Bradley’s Health Program Criticized

Bill Bradley’s health care plan would cost more than three times as much as Vice President Al Gore’s over the next decade but would cover only 3 million more uninsured Americans, a new analysis of the competing proposals concludes.

Bradley’s campaign immediately rejected the findings released Monday by Emory University professor Kenneth E. Thorpe, a former Clinton administration official whose earlier projections on the cost of Bradley’s plan have become a flash point in the Democratic presidential race.

The new study was released even as Bradley dramatically escalated his attacks on Gore’s health care proposal. In the most stinging language he’s used so far, Bradley portrayed Gore’s plan as an abandonment of the “fundamental Democratic principle of basic health care for all Americans” that President Clinton unsuccessfully pursued during his first term.

In the new study--revised after consultation with Bradley’s staff--Thorpe slightly lowers his estimate of the plan’s cost. But he raises pointed questions about the cost-effectiveness of Bradley’s approach to expanding coverage.

Overall, Thorpe calculates that Bradley’s plan would provide coverage for 15 million uninsured Americans while Gore’s would cover 12 million--though Bradley’s plan would cost $1.05 trillion over the next decade compared to $312 billion for Gore’s.

Thorpe says Bradley’s plan would be so much more expensive, while covering only a slightly larger number of people, for two principal reasons:

* It would subsidize people who already have insurance.

* It would offer a more expensive prescription drug benefit for seniors under Medicare than Gore has proposed.

While Gore’s plan targets those without insurance, Bradley’s plan is based on income. It would offer federal subsidies for purchasing health insurance to low-income families, whether or not they receive coverage now. As a result, Thorpe calculates, as many as 48 million lower-income children and adults who have private insurance would be eligible for government aid.

Although they dispute Thorpe’s numbers, Bradley aides agree that a fundamental difference between the two plans is how much they target their benefits toward the uninsured. The Bradley camp argues that its approach provides a more comprehensive solution because it would also help families who have inadequate coverage.

“It is a critical difference, because the Bradley plan . . . also looks at the problems of people who are underinsured,” argued Anita Dunn, Bradley’s communications director.

But Chris Lehane, Gore’s campaign spokesman, retorted: “Bradley’s plan breaks the budget by giving health care coverage to people who already have it. . . . It is just very fiscally irresponsible.”

By contrast, Bradley criticized Gore’s plan as overly cautious. In a Chicago speech, he drew on the “stand-and-fight” phrase that the vice president has used to question Bradley’s record on core Democratic issues. “In the case of health care, Al Gore decided it wasn’t worth standing and fighting . . . ,” the former New Jersey senator said. “The lesson Al Gore learned from the health care defeat was that big bold things can’t get done in Washington, so let’s look to the small, symbolic things.”

Bradley’s remarks drew howls of outrage from Gore’s camp. Gore aides quickly noted that Bradley came out against Clinton’s plan when it faced a critical test before the Senate Finance Committee in June 1994. “Where was Bradley in 1994? Missing in action,” Lehane said.

Dunn responded that Bradley consistently supported Clinton’s goal of universal coverage but grew skeptical of his means to reach that goal.

In his speech, Bradley filled in an earlier proposal to spend $2 billion annually on the neighborhood-based public health system. He said he would spend $800 million to enhance the existing network of community health care clinics in low-income neighborhoods; provide another $1 billion for neighborhood-based efforts to prevent disease; and offer $200 million to expand research into public health at the National Institutes of Health.

Since Gore has also talked about strengthening the public health system, the key difference between the two on the health-care issue remains their competing approaches to covering the 44 million Americans without health insurance.

Gore’s plan looks to build on existing efforts to reach those without insurance. It would make more children eligible for the existing Children’s Health Insurance Program, which covers children in working-poor families. And, for the first time, Gore would provide coverage to the parents of those children without insurance--while also providing new tax breaks to businesses that cover their workers and workers who purchase their own insurance. In addition, Gore would provide a new prescription drug benefit to seniors under Medicare.

In all, Thorpe estimates Gore’s plan would result in health coverage for 88% of the population at a cost of $312 billion over the next decade.

Gore expanded on the issue of prescription drugs Monday, unveiling a plan designed to hasten the availability of cheaper generic versions. Using a Washington pharmacy as his stage, Gore proposed that before pharmaceutical patents are extended, the cost to the consumer be taken into consideration. Such a step would require congressional approval.

Bradley’s health care proposal, unveiled in late September, takes a much different approach. The plan would scrap the existing Medicaid and children’s health insurance programs and replace them with subsidies that low-income workers could use to buy health insurance for themselves and their families. Bradley would offer the most generous subsidies to adults with earnings at the poverty level or below (about $16,400 annually for a family of four), and children who live in families earning up to twice the poverty level. He would offer partial subsidies to adults and children at slightly higher income levels.

In addition, Bradley would allow families of all incomes to deduct from their taxes the cost of purchasing health insurance and would provide a prescription-drug benefit for seniors.

Since Bradley’s subsidies are not restricted to uninsured families, about 24.4 million children and 23.2 million adults who have private insurance (the vast majority through their employers) would be eligible for the government assistance, Thorpe calculates. Critics maintain that the subsidies would encourage many employers to drop their coverage, shifting the cost from the private sector to the public.

In all, Thorpe estimates, Bradley’s plan would produce insurance for 89% of the population, at a cost of $1.06 trillion over 10 years.

Bradley’s aides maintain their plan would reach 35 million of the uninsured at a cost of about $65 billion annually, including the prescription-drug benefit for the elderly.

Thorpe’s analysis has been controversial throughout the campaign. He served as a deputy assistant secretary in Health and Human Services for the first two years of the Clinton administration, and was listed as a Gore advisor in an Emory University press release--though he says that was mistaken and he has not advised the Gore campaign in any capacity. Still, Bradley aides dismiss his analysis as biased.

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Times staff writer James Gerstenzang contributed to this story.