With skyrocketing health care costs consistently ranking as the top domestic issue, and bold reform initiatives in Wisconsin and other states renewing pressure for national reform, the 2008 elections are shaping up as a referendum on the future of our increasingly unaffordable health care system.
As Wisconsin's pivotal primary rapidly approaches, voters are eager to know whether any of the candidates for president are offering realistic plans to guarantee quality affordable health care. This scouting report is offered to clear away the rhetorical pixie dust, and get down to the essentials of what is being offered by the major candidates.
Two broad consensus positions have emerged among the presidential candidates: one for the Democratic candidates and another for the Republicans. Let's start with the Democrats.
The Democratic consensus position was staked out a year ago by then candidate John Edwards, who got the core of his plan from Yale political scientist Jacob Hacker. This reform framework was adopted by both Hillary Clinton and Barack Obama.
Both Clinton and Obama would guarantee access to affordable health care while leaving in place the parts of the current health care system which are working. Alongside the current employer-based health care system, they would establish a public plan based on Medicare, as well as a choice of private plan options, all of which would offer the same standard benefits package currently enjoyed by members of Congress. The private plan options would be heavily regulated to outlaw health insurance industry discrimination based on health status, age, or preexisting conditions and to limit windfall profits. Every American would be able to keep their current doctor, and have a choice of high quality public or private health care plans.
Obama and Clinton would fund their plans by rolling back the Bush tax cuts for the wealthiest Americans, and by charging employers a fee who do not offer quality affordable health care to their workers.
Although their plans are very similar, much of the recent campaign debate has centered on their difference over individual mandates which are included in Clinton's plan but only applies to children in Obama's. Clinton has argued that Obama's plan is not universal, as many will choose not to buy health insurance. Obama contends that people will buy health insurance if it is made affordable. This is a significant difference, as most health care policy experts believe a voluntary plan can at best cover 95 percent of those eligible. On the other hand, this difference is less than meets the eye because Obama's plan, unlike Clinton's, includes automatic enrollment in the public plan for anyone who is employed and does not have access to quality affordable coverage. As a result, Obama's plan would likely lead to higher enrollment in the public option than Clinton's, which many health policy experts believe is the best way to effectively control health care costs.
Turning to the Republican side, John McCain and Mike Huckabee have unveiled health care reform plans (Ron Paul has not). In their diagnoses of the problem, they sound similar to the Democrats, calling the current health care system broken and promising fundamental reform. This is where the similarities end.
The Republicans disavow public options such as those offered by Clinton and Obama. By so doing, they are unable to make a realistic guarantee of quality affordable coverage. They call for various tax deductions and credits to make health insurance premiums more affordable, and for replacing the current system with market based competition. They also use the tax system to discourage the current reliance on employer-based health insurance, where 68 percent of Wisconsinites get their coverage. However, neither explains how dramatically more expensive insurance policies bought on the individual market can be made affordable with modest tax credits. McCain also calls for deregulation of the health insurance system through various mechanisms that would allow insurers to offer cheaper bare bones policies that cover fewer medical services. This might lower the cost of some policies, but the tradeoff could be frightening gaps in coverage.
Interestingly, the leading Republicans back away from the proposal pushed by President Bush and Republican Legislators in Madison: Health Savings Accounts (HSAs) connected to health insurance plans with very high deductibles. Perhaps in response to mounting evidence that this approach shifts even more unaffordable costs on to working families, McCain, and Huckabee allow them to be used with low deductible plans.
Despite their many differences, the candidates of both parties are responding to the public demand for real health care reform which began here in Wisconsin and a handful of other states. This is rapidly turning the 2008 election into a debate about the future of the American health care system. So far the Democratic candidates have gone much further in spelling out plans that would guarantee access to quality affordable health care and a real choice of good public and private plans. However, just as action in the states and John Edwards; bold proposal put pressure on the Democratic primary candidates to step up to the plate, so the eventual Republican nominee may be pushed to offer more.
