Talking Points
Democratic Candidates' Health Care Proposals
December 10, 2007 by Jim Hoffmann
As we approach the 2008 elections, a very recent poll of registered voters taken October 23-29 asked this question: “Do you think it's the government's responsibility to make sure everyone in the U.S. has adequate health care, or don't you think so?”
% Think so % Don't think so % Unsure
All voters 57 38 7
Democrats 84 13 4
Independents 54 41 6
Republicans 32 62 6
Naturally, polls vary, but it is safe to say that the majority of voters want the President and Congress to make universal health care happen.
The harder questions are these:
All candidates must offer a sound program to answer these questions, or else we are left with the following unacceptable facts:
Republican candidates don't get the urgency on this key issue:
Democratic candidates are listening to voters and are offering better plans to improve health care:
1. All require major employers to either offer health care plans or contribute to the cost of coverage, except for Biden. Some subsidies or tax incentives are offered to employers, except by Edwards.
2. All, except Biden and Obama, require small businesses to participate in the same way, with similar tax incentives, except by Edwards.
3. All offer tax subsidies on a sliding scale to families to help purchase their insurance.
4. All would set up purchasing pools to help reduce the cost of insurance.
5. All offer people the opportunity to move out of their current plans which may have limited benefits or may be too costly. They can choose from a variety of private plans or a new public plan, allowing comparisons and competition between the private and public sectors.
6. Each offers various ways to recapture money now wasted on overlapping administrative costs, excessive marketing and profits, outdated medical records systems, poorly managed chronic illness cases, poor quality care resulting in deaths (or at least requiring corrective care), missed opportunities for “smart purchasing initiatives” for prescription drugs, managed care and other services.
7. Each offers various ways to improve the quality of care/health system by developing “best practices” systems, adjusting payments to plans and providers based on performance, promoting preventive care, improving treatment of chronic diseases, improving provider communications, and preventing medical errors.
8. Estimated costs for these plans, and how they would be paid for:
1. Biden: $110 billion. No specified sources of funds.
2. Clinton: up to $110 billion a year when fully phased in. To be funded by the following: savings from changes to Medicare funding and payments, from limiting tax exclusion for employer-paid health insurance, from modernization initiatives, and from discontinuing tax cuts for those with incomes over $250,000
3. Dodd: no estimated cost given. Says no new taxes needed, because funding would come from the following: a combination of employer and individual/family premiums, recapturing certain existing care subsidies, savings from eliminating existing inefficiencies in the system, savings from ending the war in iraq, and other revenue streams.
4. Edwards: $90-120 billion a year. Funding would come from rolling back tax cuts for those earning more than $200,000 a year.
5. Gravel: no estimated costs. Funding comes from savings through the voucher program.
6. Kucinich: no estimated costs. Funding from the following: increase federal payroll tax for both employers and employees from 1.45% to 4.75%, stock transfer tax of 0.25% on both seller and buyer, income tax surcharge of 5% on incomes between $184,000 and $279,999 and surcharge of 10% on incomes of $280,000 and more, repeal of the Bush tax cuts for the wealthy, and transfer of federal revenue for public programs (Medicare, etc.) to this new universal health care program.
7. Obama: $50-65 billion a year when fully phased in. Funding from savings within his system, plus savings from discontinuing tax cuts for those with incomes over $250,000.
8. Richardson: $104-110 billion. Funding from savings through streamlining health care administration, reinvesting money now spent on uncompensated care, and investing in prevention and chronic disease management. He says no tax increase needed.
What are the next steps?
1. What combination of ideas will be workable and clear enough to win the support of most voters as we make this change in a very complex health system?
2. Is now the time for a single-payer, not-for-profit health care system, or do we use a private-public combination with appropriate regulation of insurance companies, hospitals, doctors, employers etc., while still offering incentives for all to be part of a great new system?
3. How much money will be needed up front, and how will the cost be shared by all? How do we achieve significant savings as the program moves forward, so that initial costs are reduced and the program begins to pay for itself?
4. Are there issues we haven't faced yet? A September 23, 2007 New York Times editorial puts it this way: “Voters who put a high priority on covering all or most of the uninsured will prefer the Democrats’ approach, as we do. The chief danger is that the Democrats have a tendency to imply that everyone can be covered with good benefit packages without inconveniencing anyone but the wealthy. Their cost and savings assumptions will need thorough analysis when more detailed plans emerge.”
Sources for further study: