The Campaign Elephant

The soaring cost of U.S. healthcare -- think of the 41% jump in insurance premiums paid by workers and employers in the last three years -- is the elephant on the 2004 campaign trail, the threat that neither George W. Bush nor John F. Kerry has confronted squarely.

Both have ideas that would help some people get healthcare over the next 10 years. Bush would give tax credits to low-income families to purchase health insurance. Kerry’s more complex plan would subsidize catastrophic care to reduce employer premiums and expand enrollment in state-sponsored children’s healthcare, like California’s.

Neither candidate, however, has gotten to the core problem of reducing costs. The General Accounting Office has estimated that the new Medicare prescription-drug benefit alone will cost more than $8 trillion over the next 75 years, a number greater than the government’s current debt, and that Medicare and Medicaid spending overall, unless there is “fundamental and comprehensive healthcare reform,” could cost at least $10 trillion more.

The president’s proposed $3,000 credit to a family of four would, by 2006, do little to help the working poor afford coverage. By then, most health analysts predict, the average family policy will run $14,000. Kerry’s plan could stick taxpayers with paying for expensive hospital procedures whose cost efficiency and medical necessity hadn’t been analyzed.

The National Coalition on Health Care, an advocacy group that includes former presidents Bush, Ford and Carter as well as corporate and public-employee giants such as General Motors, Pfizer and the California Public Employees Retirement System, has bigger ideas.

The coalition is expected to propose a basic package of essential benefits this summer that insurers would be required to offer to all people in a given region. The cost savings would come from restricted, one-size-fits-all coverage and reduced marketing and middleman costs. It’s not a solution, but it is a start.

Politicians and advocates have wildly different ideas on what the package should be. House Ways and Means Committee Chairman Bill Thomas (R-Bakersfield), for instance, thinks it should be bare-bones catastrophic coverage, while patient-advocacy groups favor enrolling babies at birth for generous Medicare-style benefits. This won’t be an easy issue to settle.

The need for structural reform, however, is hard to dispute. As Henry Simmons, the president of the National Coalition on Health Care, said in an editorial board meeting at The Times last week: “This system is not a poor system. We don’t need more money; we need a redirection of how we use that money. The way the system is going, we’re all going to lose something. Each year we pay more and get less and less. People worry about the economy, jobs and healthcare. Well, they’re all related now.”

The solutions that the coalition is proposing are not radical, and the Clinton era’s “Hillarycare” debacle that frightened politicians away from the issue is over. The presidential campaigns just haven’t figured it out.