- Robert Kraig is the director of program for Citizen Action of Wisconsin, a grassroots advocacy organization with more than 90,000 members in Wisconsin.
As Wisconsin's pivotal primary rapidly approaches, voters are eager to know whether any of the candidates for president are offering realistic plans to guarantee quality affordable health care. This scouting report is offered to clear away the rhetorical pixie dust, and get down to the essentials of what is being offered by the major candidates.
Two broad consensus positions have emerged among the presidential candidates: one for the Democratic candidates and another for the Republicans. Let's start with the Democrats.
The Democratic consensus position was staked out a year ago by then candidate John Edwards, who got the core of his plan from Yale political scientist Jacob Hacker. This reform framework was adopted by both Hillary Clinton and Barack Obama.
Both Clinton and Obama would guarantee access to affordable health care while leaving in place the parts of the current health care system which are working. Alongside the current employer-based health care system, they would establish a public plan based on Medicare, as well as a choice of private plan options, all of which would offer the same standard benefits package currently enjoyed by members of Congress. The private plan options would be heavily regulated to outlaw health insurance industry discrimination based on health status, age, or preexisting conditions and to limit windfall profits. Every American would be able to keep their current doctor, and have a choice of high quality public or private health care plans.
Obama and Clinton would fund their plans by rolling back the Bush tax cuts for the wealthiest Americans, and by charging employers a fee who do not offer quality affordable health care to their workers.
Although their plans are very similar, much of the recent campaign debate has centered on their difference over individual mandates which are included in Clinton's plan but only applies to children in Obama's. Clinton has argued that Obama's plan is not universal, as many will choose not to buy health insurance. Obama contends that people will buy health insurance if it is made affordable. This is a significant difference, as most health care policy experts believe a voluntary plan can at best cover 95 percent of those eligible. On the other hand, this difference is less than meets the eye because Obama's plan, unlike Clinton's, includes automatic enrollment in the public plan for anyone who is employed and does not have access to quality affordable coverage. As a result, Obama's plan would likely lead to higher enrollment in the public option than Clinton's, which many health policy experts believe is the best way to effectively control health care costs.
Turning to the Republican side, John McCain and Mike Huckabee have unveiled health care reform plans (Ron Paul has not). In their diagnoses of the problem, they sound similar to the Democrats, calling the current health care system broken and promising fundamental reform. This is where the similarities end.
The Republicans disavow public options such as those offered by Clinton and Obama. By so doing, they are unable to make a realistic guarantee of quality affordable coverage. They call for various tax deductions and credits to make health insurance premiums more affordable, and for replacing the current system with market based competition. They also use the tax system to discourage the current reliance on employer-based health insurance, where 68 percent of Wisconsinites get their coverage. However, neither explains how dramatically more expensive insurance policies bought on the individual market can be made affordable with modest tax credits. McCain also calls for deregulation of the health insurance system through various mechanisms that would allow insurers to offer cheaper bare bones policies that cover fewer medical services. This might lower the cost of some policies, but the tradeoff could be frightening gaps in coverage.
Interestingly, the leading Republicans back away from the proposal pushed by President Bush and Republican Legislators in Madison: Health Savings Accounts (HSAs) connected to health insurance plans with very high deductibles. Perhaps in response to mounting evidence that this approach shifts even more unaffordable costs on to working families, McCain, and Huckabee allow them to be used with low deductible plans.
Despite their many differences, the candidates of both parties are responding to the public demand for real health care reform which began here in Wisconsin and a handful of other states. This is rapidly turning the 2008 election into a debate about the future of the American health care system. So far the Democratic candidates have gone much further in spelling out plans that would guarantee access to quality affordable health care and a real choice of good public and private plans. However, just as action in the states and John Edwards; bold proposal put pressure on the Democratic primary candidates to step up to the plate, so the eventual Republican nominee may be pushed to offer more.
- Robert Kraig is the director of program for Citizen Action of Wisconsin, a grassroots advocacy organization with more than 90,000 members in Wisconsin.
