of government: It flows from a belief that more competition, freedom and greater individual choice will lead to more innovation, greater opportunity and increased well-being," according to the editorial. "McCain will substitute the dictates of government with decisions of doctors and patients by shifting the tax breaks and buying power now reserved for large corporations and insurance companies and extending it to every individual" and "would make it easier (and hopefully cheaper) to buy health care and design coverage to meet family needs by allowing businesses and nonprofits other than insurance companies to offer coverage," the editorial states (Washington Times, 5/3).

Opinion Pieces

• Star Parker, Boston Herald: McCain deserves a "gold star" for his health care proposal, which "takes on problems that have contributed to cost escalation," Parker, an author and president of the Coalition for Urban Renewal and Education, writes in a Herald opinion piece. According to Parker, the "key salvo is aimed at the central pillar of our health care system -- tax-subsidized employer-provided health care" -- and the McCain proposal "levels the field and relocates the focus of freedom and responsibility to where it should be -- on individuals." The proposal also "would further enhance competition and consumer power by ending the 50 separate state fiefdoms and allow the health care market to be open nationwide," according to Parker. She concludes, "McCain's approach will use markets and consumer power to drive down costs and open the door to innovation. Issues remain, but McCain has gotten this debate off on the right note" (Parker, Boston Herald, 5/5).
• Froma Harrop, Detroit News: "McCain's 'market-based' concept lacks the wisdom to acknowledge what can't be changed -- that private insurers will always avoid people with costly medical conditions," as "McCain's idea of a government-run pool to cover the sick ones turns his plan into another bonanza for the insurance industry," syndicated columnist Harrop writes in a News opinion piece. She adds that "Clinton is the only leading candidate to show true grit and deliver a hard fact that many don't want to hear: Universal coverage cannot happen unless everyone participates in the system" (Harrop, Detroit News, 5/4).
• Debra Saunders, San Francisco Chronicle: "The more Washington politicians promise to control health care costs, the higher they go," Saunders, a Chronicle columnist, writes. She writes that Clinton and Obama "propose to offer and subsidize more health care without raising costs for the majority of Americans who already have it. What next? Consume more calories, weigh less?" Saunders writes, "Unlike Clinton and Obama, McCain would not require that insurers cover people with chronic illnesses." In addition, she writes, "Politically, Plan McCain may be suicide," as "Clinton and Obama have kept to the current employer-based system -- which gives workers the happy illusion of not paying for their health care, when in fact it comes out of their paychecks" (Saunders, San Francisco Chronicle, 5/4).
• Scott Gottlieb, Wall Street Journal: Mandates on private health insurance, such as those Obama has supported in the past, "drive up the cost of insurance for the very people priced out of coverage," Gottlieb, a resident fellow at the American Enterprise Institute and former deputy commissioner at FDA, writes in a Journal opinion piece. The increased costs that result from such mandates "aren't shared equally among all who have health insurance," as those "who are covered through self-insured employers (usually large corporations) are shielded from state mandates because of the federal Employee Retirement Income Security Act (ERISA), which prevents states from enacting controls on plans that cross state lines," according to Gottlieb. He adds, "The burden of paying for state mandates is usually borne by individuals who buy their own insurance, small employers and others not covered by ERISA." Gottlieb writes, "It doesn't have to be that way," adding, "If insurers were allowed to offer 'bare-bones' plans -- which would be cheaper because they would cover just essential care -- many consumers who are priced out of health insurance now would likely buy these plans instead of living without insurance" (Gottlieb, Wall Street Journal, 5/5).