Democratic candidates share views on health care

Presidential hopefuls focus on cost control, not just insurance access, in their proposals.

By Doug Trapp — Posted June 18, 2007

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Three of the leading Democratic presidential candidates have made health system reform an early campaign priority.

Sen. Barack Obama (D, Ill.) and former Sen. John Edwards (D, N.C.) have unveiled comprehensive plans for increasing the number of insured Americans and addressing rising health care costs.

Sen. Hillary Rodham Clinton (D, N.Y.) is developing a three-part plan, the first of which focuses largely on controlling costs, and was released last month. The rest of her proposal, including ideas for expanding insurance access, is expected in coming months.

All three plans share certain themes, such as expanded health information technology, better preventive care and health insurance industry reform. As for access, all would build on the existing employer-sponsored health insurance system, instead of dismantling it the way the single-payer proposal of fellow candidate Rep. Dennis Kucinich (D, Ohio) would.

Health policy analysts said the similarities between the plans are significant, as is the fact that the three leading candidates had unveiled health care platforms early in their campaigns.

"Having a plan for universal coverage is the price of admission into the Democratic primaries," said Paul Ginsburg, PhD, president of the Center for Studying Health System Change, a non-partisan health care research organization.

However, it's too early to devote too much attention to the plans' details because most Republican candidates have yet to join the health care discussion, said Drew Altman, president and CEO of the Kaiser Family Foundation, a non-partisan health care research organization. While Democrats tend to favor expanding access with the help of public programs, Republicans are more likely to favor health savings accounts and other consumer choice measures.

"That's going to be the real debate," Altman said.

A consensus of ideas

All three Democratic candidates would use a variety of means to reduce health care costs.

Clinton estimated that her cost-control proposal would save $120 billion, or $2,200 per family each year. It includes new medical liability limits for physicians who disclose medical errors and offer to negotiate settlements with patients.

Clinton and Obama would allow drug importation, encourage competition from generic drug companies and allow Medicare to negotiate lower drug prices. Obama said the average family would save $2,500 a year through his plan.

All three candidates would create a best practices institute to compare the effectiveness of treatments and would improve disease management and prevention with public and private initiatives.

Boosting the number of insured people

Edwards and Obama would expand Medicaid and the State Children's Health Insurance Program. Both would create health insurance pools and require employers to contribute to employees' health care.

Obama would create a national health plan modeled after the insurance program for federal employees. It would be open to people who don't have coverage through work or another public program.

He also calls for a National Health Insurance Exchange to help people who want to buy private insurance. The exchange would act as a watchdog by creating rules and standards for participating plans. Income-based subsidies would be available on a sliding scale for people who need help paying premiums.

Obama's plan, unveiled in May, would mandate coverage for all children. It would require full cost and quality transparency from physicians and hospitals.

Edwards would create sliding-scale, refundable tax credits to help people buy insurance though his proposal's regional insurance pools. These pools would offer choice between competing insurance plans, at least one of which would be modeled after Medicare.

His plan, released in February, would implement an individual insurance mandate once affordable health insurance was available to all.

The American Medical Association -- as a member of the Health Coverage Coalition for the Uninsured -- supports offering refundable, advanceable tax credits to help pay for health insurance and improving SCHIP and Medicaid enrollment.

The American College of Physicians and the American Academy of Family Physicians said they are encouraged by Democrats' discussion of key issues, such as preventive care and financial support for physicians to adopt health IT.

Keeping the employment-based system

The three leading Democratic candidates' health plans are more comprehensive than those of the last decade, health policy analysts said, but don't expect candidates to propose changing the employer-sponsored health care system.

Millions of Americans are satisfied with their health care, but not with having 45 million uninsured people and ever-increasing health care costs, according to Robert Blendon, ScD, a professor of health policy and political analysis at the Harvard School of Public Health.

"They're looking for fixing pieces of what we have and trying to take some sort of step about this uninsured issue," Dr. Blendon said.

It will be a long time before any proposal will be introduced as legislation and fully debated in Congress. But health care will continue to be an important issue in the elections, said Joseph Antos, PhD, a health care scholar at the American Enterprise Institute, a conservative think tank.

"Now that it really is a middle-class issue, it's an issue of staying power," Dr. Antos said.

Dr. Blendon said the elections will set the course for health care reform. The major parties have very different views on the role of government in health care. "If the country shifts more toward the Democrats, I think there will be some larger initiative," he said.

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A look at key issues


Health IT Create a temporary $3 billion annual fund for physicians and hospitals to adopt health IT; require physicians working with federal programs to adopt health IT.

Insurance industry reform Require health insurers to offer coverage to everyone and grade health plans on their administrative costs and quality.

Preventive care Require health insurers to cover preventive services recommended by the U.S. Preventive Services Task Force; coordinate and pool public funding.


Health IT Support use of handheld devices, computerized patient reminder systems, computerized physician order entry and patient-physician e-mail systems.

Insurance industry reform Require health insurers to offer coverage to everyone.

Preventive care Offer preventive care at little to no cost as part of pooled insurance plans; support nutrition counseling for diabetics and other preventive care for chronic diseases.


Health IT Invest $10 billion annually for five years in health IT systems developed in coordination with physicians and others.

Insurance industry reform Investigate and prosecute monopolization of the health insurance market; require insurance companies to spend a certain percentage on enrollees' health care.

Preventive care Require health insurers to cover evidence-based preventive care services.

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