health policies highlight kerry and bush differences, analysts say
nowhere are the policy differences between john kerry and president bush more apparent, health analysts say, than on what to do about rising healthcare costs and lack of insurance.
new york times, may 14, 2004
political memo
biggest divide? maybe it's health care
by robin toner
ashington, may 13- senator john kerry has spent this week campaigning relentlessly on the problems in the nation's health care system and maintaining that president bush has failed to address them. the bush campaign has countered furiously, saying mr. kerry's proposals are far too expensive and would inevitably lead to government micromanagement of private health care.
this is not just another exercise in partisan maneuvering. nowhere are the policy differences between mr. kerry and mr. bush more apparent, health analysts say, than on what to do about rising health costs and the growing number of americans without insurance.
few dispute the extent of the problem. after several years of stability in the mid-1990's, the cost of coverage is soaring again. premiums were up an average of 13.9 percent last year, the third consecutive year of double-digit increases. more and more small businesses say they are staggering under the strain.
the number of americans without insurance, meanwhile, has jumped to 43.6 million, according to a census report last fall, and more than a fifth are children.
mr. kerry argued this week that those problems had worsened on mr. bush's watch.
"george bush has had four years to offer america a real health care plan, and he hasn't," the senator declared wednesday in orlando, fla.
republicans say that they are, in fact, responding: senate republicans stepped forward tuesday to endorse a package of tax measures - including mr. bush's main proposal - aimed at the uninsured.
but the bush and kerry plans differ substantially in cost, the number of uninsured they hope to cover, the methods they would use and the underlying philosophy. health care analysts say the difference in scale alone is striking.
one expert on health, robert d. reischauer, president of the urban institute, said, "the president's proposals remain very modest, while senator kerry is willing to make health a major priority of his administration."
mr. bush's main proposal for the uninsured would cost $70 billion over 10 years. it would give a new tax credit to low- and moderate-income families to help them buy health insurance. the proposal, first unveiled in the 2000 campaign but never enacted, would provide up to $1,000 for individuals and $3,000 for families. the administration estimates it would benefit 4.5 million americans when put fully into effect.
mr. bush presents the plan as a part of his philosophy of giving individuals more choices and more control over their health care, and of trusting the private market to respond to their needs.
"i've made my stand,'' the president said in march. ''i believe that the best health care policy is one that trusts and empowers consumers and one that understands the market."
similarly, mr. bush proposes to hold down health costs through the approach sometimes described as consumer-driven health care. the idea is to make consumers more conscious of the cost of medical care, encouraging them to shop around for better deals and eventually reducing unnecessary care.
as the president envisions it, consumers would combine high-deductible insurance plans, which are relatively inexpensive, with tax-free health savings accounts that they would create to cover the cost of routine medical care. this year he has proposed making the premiums for those plans deductible, to further encourage their use.
[color=olive]critics fault the president's plan on several grounds. they say that his $3,000 tax credit falls far short of what it takes to buy a substantial family plan, and that he relies too much on the market of individual health insurance rather than buttressing the employer-based system of group coverage, considered far more stable. in the end, the critics assert, mr. bush's proposals would leave tens of millions of americans uninsured, and many millions more squeezed by the soaring costs of an unfettered market.
mr. kerry, for his part, has a sweeping plan that tries to cover all uninsured children and most uninsured adults without the kind of fundamental structural change that doomed past democratic proposals. it would cost $650 billion over 10 years, his campaign estimates, and would be financed by rolling back the bush tax cuts for those earning over $200,000 a year.
the most unusual part of mr. kerry's plan would have the federal government pick up 75 percent of the cost of the most expensive medical cases - those of over $50,000 a year - if employers guaranteed that they would pass the savings along to their workers through reduction of premiums. this is intended to ease the burden on businesses, especially small ones, and provide cost relief to americans with insurance.
in general, mr. kerry would provide a variety of new subsidies to help small businesses and low-income people buy health insurance: $177 billion over 10 years in tax credits, more than twice the size of mr. bush's credits.
the senator would also create a new version of the federal employees health benefit plan, a collection of private plans now available to congress and federal workers, that would provide good group coverage to other americans and small businesses.
and he would expand assistance to the states to cover more children and low-income adults under medicaid.
mr. kerry argued this week that his plan would succeed because it was not a "government plan" with new mandates and bureaucracies. republicans say it would nonetheless lead to new government regulation and essentially transfer to the federal government the responsibility for a huge share of health care spending.
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