Presidential Candidates Debate Health Care Proposals In Preparation For Iowa Caucuses

Main Category: Health Insurance / Medical Insurance
Also Included In: Public Health
Article Date: 03 Jan 2008 - 9:00 PDT

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Presidential candidates have debated their health care proposals in preparation for the Iowa caucuses on Thursday, the Chicago Tribune reports (Pearson/Chase, Chicago Tribune, 12/31/07).

Democratic presidential candidate Sen. Barack Obama (Ill.) on Monday at a Perry, Iowa, community center defended his proposal against claims made by rival former Sen. John Edwards (D-N.C.). In response to claims by Edwards that Obama should not negotiate with health insurers and pharmaceutical companies, Obama said, "I'd have a big table, and everybody would be invited." He added, "Yes, I'd invite the drug companies and the insurance companies and the HMOs. They'd have seats. They just wouldn't be able to buy every chair." He also said that C-SPAN would televise the negotiations to increase the influence of the public and reduce the influence of special interests. According to Obama, "That's how you get things done, not by shouting" (Eichel, Philadelphia Inquirer, 1/1).

Edwards on Sunday in northern Iowa addressed questions by the Obama campaign about comments he made last year about the role of special interests in health care reform. In comments made in a story on the Web site www.mydd.com, Edwards said that he would "try to bring everybody to the table" on health care reform, although during his campaign he has said that he would not negotiate with special interests. Edwards on Sunday said that he meant health insurers would continue to play a role in the health care system under his proposal. He said, "What I was talking about then was what we needed to do to actually bring about universal health care and the difference between single-payer, government-run health care and what I'm proposing." Edwards added, "I don't eliminate insurance companies from the health care fix. ... People have choice in my health care proposal between a private plan and a government-run plan" (Chicago Tribune, 12/31/07). On Friday during a campaign event in Dubuque, Iowa, Edwards "tried to distinguish himself from his Democratic rivals" on health care and other issues, the New York Times reports (Bosman/Luo, New York Times, 12/29/07).

Drew Altman, president and CEO of the Kaiser Family Foundation, said that health care is "not a wedge issue" and is not "emerging as a pivotal distinguishing issue" in the presidential primaries. However, Altman said, "We're in the early stages of health care re-emerging as a top national issue. It's the next great debate" (Feder Ostrov, San Jose Mercury News, 12/25/07).

Additional Developments

• Sen. Hillary Rodham Clinton (D-N.Y.): Clinton on Wednesday plans to launch a television ad in Iowa that will ask voters to "take the first step" in efforts to address health care and other issues through their support for her in the caucuses. In the ad, Clinton says, "As we start this new year, America is at a crossroads," with "47 million people without health care." She adds, "All the men and women across the state who have whispered their health care problems to me -- bills they can't pay, parents they can't afford to care for, insurance companies who refuse to help" have "welcomed me into your hearts and your homes" (Glover, AP/Kansas City Star, 1/2). In related news, Clinton on Dec. 23 during an appearance at the Iowa Veterans Home reiterated her promise to provide adequate health care and other benefits to U.S. troops who return from the wars in Iraq and Afghanistan. Clinton said that "no one has given more to our country than our country's veterans." She added, "I believe that when you sign up to serve our country, our country must serve you with the health care, the compensation and the support that you so richly deserve" (Lorentzen, AP/Lexington Herald-Leader, 12/25/07).
  
  
• Former New York City Mayor Rudy Giuliani (R): The New York Times on Friday examined consultant work provided by Giuliani to Purdue Pharma in efforts to defend against federal allegations that the company misled the public about the potential addictiveness of the pain medication OxyContin. According to the Post, Giuliani participated in two meetings between Purdue Pharma officials and the Drug Enforcement Administration acting administrator, and, as a "celebrity, Mr. Giuliani helped the company win several public relations battles." In addition, Giuliani "became the public face" of Rx Action Alliance -- a group of pharmaceutical companies, physicians and law enforcement authorities that seeks to fight prescription drug abuse, the Post reports (Meier/Lipton, New York Times, 12/28/07).
  
