As noted previously in this journal, health care has again become central political issue (Gorin & Moniz, 2007). This article examines the health care debate in the presidential primary campaigns and considers implications for future health policy. As of this writing, no candidate on either side has officially won their party's nomination. Consequently, we focus on the positions of the three leading candidates, Democrats Barack Obama and Hillary Clinton and the Republican John McCain. Although the eventual nominees are likely to refine their proposals for the general election, we can discern the broad outlines of the positions they will present to the voters in November. The 2008 presidential primary contests have been hardly run-of-the-mill. For the first time since 1928, the field does not include an incumbent president or vice president. Senators will be the standard bearers for both parties ensuring the first election of member of that body as president since 1960. And the Democrats are poised to select either woman or an African American to head their ticket. Change is the buzzword for the 2008 campaign, and whatever the outcome, change seems ensured. What changes can we expect to see in the health care system? There is widespread consensus across party lines regarding the major problems plaguing the U.S. health care system. Simply stated, the system serves too few, too much, harms too many, and is too inefficient. Although increases in personal health care spending have slowed in recent years, Ginsburg (2008) argues that relief for purchasers and consumers will be short-lived (p. 30). A decade ago, affordability was primarily problem limited to low-income families, but it has increasingly become an issue for middle-income families (Banthin, Cunningham, & Bernard, 2008). To address widespread delivery system inefficiency, all three candidates have advocated similar solutions: conversion to electronic medical records, greater treatment transparency and consumer information, further shift toward pay-for-performance for providers, improved chronic disease care management, greater emphasis on preventive care, and unspecified malpractice (Collins & Kriss, 2008). The three leading candidates also agree that subsidies to purchase private for low-to-moderate-income families are needed and would best be distributed through the income tax system, although the proposed subsidy levels vary greatly. They also agree that affordable, new private options should be made available at the state, regional, or national level for the uninsured population and those in the individual private market (Collins & Kriss, 2008). Finally, converting to single-payer system is perceived as either undesirable or politically impossible. This is where the candidates' consensus ends. On the fundamental issue of extending coverage to the 47 million people without insurance, an enormous gulf exists between the two political parties. Republicans have long opposed efforts to expand public coverage. President George W. Bush has developed proposal that at best would have minimal impact on the insured population and could make matters worse (Gorin, 2007). More recently, the president has strenuously opposed efforts to expand the State Children's Health Insurance Program (SCHIP) (Gorin & Moniz, 2007). All the Republican presidential candidates have followed suit, including Senator McCain, who advocates a genuinely conservative vision for health care reform, which does not rely on state power to mandate care, coverage or costs (http://www. johnmccain.com/Informing/News/Speeches/ 8f5febd6-cdca-4136-b0d8-a97f5287235d.htm). He would reform the tax codes to eliminate the bias toward employer-sponsored health insurance and, to expand coverage, offer tax credits to families and individuals (http://www.johnmccain. com/healthcare/). …
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Jan 1, 2013
Thankam P Thyvalikakath + 2
Open Access