Rival views of the government's role
The one issue that most clearly demonstrates the ideological divide between John Kerry and George W. Bush, and the parties they represent, may well be healthcare.Skip to next paragraph
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Their positions on Medicare, health insurance, drug costs, and related subjects have been shaped by years of partisan battle - and bipartisan progress - affecting virtually all US voters. Senator Kerry wants to expand the federal government's healthcare role and spend more money, but would generally work within existing systems. President Bush proposes to spend less - but also urges radical restructuring of the health-insurance market, with many more Americans buying coverage themselves.
Whoever wins is likely to face intense pressure from voters and lawmakers to do something about rising costs and the growing number of the uninsured. Polls show that healthcare ranks among voters' top worries.
"Lack of health insurance is a serious matter for milllions of Americans, and the political resolve to address the problem may be at hand," concludes Joseph Antos, a healthcare scholar at the American Enterprise Institute (AEI), in a recent report on the subject.
Enacting fixes remains a daunting challenge, as recent news shows. On average, worker costs for medical insurance have risen by 36 percent since 2000, according to a new study by Families USA.
The main premium paid by Medicare beneficiaries is set to rise 17 percent next year. Meanwhile, the Census Bureau reports that in 2003 the number of Americans without health insurance hit a record 45 million, about 15.6 percent of the population.
These trends may be the result of tepid economic growth, placed in a context of an explosion in medical technology and drug development. Furthermore, when it comes to health treatment, most Americans want the best they can get for themselves and their families - and Medicare and most health insurance buffers them from the economic consequences of treatment decisions.
"The reason we have a cost problem is that the person consuming the services is insulated from the cost of those services by third-party payment," said Dr. Daniel Johnson, a former president of the American Medical Association, at a recent Heritage Foundation symposium.
Kerry, in addressing these issues, takes a traditional Democratic approach. His proposals amount to far less than the overhaul of the healthcare system proposed by President Clinton, but they nevertheless would amount to a significant additional commitment of federal funds.
Kerry would encourage employers to offer their workers health insurance by having the federal government reimburse them for 75 percent of the cost of their most expensive beneficiaries - those whose medical costs are $50,000 or more a year. He would also create a new Congressional Health Plan that would allow both individuals and businesses to buy US-subsidized coverage.
Kerry proposes to expand existing government healthcare safety-net programs, such as Medicaid and the State Children's Health Insurance Program, to cover 18 million more children and poor and near-poor adults. He would also push tax credits to help individuals with high out-of-pocket medical costs, and he supports allowing the federal government to negotiate directly with drug providers.
According to Kerry's campaign, his plan would provide coverage to about 25 million people who are currently uninsured, and would cut costs for people who now have insurance by about 10 percent. It would cost about $653 billion over 10 years - money that would be raised by eliminating Bush's tax cuts for those making over $200,000 a year.