[Mb-civic] EDITORIAL BUSH VS. KERRY Anemic Healthcare Plans LATimes

[Michael Butler]

http://www.latimes.com/news/opinion/editorials/la-ed-health8oct08.story

BUSH VS. KERRY

Anemic Healthcare Plans

Neither candidate is making the bold proposals needed to reform the system.

 October 8, 2004

 Healthcare should get its Rodney Dangerfield moment of respect tonight
during the debate between President Bush and Sen. John F. Kerry. If things
go true to form, Bush will blame the problem of soaring healthcare prices on
trial lawyers, while Kerry will point to greedy health insurers and unfair
prescription drug policies. Too bad the issues are nowhere near that simple.

 Given that both candidates have been advised to avoid talking about the
real, complex woes afflicting the U.S. healthcare system, it's likely the
debate will quickly mire itself in digressions. Like: Which is more
sensible, Bush's modest plan to give health insurance to 7 million Americans
over 10 years (at a cost of at least $90 billion) or Kerry's much more
ambitious plan to insure 27 million Americans over a decade (costing at
least $650 billion)?

 What's troubling about such tussles is that they will distract voters from
what should be their key concern: Though both candidates have plenty of
ideas about how to increase healthcare expenditures, neither has a viable
plan to reduce them.

 That's a big problem because U.S. healthcare costs, which are rising faster
than inflation, have trapped the nation in a vicious cycle. As premiums
rise, more businesses and individuals forgo coverage, throwing more patients
into public programs. To make up for the low reimbursements of those
programs, doctors, hospitals and insurers charge employers and individuals
with private coverage even more. As two top healthcare economists,
Princeton's Uwe Reinhardt and Johns Hopkins' Gerard Anderson, put it in a
recent journal article, "It's the prices, stupid."

 It's unlikely that the debate's moderator, Charles Gibson, the sunny anchor
of ABC's "Good Morning America," will be able to expose the faulty economics
inherent in both candidates' healthcare reform plans, but we hope that
someone will pose hard questions like these:

 €  Mr. President, though tax credits have been the centerpiece of your
healthcare reform proposals since 2001, you haven't indicated how you'd pay
for them. Further, your proposed tax cut of up to $3,000 to help low-income
families buy health insurance won't do much to pay for such policies, which
now cost $9,000 to $10,000 a year. So where does the money come from?

 €  Sen. Kerry, you propose extending coverage mostly by expanding Medicaid
and the Children's Health Insurance program to enroll families with incomes
up to three times the federal poverty level. You say you will reduce
employer healthcare costs by about 10%, but because employers' premiums rose
by 11.2% this year alone, how can you argue those savings will stem the
tide? Moreover, you propose to pay for your plan by repealing the taxes
President Bush cut on people making more than $200,000 a year. What happens
if Congress doesn't let you fully repeal that tax cut? What's Plan B?

 There's one last question that we wish Gibson or some other moderator would
ask Kerry and Bush: Why are you advocating reforms far less ambitious than
any of your predecessors, when the problems have grown much worse?

 Kerry and Bush are both fond of saying all Americans should have access to
the same health plan that covers members of Congress. But in recent years,
that plan's costs have risen even higher than those of the average
employer-based plan. Instead of disingenuously promising Rolls-Royce
coverage, which they are unlikely ever to find the money for, they should
support Volkswagen plans for a bigger population.

 In a report to Congress earlier this year, the federal Institute of
Medicine urged U.S. leaders, for both moral and fiscal reasons, to commit to
guaranteeing that kind of basic health insurance to all Americans by 2010.
The institute showed that the cost of providing medically necessary benefits
to all 45 million uninsured Americans could be kept to under $70 billion a
year, not much more than Kerry would spend to insure 27 million people, if
the federal government did what both Bush and Kerry have so far been too
timid to do: provide subsidies only for the most cost-effective medical
treatments and drugs.

 In recent months, think tanks ranging from the conservative Heritage
Foundation to the centrist New America Foundation have come to support a
government mandate for all Americans to have health coverage, much as all
citizens are required to have auto insurance now.

 Despite lofty talk from both candidates, neither is proposing the kind of
fundamental reforms the system needs and neither is being realistic about
funding. One can only hope the winner has a better plan to be unveiled after
the election.


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