Each Candidate Has Own Cure for U.S. Health Care

Everyone agrees it’s broke, but nobody can agree on how to fix it.

Health care is of concern not only to the estimated 36 million people who lack insurance coverage, but to the millions whose protection is inadequate, to those who are struggling with changes in their coverage--even to people with ample insurance who are nevertheless frustrated by the escalating costs of a system seemingly out of control.

The total annual spending on health care in the United States is about $800 billion, and costs are rising faster than inflation.

The presidential candidates agree that something must be done, but they favor different approaches.

PRESIDENT BUSH: The Bush Administration seeks market-driven reforms to improve the current system. The President strongly resists the idea of increased government intervention into the area, especially the idea of forcing employers to provide coverage for their workers.

He has proposed new tax benefits to help uninsured Americans buy health insurance and has proposed legislation to allow self-employed individuals to deduct all of their health care costs and to encourage states to put a cap on awards patients could receive in malpractice lawsuits.

Bush also is seeking to reform the insurance industry, calling for such changes as preventing a company from denying coverage of pre-existing medical conditions.

He opposes the idea of a government-run national insurance program, and also is against requiring businesses either to provide insurance or buy into a federal program to cover the unemployed.

BILL CLINTON: He has promised guaranteed health care for every American.

Under a Clinton Administration, all employers would be required to insure their workers, either directly or through a purchasing group. Clinton would phase in these requirements, with smallest businesses coming last. He advocates tax credits to businesses who cannot afford to cover their workers.

He says he will control costs by establishing a national health standards board to set a national health budget and define a core package of benefits. The board would set a cap on health care spending, and the national figure would then be divided among the states, with each state deciding how its health care providers would meet the cap.

He would also seek insurance industry reform by, among other things, banning exclusion of pre-existing medical conditions and setting up purchasing groups in which small businesses and individuals could band together to buy private coverage, theoretically at lower costs than otherwise available.

Clinton would have publicly sponsored purchasing groups provide insurance for the unemployed, with a sliding scale based on income. In effect, it would amount to a government subsidy to buy private insurance.

Also, he would try to discourage pharmaceutical companies from raising drug prices faster than the inflation rate by ending special tax breaks for those that did so.

ROSS PEROT: The independent presidential candidate has not offered a specific program to deal with the health care system.

But in his book, “United We Stand: How We Can Take Back Our Country,” he recommends a short-term cost containment program, but does not provide details. He suggests a long-term plan that would include establishing a national health board to oversee cost containment, asking the states to submit reform proposals, changing federal rules to allow states more flexibility in trying pilot programs, and greater emphasis on preventive care.

WHAT THE EXPERTS SAY: Most health policy experts agree that the candidates share one trait: They are vague about exactly how they would accomplish their goals. But this may not necessarily be a bad thing for now, they add.

“At this point, being specific is being dogmatic,” says Stephen Zuckerman, a senior research associate at the Urban Institute who specializes in health economics. “You have to maintain some willingness to consider a variety of options. What might seem like a perfectly reasonable plan in California might not work in New York.”

A five-member bipartisan panel of present and past federal health officials recently analyzed the major parties’ plans and projected that America’s health bill would be $1,179 less per family by the end of the decade under Clinton’s plan than under Bush’s. In the year 2000, health spending would reach $10,398 per family under the Bush plan and $9,219 under the Clinton plan, in 1992 dollars, the panel said.

The study also concluded that the Clinton plan would reduce the number of uninsured Americans to zero by 2000, while Bush’s plan would still leave about 27 million Americans without coverage.

Bush Administration health officials challenged these findings, saying they estimated that by 1997 the savings under the Bush proposals would be twice the amount predicted by the study.

Most experts remain skeptical that either candidate has prescribed the strongest medicine needed to cure the ailing system.

“I think Clinton has an understanding that serious reform is the answer to the health care crisis, but he hasn’t gotten specific enough in his proposals to date,” says Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota. “I think Bush believes that the system works well; it only needs fine tuning to get it where it should be.”

Bush’s approach is consistent with his reluctance to use the federal government to force programs upon businesses.

Robert Blendon, chairman of the department of health policy and management at the Harvard University School of Public Health, predicts that Bush’s proposals would be “better for the poorest people and worst for working people. The majority of the uninsured are above the poverty level,” he says. “His plan helps the most if you are below poverty, helping the poorest of the poor. Credits help you if you don’t have any income to pay.

Clinton’s plan, he says, to require businesses to provide coverage “is either a negative or a positive--depending on whether you are an employee or an employer.”

Of Clinton’s idea to establish a national health board to control costs, Blendon says it could have “enormous very short-term savings for those who already have insurance . . . very fast savings that people would see.”