Holes remain in candidates’ health care plans: think tank

WASHINGTON (PAI)--A think tank that assembled a task force of experts two years ago to examine U.S. health care and draft principles for a comprehensive and affordable health care system, says there are holes of varying sizes in the health care plans of the top eight remaining Democratic and Republican presidential contenders.

The analysis, issued by the Commonwealth Fund in mid-January, says the big problem with the four GOP contenders’ health care plans is they don’t cover everybody, while leaving individuals at the mercy of the market and giving them tax incentives many people can’t use.

Meanwhile the big problem with the four Democratic contenders’ plans is lack of figures on cost controls. And three of those four plans are extremely complex, too. The fund adds that three of the four would be paid for by rolling back GOP President George W. Bush’s tax cuts for the rich, but it points out that none of those plans provide a revenue figure.

The analysis comes as the AFL-CIO’s Working America affiliate launched its own online health care survey, designed to ask both union members and non-members about their health care coverage, and to gather stories in preparation for making health care the #1 domestic issue in this year’s campaign.

The survey asks people whether they are covered, their level of satisfaction, whether the price of insurance has risen -- but not by how much -- and whether they had to forgo prescriptions, procedures or doctors’ visits, among other things, due to cost.

It does not ask people if they favor alternatives to the present health care system, but there is a box for people to write in suggestions about “what they would tell policymakers” about health care.

In general, the Commonwealth Fund’s panel said the presidential hopefuls’ plans fall into three groups. The Republicans’ plans are far less detailed, the panel said. Former Govs. Mitt Romney (R-Mass.) and Mike Huckabee (R-Ark.), former New York City Mayor Rudolph Giuliani and U.S. Sen. John McCain (R-Ariz.) all would sever the link between employers and health insurance, throwing individuals and families onto the mercy of the market and the insurance companies. All also lack cost controls.

The fund also noted that by turning the market loose on individuals, the GOP proposals could only make a bad situation, where the number of uninsured has risen by 8.6 million since Bush took office, to 47 million, worse.

Three of the four Democrats -- Sens. Hillary Clinton (D-N.Y.) and Barack Obama (D-Ill.) and former Sen. John Edwards (D-N.C.) -- would keep the present mixed private-public system, but require everyone to buy insurance, with subsidies for low- and moderate-income people. Edwards would have penalties for those who don’t. They would also use regulation as a method of cost control, along with mandating insurers could not reject people because of age or pre-existing conditions.

The fourth Democrat, Rep. Dennis Kucinich (Ohio), backs government-run single-payer health care, in essence expanding Medicare to cover the entire country, but without a role for the health insurers. But Kucinich, like the other Democrats, is somewhat vague on how much the expansion costs, the Commonwealth Fund said.

The fund’s commission reiterated the health care principles it unveiled two years ago, then measured the candidates’ proposals against them.

The principles included: “Provision of equitable and comprehensive insurance for all,” benefits to cover essential services with appropriate financial protection, premiums and deductibles and out-of-pocket payments “affordable relative to family income,” the broad pooling of health risks to cut costs, simple administration and coverage that is automatic from job to job, minimum dislocation when people switch jobs or move and financing that is “adequate, fair, and shared across stakeholders.”

“Measured against these principles, the mixed private-public group insurance with a shared responsibility for financing proposed by the leading” Democrats, plus Kucinich’s “public insurance reform proposals have the greatest potential to move the health care system toward high performance,” the fund’s panel concluded.

“Those approaches have the potential to provide everyone with comprehensive and affordable health insurance, achieve greater equity in access to care, realize efficiencies and cost savings in the provision of coverage and delivery of care, and redirect incentives to improve quality.

“However, from a pragmatic perspective, the mixed public-private approach,
which allows the more than 160 million people who now have employer-based health coverage to retain it--and does not require them to enroll in a new program as in the public insurance models,” like Kucinich’s does, “would cause far less dislocation.”

The Republican proposals, in so many words, flunk. “Proposals for reform
that rely on tax incentives and voluntary purchase of coverage in an unregulated individual insurance market are, on their own, unlikely to achieve universal coverage. Buying coverage in the individual market will continue to be challenging if tax incentives are not coupled with an individual mandate,” minimum benefits, bans on insurers’ cherry-picking and spending limits keyed to income.

The full analysis is at www.commonwealthfund.org/publications