  
• Obama: Obama on Friday launched a television advertisement in Iowa that promotes his health care proposal over those announced by Edwards and Clinton. According to the Washington Post "The Trail" blog, the ad "misrepresents some newspaper assessments" of the Obama proposal. The ad cites a St. Paul Pioneer Press article that said the Obama proposal "guarantees coverage for all Americans" but omits the end of the statement: "but does not require all to have it." The ad also cites an Iowa City Press-Citizen article that praised the Obama proposal as "the best." However, the ad fails to indicate that the article involved a comparison of the proposal to a single-payer health care system, not the plans announced by Clinton and Edwards. In addition, the ad cites a Post article that states the Obama proposal would save "$2,500 for the typical family," although the article attributed the figure to Obama aides without outside verification (Kurtz, "The Trail," Washington Post, 12/29/07). On NBC's "Meet the Press" on Sunday, Obama "sidestepped whether his spot was a stretch" on whether his proposal would expand health insurance to all U.S. residents, the Chicago Sun-Times reports (Sweet, Chicago Sun-Times, 12/31/07). In related news, Obama last week in Mason City, Iowa, promised to not "play politics" on the issue of health care for veterans. Obama said that he would seek to improve health care for veterans and provide them with mental health screenings. According to Obama, "We have to fund all the services that have been promised to our veterans. We can't play politics with it" (AP/Arizona Daily Star, 12/27/07).

Polls
Almost two-thirds of U.S. residents support a health care system "in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers," according to a recent poll commissioned by AP/Yahoo! News. The poll, conducted over the Internet by Knowledge Networks, included telephone contacts with more than 1,800 residents followed by online interviews. The poll also found that 64% of respondents cited concerns about the possibility of unexpected major medical expenses (Kuhnhenn/Tompson, Associated Press, 12/28/07).

In related news, a recent Boston Globe poll of likely voters in the Jan. 8 New Hampshire primary found that 80% of Democratic respondents believe the federal government should provide health insurance, compared with 30% of Republican respondents (Mooney, Boston Globe, 12/26/07).

Opinion Pieces
Summaries of several recent editorials and opinion pieces related to health care in the presidential election appear below.

• Edwards, Boston Globe: "I am running for president to make sure that every child can have the same opportunities in life that I've had," and one "thing we need to do is create universal health care in America," Edwards writes in a Globe opinion piece. "Not only are health care costs putting a huge strain on American families and our competitiveness in the global economy, but our broken health care system that leaves 47 million Americans without health care is also a moral disgrace," Edwards writes, adding, "I have proposed a health care plan that calls for shared responsibility among people, businesses, and the government, and will ensure that every man, woman, and child in America has access to affordable, quality coverage" (Edwards, Boston Globe, 12/28/07).
  
  
• Los Angeles Times: "A sick America can't be a working America," and "changes to the health care system will be necessary to keep us in good health," according to a Times editorial. The editorial states, "The Congressional Budget Office reported this month that rising medical costs, which far outstrip inflation, pose the No. 1 threat to the country's ability to balance federal budgets in the future." The editorial, which recommends a health care "plan that would achieve universal coverage through an individual mandate, requiring every American to buy health insurance," states that most Democratic presidential candidates "line up with our approach" and "seek to expand coverage and to create new purchasing pools to expand choice." However, the "GOP candidates prefer market-based solutions such as health savings accounts, tax refunds for those who buy individual coverage ... and boosting citizens' ability to spend wisely by requiring greater transparency on prices and outcomes from health care providers," all of which are "appealing ideas in theory" but "will not improve care for all Americans," the editorial states (Los Angeles Times, 12/28/07).
  
  
• Paul Krugman, New York Times: The Democratic presidential candidates are "offering strongly progressive policies on taxes, health care and the environment," Times columnist Krugman writes. However, Republican presidential candidates support "Bushonomics," although the "public is very unhappy with the state of the economy ... with a declining fraction of Americans receiving health insurance from their employers," he writes (Krugman, New York Times, 12/31/07).
  
  
• David Leonhardt, New York Times: The only difference between Clinton and Obama "on any domestic policy that has received much attention" is the issue of a health insurance mandate, which Clinton has included in her health care proposal but Obama has not included in his plan, Times columnist Leonhardt writes. "Outside of health care, the campaigns -- and we in the media -- have focused on more exalted concepts, like experience, change and judgment," but "there really are some other important differences between the candidate," such as "policies as a whole" and "competing economic philosophies," Leonhardt writes, adding, "The fight over health insurance is just one part of their disagreement." According to Leonhardt, "Mrs. Clinton and Mr. Edwards favor a mandate because -- as they point out -- there will never be universal health care without one," and "skepticism about government tinkering" raised by Obama "helps explains his stance on a health care mandate." He adds, "Obama is right that some people would ignore a health care mandate. But some wouldn't. As any good behavioral economist knows, there really are people who can afford health insurance and who would like to have it -- but who haven't gotten around to getting it. A mandate would nudge some of them to do so, and the whole health care system would be better off as a result" (Leonhardt, New York Times, 1/2).
  
