Cardin, Steele Differ on Health Care

Standing outside a hospital in Prince George's County surrounded by health-care advocates, retired doctor Nelson Goodman pronounced Rep. Benjamin L. Cardin (D) a champion for physicians because of his work in Congress to block cuts to doctors' payments under Medicare.

"Congress is balancing the budget by cutting reimbursements for doctors," Goodman said last week, "and Ben is trying to prevent them from doing that."

Cardin's Republican opponent in the race for Maryland's open U.S. Senate seat, Lt. Gov. Michael S. Steele, shares the view that doctors' fees should not be cut, and each candidate bemoans the fact that millions of Americans are without insurance.

But after that, their views on how to change the nation's health-care system diverge strikingly.

Cardin, who has been showered with donations from health-care interests, would expand federal programs such as Medicare and require that, with the help of government subsidies, everyone enroll in an insurance plan.

Steele emphasizes allowing small businesses to pool resources, which would enable them to bargain for cheaper policies, and encouraging individual health savings accounts.

These different approaches underscore broader philosophical differences on health policy. Steele's initiatives would shift responsibility for health care away from the government while deregulating the industry for small companies. Cardin's proposals would move toward universal coverage by building on existing government programs.

"Steele reflects the desire to move toward a consumer-driven health-care system, which means a more limited role for the government," said Helen Ann Halpin, director of the Center for Health and Public Policy Studies at University of California-Berkeley. Cardin, she said, shows "more reliance on the public system while maintaining the private system."

In the early 1990s, Cardin got behind President Bill Clinton's plans for universal coverage, which included some mandates on employers to provide health insurance for workers. Cardin said yesterday that the most realistic approach in the current political climate is to elevate a plan passed by legislators in Massachusetts to the federal level. All uninsured residents in that state will be required to purchase insurance or face a fine, and the government will subsidize new, less expensive plans.

"It's like driving a car," Cardin said last week. "You have to have car insurance to drive a car. You have to have health insurance."

Steele opposes universal health care, which he has equated to a government-run system. "Sounds good," he said at a candidates' forum sponsored by the Hagerstown-Washington County Chamber of Commerce. "But I'll be honest with you, I really don't want the guy who runs the DMV to run my health care."

Steele's position reflects his experience as a self-employed consultant who went for three years without health insurance.