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The 2000 Presidential Race: Where the Candidates Stand on Health Care IssuesTheir Preferred Issues
Both Bush and Gore address three basic problems: (1) the problem of the un- or under-insured; (2) prescription drug coverage under Medicare; and (3) patient rights under managed care. (They also have made other proposals, such as Gore's plan to give tax credits to people who care for the chronically ill and Bush's push for more funds for community and migrant health care plans, but these three are by far their major focuses.)
Neither candidate addresses health care inflation, even though health care costs are rising at between eight and 10 percent per year (compared with an overall rate of inflation of around three percent)(Chicago Tribune, 4/14/00). This is unfortunate, since rising health care costs are, in part, responsible for people lacking adequate health insurance and being unable to afford prescription drugs, and for employers and other third-party payers pushing people into managed care plans where they may feel their rights are being compromised. Unfortunate, but perhaps not surprising: the problem of increasing health care costs, arguably, is much tougher than the problems the candidates do tackle. It will be interesting to see if health care inflation emerges as an issue later in the campaign. In addition, neither candidate has said much about nursing home care, although Gore does propose up to $3,000 in tax credits for persons caring for people with long-term illnesses. The Big Three
Let's examine what the two candidates have to say about these three issues:
Lack of Insurance
Everyone seems to recognize that we have a serious problem in the U.S.: at any one time, 44.3 million individuals, many of them children, lack health insurance, and many people who have health insurance don't have policies that meet all of their perceived health care needs. Two points are not so obvious: Why do these people lack insurance and what should an adequate insurance plan cover? The second point is important from a policy perspective because of its relationship to the overall lack-of-insurance problem: If our goal were merely to provide everyone with some health insurance, we could solve our problem quite easily by giving everyone an entitlement to, say, one aspirin tablet a year. Everyone would now be insured, but of course for only one aspirin. To resolve the problem of lack of insurance without being absurd, we must decide what health care people should have access to at a minimum, and make sure that our solution provides at least this degree of access. (President Clinton's health insurance proposal attempted to do this, for example, by stipulating a minimum benefits package.)
The first point is also critical because it pertains to whether those who lack health insurance have voluntarily made this choice. Twenty percent of the uninsured have access to health insurance through their employer but do not purchase it. (Dallas Morning News, 4/2/00). This may be because they can't afford to pay their portion of the premiums or because they are young and healthy and gambling on the odds of not getting sick. Subsidizing the purchase of insurance will not result in everyone becoming insured; most likely, some individuals in the latter category still will decline. Yet health insurance only functions as insurance (as opposed to a sort of lay-away savings plan) if those who do not submit claims are among those who are paying the premiums. (That is presumably why former senator Bill Bradley proposed to require that every newborn be insured before they left the hospital.) So subsidies to aid the purchase of insurance can be targeted at two very different populations - the poor and the gamblers - and the difficult question is how much assistance should be given to each group.
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