This is not specifically on Parkinson's, but as patients and families
trying to live and cope with chronic disease, this editorial discusses
issues that affect all of us....
Kerry vs. Bush on Health Care
New York Times | Editorial
Sunday 03 October 2004
The faults in the American health care system become more glaring
with each passing year. Large numbers of Americans have no health
insurance at all, and those who do have insurance are faced with soaring
premiums that threaten to make coverage unaffordable for individuals,
families and employers. The two presidential candidates have responded to
these problems with health plans that differ markedly in scope and
philosophy. Both tinker at the edges of the current system rather than
seeking a broad, nation-shaking change. Sadly, the fervor for sweeping
reform died a decade ago with the disastrous demise of the Clinton health
plan.
That said, President Bush and Senator John Kerry clearly want to
nudge the nation's health care system in different directions. Senator
Kerry would build on the status quo by expanding existing government
programs for the poor and by increasing subsidies for employer-based
coverage, the core of the current system. This is hardly a government
takeover that would put bureaucrats in charge of your health care, as
President Bush has shamelessly contended. Indeed, the strength of the
Kerry approach is that it relies primarily on well-tested
health-insurance arrangements.
President Bush would also continue to rely on - and even expand -
employer-based coverage. But he would supplement this approach with tax
credits to help individuals and families buy their own policies or invest
in so-called health savings accounts backed by high-deductible coverage.
This is the health care version of the president's "ownership society."
If adopted widely, such individual coverage would represent a radical
alternative to employment-based policies, but for now the Bush plan takes
only small steps in that direction.
Over all, Mr. Kerry's approach would do more and cost more than Mr.
Bush's. One independent analysis pegs the cost to taxpayers of the Kerry
plan at $650 billion over a decade. Mr. Kerry says he would cover the
cost by canceling the administration's tax cuts for the wealthiest
Americans, those earning more than $200,000 a year. However, the price
tag could be higher - one conservative research group calculates the cost
at $1.5 trillion, a level that would certainly force Mr. Kerry to scale
back his plans. Independent estimates put the cost of the Bush plan at
$90 billion to $130 billion over a decade.
The Uninsured
On the vexing issue of how to provide coverage for the 45 million
Americans who currently lack health insurance, Senator Kerry would do a
far better job. His plan would extend coverage to some 27 million of the
uninsured, mostly by expanding Medicaid and the Children's Health
Insurance Program to include children and adults whose income is twice to
three times the poverty level. Mr. Kerry would also provide subsidies to
encourage more employers to offer coverage. In a bow to a favorite
nostrum of conservative health analysts, he would set up a new health
plan modeled on that serving federal employees. It would be open to
individuals and businesses and subsidized with tax credits.
President Bush would rely primarily on a tax credit of up to $3,000
to help lower-income families buy health insurance and on a tax deduction
to encourage people to buy high-deductible policies. But the credit will
not go far toward paying for policies that can cost $9,000 to $10,000 a
year. Independent estimates suggest that the Bush plan would cover at
most seven million of the uninsured.
Affordability
For the vast majority of Americans and most businesses as well, the
chief worry is soaring premiums. Here Mr. Kerry has proposed an
innovative solution. He would have a federally funded "reinsurance"
program reimburse employers for 75 percent of all medical bills exceeding
some catastrophic limit - say, for example, $30,000 a year. That would
mean companies and group health plans would no longer have to shoulder
the most costly cases that account for a huge chunk of all health
expenditures. In return, the companies would have to pass the savings on
in reduced premiums, cover all workers and set up disease management
programs. The Kerry camp estimates this might reduce premiums by 10
percent, mostly by shifting the cost to the taxpayers.
President Bush would try to make insurance more affordable partly
through his tax credits and partly by enabling small businesses to band
together in "association health plans" that would give them greater
purchasing power to bargain for low insurance rates. He would also
encourage an expansion of tax-free health savings accounts, coupled with
insurance to cover catastrophic illnesses. The notion is that
catastrophic coverage is relatively cheap and that the savings accounts
would be used to pay routine medical bills, making the individual more
prudent in spending for health care services. Such accounts are an
unjustified tax break for those who least need it. They would primarily
benefit those in high tax brackets and would most likely attract only the
healthiest people with few medical needs, leaving traditional health
plans to deal with the sickest and costliest patients, inevitably forcing
an increase in their premiums.
Cost Control
Neither plan looks like it would make a major dent in the
ever-escalating cost of medical care. Both candidates would promote
electronic record keeping in a laudable effort to drag the paper-driven
medical system into the modern age of computers. Analysts of all
political persuasions agree that widespread use of the newest information
technologies could save money through reduced paperwork, greater
productivity and a probable reduction in costly medical errors, but how
much and how soon are uncertain. Both candidates also favor better
disease management, especially of such costly chronic ailments as
diabetes and cardiovascular disease. This is a reform espoused by many
health analysts and would surely help control costs in the long run. In a
remedy that seems more ideological than practical, Mr. Bush also stresses
the need for a cap on medical liability damages, whereas Mr. Kerry
rejects caps and proposes other ways to rein in malpractice litigation
costs. Liability litigation is a small element in the overall cost
picture, and neither approach would produce much savings.
New Drug Benefit
President Bush had expected to get campaign mileage from the Medicare
prescription drug benefit enacted last year - indeed, that was the main
reason the Republicans forced it through Congress - but the Democrats
have focused so much attention on its shortcomings that it may have
become a political liability. Voters can be sure the two candidates would
approach the issue of drug prices differently. President Bush has opposed
the importation of cheaper drugs from abroad and supports the Medicare
drug law that prohibits the federal government from negotiating drug
prices with the manufacturers. Mr. Kerry supports drug importation and
believes the federal government should use its purchasing power to
negotiate lower drug prices. This page has endorsed both importation and
federal negotiation as sensible ways to restrain drug prices, the
fastest-growing segment of medical costs. However, if the Republicans
retain control of Congress, a President Kerry might be powerless to crack
down on the drug companies.
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