Health Care

USA Today has published a comparison of the health care proposals by both Bush and Kerry during the campaign.

Though his opponent likes to depict him as a liberal, Kerry actually is offering the more conservative of the two proposals — in concept, if not in dollars. He wants to build on private, employer-provided health insurance as well as the public Medicare and Medicaid systems for seniors, the poor and disabled, and working Americans who can't afford insurance on their own.

Bush would steer the nation's health care system in a different direction. He wants more Americans to shop for their insurance coverage or medical services, reasoning that if they are more attuned to the costs, market forces will limit health care inflation.

The key difference, according to this article, is that the president wants to transform health insurance to something more driven by the consumer rather than employers, whereas Kerry wants to extend the existing system to make it more affordable and allow coverage to be extended to more Americans. Comparing cost and impact,

The two candidates differ in the scope and ambition of their proposals. Kerry's is far more expensive. But even conservative analysts say it would provide coverage to far more people than Bush's proposal.

Bush's plan includes tax breaks to encourage Americans to purchase coverage or set aside savings to pay their own medical bills. He estimates it would cost $145 billion over the next decade while extending coverage to 11 million people. A study of the two plans by the American Enterprise Institute, a conservative think tank, estimates that Bush's plan would extend insurance coverage to fewer than 7 million people.

Kerry estimates his plan would cost $650 billion over 10 years while providing coverage to 27 million Americans. The same conservative study agreed with that number but estimated that it would cost more than twice the amount Kerry advertises.

I dislike Bush's proposal. It reflects his focus on the affluent rather than the ordinary American. Most Americans do not have surplus money in their paychecks to contribute to insurance savings accounts. This is especially true of those American who have no coverage currently. They have no coverage because they cannot afford it. Lowering the cost will not impact those Americans. If you only have $25 to spend, lowering the cost of something from $80 to $40 is inconsequential because you still can't afford it. This is why Bush's plan will not adequately address the problem of millions of Americans without coverage.

One of the fears Republicans try to play on in debate about health care is that the Democrats want to put control over health decisions into the hands of government bureaucrats. In the third presidential debate, President Bush said, "Our health-care system is the envy of the world because we believe in making sure that the decisions are made by doctors and patients, not by officials in the nation's capital." Have these people actually used the kind of health insurance ordinary people get? Decisions are not made by doctors and patients. Decisions are made by insurance companies who decide what will be covered and what will not, what doctor you can see and what doctor you cannot. At best, the insurance companies set the boundaries of what care can be provided, and the doctors and patients make their decisions within those constraints.

I don't believe in a government-run program. I agree with the president, that "once a health-care program ends up in a line item in the federal government budget, it leads to more controls." The thing the government is best at is presiding over an ever expanding army of civil servants armed with reams and reams of red tape and waste. Health care must be managed by private business. But the government has an obligation to help provide coverage to those who cannot afford it, and to help control the costs for those who can afford it.