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Potomac Sources
President George W. Bush wants to use the tax code to encourage people to buy health insurance for themselves. Sen. John Kerry wants the federal government to pay the bills whenever an individual's medical costs climb above $50,000 in a single year. Those are the core differences between the healthcare prescriptions from the Republican incumbent and his opponent, the Democratic senator from Massachusetts.
Small government vs. big government, tax cuts vs. spending for social purposes--this clash of philosophies permeates the beliefs and ideas of the two candidates and is clearly expressed in their approaches to healthcare. The price tag for the Bush proposal is an estimated $102 billion over 10 years. The Kerry plan would cost almost 10 times as much, about $650 billion over a decade. The Bush plan would bring coverage to an estimated 6 to 10 million people who currently lack health insurance. The Kerry proposals are estimated to expand coverage to 27 million uninsured people.
Significantly, neither man claims he can figure out how to bring health insurance to all of the 43 million Americans who have no coverage. Most of them are full-time workers, and their spouses and children. The majority of Americans get their health insurance on the job. If they don't, insurance is often expensive and difficult to obtain, especially for individuals and families with health problems.
MODEST GRADUALISM
So neither Sen. Kerry nor President Bush claims he can control health costs while bringing everyone under the sheltering umbrella of a good insurance policy.
BUSH'S TAX CREDITS AND HEALTH ACCOUNTS
In addition, the annual contribution to a savings account varies depending on the size of the deductible: It can be as much as $2,600 for an individual and up to $5,150 for a couple. Someone age 55 or older can add another $500 per year to the individual account. Funds left in a Health Savings Account at the end of each year in the plan can be rolled over into the next year and grow tax-free. Banks and brokerage firms will be offering the HSAs. Advocates of HSAs contend that the new accounts will encourage people to be better consumers and use the doctor only when necessary because their own money will be at stake. The President believes these accounts will be widely used by individuals who currently lack coverage and by small-business owners who can't afford the current premiums. Annual health insurance premiums for a comprehensive policy commonly run $3,000 for a single worker and more than $9,000 for a family. The President is an enthusiastic supporter of HSAs and wants to make them even more attractive by allowing people to take a tax deduction for their premiums. Democratic critics say the HSAs will split the health insurance market into different segments: The healthy and wealthy would opt for the new accounts for their tax advantages, but people with less money and poor health would stay in regular health insurance programs. By drawing more well-to-do Americans into HSAs and out of the insurance risk pool, say the Democrats, insurers would be forced to raise premiums for their remaining policyholders.
President Bush also would expand the federally funded community health centers, walk-in clinics that serve more than 20 million low-income and moderate-income people who lack health insurance. He wants to open more centers and increase their budget.
KERRY DISEASE MANAGEMENT
Kerry also wants to expand federal coverage for all low-income, uninsured children. He would expand the federal Children's Health Insurance Program and would have the federal government take full financial responsibility for coverage of children under Medicaid, the health program for low-income individuals. Now, the cost is shared between the federal government and the states. He also would give the states a separate, special federal grant to help defray the sharply rising costs of Medicaid. Another healthcare campaign issue with a surprising political outcome is the Medicare prescription drug bill--the first federal spending for drugs consumed at home under the Medicare program--which will provide $400 billion and possibly more to Medicare beneficiaries over 10 years. The Republicans hoped it would be a winner for the President and their Congressional candidates on the campaign trail. Instead, withering attacks from the Democrats have turned the issue into a negative. The $400 billion represents just a quarter of the sum elders are expected to spend for prescription drugs through 2014. David Winston, a GOP pollster, noted recently, "Actually, a majority of people don't know that Congress has passed a bill. Only 31% are aware that it was passed and signed into law, 16% believe it wasn't passed at all and 54% don't know. Similarly, 54% don't feel they understand the new changes in prescription drug coverage well enough. Just a third say they do. One of the more startling numbers for a policy that was really directed at one age cohort of Americans, those who would benefit most directly from a Medicare prescription drug bill, is that seniors opposed the new drug benefit passed by Congress by a nine-point margin." Which approach will prevail for the next four years? The decision is yours: Vote on Nov. 2.
Robert A. Rosenblatt is a writer and editor based in Washington, D.C. He regularly contributes "Potomac Sources" to Aging Today. He is a Senior Fellow of the National Academy of Social Insurance and a columnist for the California HealthCare Foundation's Health Currents.
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