Editor's note: This article is the second in a series on issues in the 2004 presidential campaign.
Although Sen. John Kerry (search) and President Bush (search) both want to spend billions of dollars to provide millions more Americans with health care coverage, they disagree on the magnitude of health care reform.
Kerry's reform would be much larger and costlier with an aim to allow prescription drug imports (search) as well as insure 26.7 million new people, according to Kenneth Thorpe, a health care economist at Emory University, whose numbers are often cited by the Kerry campaign. Thorpe estimates Kerry's plan would cost $653 billion over nine years.
Bush, on the other hand, would offer a smaller reform that would rely in part on private health care accounts, and he would not allow drug imports. The Bush campaign puts the cost of the president's proposal at $145 billion with 11 million to 17 million more people being insured.
The candidates have been describing their plans — and attacking each other's — in an attempt to appeal to voters in swing states.
"We have a difference of opinion in this campaign," Bush told supporters in Muskegon, Mich., on Sept. 13. "I'm running against a fellow who has got a massive, complicated blueprint to have our government take over the decision-making in health care. Not only is his plan going to increase the power of bureaucrats in your life, but he can't pay for it unless he raises your taxes."
"Five million fellow Americans have lost their health insurance in the last four years," Kerry said at a town-hall style meeting in Toledo, Ohio, the next day. "I have a plan that will lower the cost of health care for all people who have it today" while adding coverage for millions more Americans, he said.
The August 2004 survey from the U.S. Census Bureau (search) found that 45 million people were uninsured in 2003. A study by the Kaiser Family Foundation (search) and the Health Research and Educational Trust finds that family premiums in employer-sponsored plans surged 11.2 percent this year over last.
The question of the uninsured is far and away the most important health care issue this year, said Robert Blendon, professor of health policy and management at Harvard University (search). But Blendon doubts the issue will have much impact on its own, suggesting that war and the economy will be top priorities and issues like health care and education will fall into secondary positions.
That said, "if the election is close, it’s the kind of issue that could involve 3 or 4 percentage points," Blendon said.
Kerry, who until recently has tried to steer the political discourse toward domestic issues, hammering Bush on education, health care and Social Security, says his proposal would expand Medicaid and provide subsidies to employers to encourage them to insure more workers. Under Kerry, the government would pick up the tab for 75 percent of employer-sponsored plans after a beneficiary has spent $30,000. The Kerry campaign said this move would lower insurance premiums by 10 percent. Kerry said he also wants to allow drug importation from Canada.
Bush's plan would rely on tax credits and deductions to help individuals purchase their own insurance, and would institute insurance market reforms to make insurance easier to obtain. Small businesses would be allowed to pool resources to lower costs. The president said he also wants more funding for health centers to serve low-income Americans and expanded health savings accounts. Another part of his plan is medical liability reform that would prevent doctors' insurance premiums from skyrocketing, an experiment already being pursued with some success in the president's home state of Texas.
Polls show Bush has maintained a significant advantage on national security. But Blendon said Bush has also been surprisingly strong on the matter of health care reform.
"In general, Democrats have owned the health care issue," but recent polls show that "the president has narrowed the issue although Kerry still has a lead," Blendon said.
"In terms of effectiveness, the Kerry plan is not very effective in money versus the number of people insured," said Gail Wilenski, a senior fellow at the international health education foundation Project HOPE (search). "For the Bush proposal, more money needs to be spent to pick up a larger number of the uninsured."
Wilenski spoke recently at the American Enterprise Institute (search). AEI estimates that Kerry's plan would cost $1.5 trillion and insure 27.3 million new people over 10 years. The Bush plan would cost $128.6 billion and insure 6.7 million new people, according to AEI estimates.
Blendon said the dueling health care proposals are huge, complicated and difficult to compress into sound bites, a fact that hurts Kerry. He said if voters understood the proposals, they might take Kerry's plan more seriously.
"If they did, Kerry would look better about health care because he's doing something big about problems people think are important," he said.
Wilenski said both candidates need to do a better job of explaining their proposals to the electorate. "I would like to see more discussion" about the details of the proposals. "I would like to see more focus on the fundamentally different implications."