Jewish World Review March 19, 2004 /26 Adar, 5764
Drs. Michael A. Glueck & Robert J. Cihak
What Do and Don't Bush and Kerry Plan to do to Your Health Choices
President Bush sewed up the Republican Party nomination for the November
2004 presidential election in last week's primary elections. Among the
Democrat contenders, Sen. John Kerry (D-MA) is almost certain to capture the
Democrat Party nomination.
So, it's time once again to compare the presidential candidates' approaches
to American health care.
In his State of the Union address this year, President Bush said, "A
government run health care system is the wrong prescription. By keeping
costs under control, expanding access, and helping more Americans afford
coverage, we will preserve the system of private medicine that makes
America's health care system the best in the world."
Senator Kerry, not surprisingly, would get the federal government more
deeply involved in many ways. He wants the government to pay for 75% of
health care costs over $50,000 for insured employees, thus aiding employers.
But employers would have to follow a number of government mandates in order
to qualify for this subsidy, such as to "provide affordable health coverage
to all of their workers."
However, if history is any guide, the government is likely, long-term, to
cut back on payments even as it lays more requirements on businesses buying
into the plan. This is happening today with Medicare and Medicaid. In
Medicare, the federal government ratchets down spending while pretending
that access to care and quality can be maintained. It can't. It happened
with federal funding for hospital construction; the government continued to
mandate requirements on hospitals decades after hospitals had spent the
Senator Kerry would also establish more government programs and increase the
size of ones already in place, for example Medicaid and the State Children's
Health Insurance Program (S-CHIP).
President Bush says he's pushing for more consumer choice in health care.
For example, the 2003 Health Savings Account (HSA) legislation encourages
people to use their own tax-free savings, because people using their own
money to buy health services causes doctors and hospitals to pay attention
to the patient rather than the insurance company. This is especially true
when medical services, such as cosmetic surgery and laser eye surgery, are
not covered by insurance. Interestingly, in these cash-dominated "elective"
specialties, quality has gone up while costs have gone down.
In health insurance, President Bush says "The more competition the better."
In addition to Health Savings Accounts (HSAs), he promotes association
health plans, where groups of affiliated people (such as church, business or
fraternal groups) could negotiate insurance packages for members, just like
employers. This implies he would promote a federal law to preempt the many
state laws which effectively make this impossible.
Senator Kerry, meanwhile, has adopted part of a Heritage Foundation proposal
and would allow "all Americans" to join the Federal Employees Health
Benefits Program (FEHBP), especially individuals and employees of large
businesses. As Kerry says, federal employees have "a wide choice of
affordable health plans with group protections and good benefits." Insurance
companies compete vigorously.
Unlike Medicare and Medicaid, the FEHBP allows federal employees options in
coverage and premiums. Also, national FEHBP plans pre-empt health insurance
mandates in state law, greatly simplifying designing and comparing health
At the same time, Kerry proposes reforms to "keeps Medicare strong, instead
of privatizing it." This implies that the private purchasing and competition
inherent in the FEHBP wouldn't apply to Medicare recipients but that these
seniors will have to deal with an even stronger and more stringent
Kerry's package of proposals puts a $72 billion/year price tag on his
changes. These, he claims, "would provide health care coverage to nearly 27
million Americans who were previously uninsured, while making health care
more affordable for millions of others." He doesn't break down most of the
costs, however, so it's impossible to tell where the numbers come from.
However, we can be quite sure that the cost estimate is way low.
Indeed, the whole history of state medicine shows the same pattern. Initial
estimates of costs are so incredibly understated that not even the advocates
believe them. As costs skyrocket, it becomes necessary to at least pretend
to constrain them. This is done in two ways: by micro-management (read here,
endless paperwork and criminal prosecutions) and rationing, i.e.,
withholding care. And yet, the politicians and the people keep repeating the
The answer is "affordability." To you and me, what's affordable is
determined by two factors: what we need, and how much money we have. If
we're rational, we prioritize our needs, and then spend the money
accordingly. But to the government, "affordable" means something entirely
different. Affordability is determined by what's needed to keep their racket
going. As for the money . . . well, that comes from somebody else. When
politicians talk about affordability, they're not talking about what they
can afford; they're talking about how much money they'll force you to spend
to keep them employed.
Of course, Congress and changing times will modify any proposal. But the
direction each candidate would go is clear from their past actions and
votes. Kerry believes in more government control over your choice of health
plan, doctor and other health services; Bush believes in more individual
choice and freedom.
Editor's Note: Robert J. Cihak wrote this week's column
Michael Arnold Glueck, M.D., is a multiple award winning writer who comments
on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute
Senior Fellow and a past president of the Association of American Physicians
and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists.
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