  
• Jacob Sunshine, Seattle Post-Intelligencer: "There are many reasons physicians and people in health care are lukewarm about John Edwards' presidential candidacy," and none "is bigger probably than his professional past," Sunshine, a student at the University of Washington School of Medicine, writes in a Post-Intelligencer opinion piece. Sunshine writes, "In the '80s and '90s, he amassed a fortune as a trial attorney, in no small part through malpractice cases against OB/GYNS in North Carolina," and "this makes some people in health care uneasy." However, "no matter how you feel about Edwards' past, of all the candidates seeking the presidency, he is the one most committed to improving the public's health, in addition to health care," based in part on his "having the most progressive universal health plan" and his focus on poverty, Sunshine writes. He adds, "Make no mistake; those measures will not be easy. But by focusing on poverty, in addition to his health plan, Edwards is in a position to do a tremendous amount to improve our country's collective health" (Sunshine, Seattle Post-Intelligencer, 1/2).
  
  
• Washington Post: "When it comes to health care, the way policy makers define the problem determines the answer they produce," as "Democratic presidential candidates tend to focus on the uninsured" and Republicans candidates tend to focus on "rising costs," a Post editorial states. According to the editorial, "Both are important: The unaffordability of health insurance won't be addressed without tackling health-care costs, but reducing cost growth alone won't solve the insurance problem." A health care proposal announced by presidential candidate Sen. John McCain (R-Ariz.) is the "most detailed and thoughtful of the Republican proposals" but "does not put enough emphasis on dealing with the uninsured," the editorial states. In addition, McCain "puts too much emphasis on the ability of consumers, once they are aware of and responsible for health-care costs, to drive down prices," and his "plan is weakest on the underlying problem with the health-insurance market, in which insurers have every incentive to cherry-pick the healthiest purchasers," the editorial states. However, according to the editorial, "his suggestions for constraining costs and reforming the irrational tax treatment of health insurance merit serious consideration by whoever is elected." The editorial states, "The McCain plan represents an important improvement on a dead-on-arrival proposal from President Bush earlier this year," adding, "Getting rid of the tax preference would be a good step toward achieving a more rational system, one that does not favor some purchasers of health insurance over others and does not encourage spending on gold-plated health care plans" (Washington Post, 12/22).

Broadcast Coverage
"Meet the Press" on Sunday included a discussion with Obama about his health care proposal and other issues (Russert, "Meet the Press," NBC, 12/30). Video of the complete program is available online. A transcript of the complete program also is available online.

Forum
PBS's "NewsHour with Jim Lehrer" last week reported on the latest in a series of health policy forums in Washington, D.C., organized by Families USA and the Federation of American Hospitals. Democratic presidential candidates Sen. Joe Biden (Del.); Clinton; Edwards; Rep. Dennis Kucinich (Ohio); and New Mexico Gov. Bill Richardson participated in the forum (Dentzer, "NewsHour with Jim Lehrer," PBS, 12/25/2007). Republican candidate Sen. John McCain also has participated in the forum.

The Kaiser Family Foundation hosts the forums in its Barbara Jordan Conference Center in Washington, D.C. Kaiser is webcasting the forums live through kaisernetwork.org, its health policy news and information service. Susan Dentzer of "NewsHour" will moderate the forums, and additional panelists will include journalists from NPR, Wall Street Journal and ABC News. Live and archived webcasts of the six forums held to date, as well as additional information about them, are available on a dedicated Web site, http://presidentialforums.health08.org. The forums are being funded by The California Endowment and the Ewing Marion Kauffman Foundation (Kaiser Daily Health Policy Report, 11/20).

The "NewsHour" segment includes comments from Biden; Clinton; Edwards; Kucinich; Richardson; Laura Meckler, a reporter for the Journal; David Muir, a correspondent for ABC News; and Julie Rovner, a correspondent for NPR ("NewsHour with Jim Lehrer," PBS, 12/25/2007).

Audio and a transcript of the segment are available online.

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.