By Craig Stoltz
Special to The Washington Post
Tuesday, February 12, 2008
As Washington area residents head to the polls, months into a heated primary campaign, health care remains a top voter concern. A recent Washington Post-ABC national survey showed health care ranked third (after the economy and the war in Iraq) among Democratic voters; among Republicans, health care ranks among the top 10 issues.
But if you're confused on just how the front-runners compare on key health-care issues, you're not alone. Here's some help.
The caveats: We report candidates' stated positions, not what they'll do if elected. Underlying the health-care debate is the matter of cost. Democrats' plans involve regulating insurers and offering all Americans a menu of insurance choices similar to those available to federal workers. Republicans would deregulate insurers, arguing that a free market will reduce costs and boost quality. All say savings will come from technology such as digital medical records and from disease prevention and chronic care.
And a note: Some say the focus on health care is not enough. A former assistant surgeon general, Douglas Kamerow, writing last week in the journal BMJ, says candidates' proposals don't address the "crisis" in U.S. primary care, the need for better pay for primary care doctors or ways to reward continuity of care.
Click here for an interactive tool that looks at the candidates positions.
Here are the Democratic and Republican front-runners' stands on several key health questions:
Will all Americans be covered by health insurance?
Hillary Clinton: Yes
Mike Huckabee, John McCain,
Barack Obama: No
Clinton's plan includes a federal mandate that all individuals not covered by employer or public plans have health insurance. She has not specified how this would be enforced. Obama proposes a stepped approach starting with a mandate to cover all children, with the eventual possibility of full mandates if incentives, subsidies and cost controls fail to achieve universal coverage. Huckabee and McCain have spoken out plainly against mandates.
Will your employer be required to provide health insurance?
Clinton, Obama: Yes, or pay into a common fund to defray costs for all.
Huckabee, mccain: No
Clinton's plan would require big employers to provide coverage or pay into a fund that supports a new system. Small employers would get incentives, not mandates, to offer insurance. Obama would require employers to offer "meaningful" coverage or pay a percentage of payroll into a fund. Republicans oppose employer mandates.
What help will go to people seeking individual coverage?
Clinton, Obama: New insurance marketplace would offer private and public choices meeting certain standards. Insurers would have to cover anyone, regardless of preexisting conditions. Tax breaks would make insurance easier to afford.
Huckabee: A deregulated insurance market would provide insurance options, but coverage would not be guaranteed or mandated. Tax breaks would make insurance easier to afford.
McCain: Same, but people could also buy insurance through organizations and associations.
Clinton and Obama would offer a menu of public and private insurance choices, with tax breaks based on income. Insurers would have to issue coverage despite preexisting conditions and meet federal rules for minimum coverage, including preventive and chronic care. McCain would let individuals deduct insurance costs; Huckabee would offer tax breaks only to low-income people buying private insurance.
Will the federal government be permitted to bargain with drug companies for lower pharmaceutical prices, and will it be legal to import cheaper drugs from other countries?
Clinton, Obama, McCain: Yes
A law now prohibits the federal government from bargaining with drug companies for lower prices for its millions of Medicare beneficiaries. Another law prohibits importation of lower-cost drugs from other countries. Obama, Clinton and McCain would overturn these laws. Huckabee would not.
Will medical research with embryonic stem cells be expanded?
Clinton, Obama, McCain: Yes, with federal funding
All candidates except Huckabee would permit and federally fund stem cell research using embryos created from in-vitro fertilization that would otherwise be destroyed. Huckabee would permit research, without federal funding, using only the existing stem cell lines currently available to researchers.
Clinton: Doctors get incentives for best practices in preventive and chronic care.
Obama: Children younger than 25 can be covered under parents' plan.
McCain: Veterans can get care at any medical facility.
Huckabee: Speaks about prevention and healthy lifestyles, but offers no specific plan.
Craig Stoltz, a former editor of Health, designed the interactive Web tool mentioned above for HealthCentral, a network of health-related communities aimed at consumers. Comments:email@example.com.