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Health Care Carries Weight in Presidential Debates
The commonwealth fund
October 8, 2004
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Health care issues are likely to take center stage when President Bush and Sen. John Kerry, D-Mass., meet for their final two presidential debates. Recent headlines suggest that health care might be foremost on voters' minds. Health insurance premiums are continuing to climb at double-digit rates and the number of uninsured Americans continues to rise as well. Proponents of drug importation are pushing Congress to act on the issue this year.
Prior to the October 8 debate, CQ HealthBeat editors compiled a list of health care topics to listen for as the candidates debate, including medical malpractice, Medicare prescription drugs, and covering the uninsured. We predicted what charges each candidate might make against his opponent, and offer research and independent analysis to guide you through the issues. What the candidates said is indicated in bracketed editor's notes below.
Medical Malpractice
Bush: Bush is likely to say trial lawyers-such as Kerry's running mate, Sen. John Edwards, D-N.C.-are responsible for runaway jury verdicts that have forced medical malpractice premiums to rise, which has forced many physicians to leave medicine.
The president might put forth that capping medical malpractice awards will get these doctors back in practice and lower health care costs for everyone. He might blame the Senate for stalling medical malpractice legislation that the House has passed several times. [Bush did indeed point to liability suits as a major factor in rising health care costs, blamed trial lawyers and criticized Kerry for having a trial lawyer as his running mate, and noted that a tort reform proposal has been made but it stalled in Congress.]
Kerry: Kerry might start by discussing his "mediation first" concept as a way to reduce frivolous medical malpractice lawsuits, and he'll probably promise to discipline lawyers who file them.
Just as Edwards did in his Oct. 5 debate with Vice President Dick Cheney, Kerry is likely to cite a Congressional Budget Office report that said the medical malpractice legislation Bush favors reduces health insurance premiums by less than 1 percent. [Kerry indeed argued that malpractice costs don't amount to but a small percentage of the overall health care bill and said he had a plan to address frivolous lawsuits, but didn't go into extensive detail.]
The Facts: The same CBO report also says the legislation would ultimately reduce medical malpractice insurance premiums by an average of 25 percent to 30 percent, less in states that already limit malpractice payouts.
Medicare Prescription Drugs
Bush: Bet on Bush to promote the new Medicare prescription drug law (PL 108-173) as one of his administration's major accomplishments. He might also say the private market can do a better job than the government can at providing affordable drug coverage to seniors.
He also might stress that the benefit is voluntary, and seniors do not have to enroll. He'll probably accuse Kerry of scaring seniors with his criticisms of the Medicare drug benefit. [Bush did indeed focus on the Medicare law as a major boon for seniors, saying that he was able to provide the elderly with the drug benefit that had eluded previous administrations.]
Kerry: Kerry is sure to call the bill a boondoggle for drugmakers and insurance companies. He will probably cite the $24 billion in additional payments to private insurers that are in the bill and say drugmakers stand to make $139 billion in profits from the legislation. Kerry is also likely to say the government can do a better job of negotiating prices for Medicare beneficiaries than leaving that task to private insurers.
Expect Kerry to highlight administration estimates that put the Medicare bill's cost at a figure far higher than the Congressional Budget Office's estimate of $400 billion. He also will probably attribute much of the recent 17 percent increase in Medicare Part B premiums to insurer payments included in the Medicare drug bill. [Kerry did make several of these points and repeatedly accused Bush of siding with pharmaceutical manufacturers and insurers over consumers in the push for a drug benefit.]
The Facts: CBO has said private companies will do a better job of extracting discounts from drugmakers than the government. The agency, which is the official scorekeeper for legislation before Congress, also scored the drug bill at $400 billion. But an Office of Management and Budget estimate early this year set the figure at $534 billion.
The $24 billion in incentive payments to insurers is part of the CBO's score of the bill but the $139 billion figure that Kerry cites for drugmakers is from a Boston University study published last year.
The benefit is voluntary, but seniors who do not enroll when Medicare drug coverage begins in January 2006 will pay a penalty for waiting. Unless they fall under a special set of circumstances-such as their former employer dropped health care coverage for retirees-their monthly premiums will be increased by either an amount the HHS secretary determines is actuarially sound, or 1 percent for each month the individual does not have coverage after the end of the initial enrollment period, whichever is greater.
Some, but not all, of the recent increase of Medicare Part B premiums is attributable to the payments to insurers included in the new drug benefit. CMS officials say $1.74 of the $11.60 monthly increase is attributable to the Medicare Advantage program.
Covering the Uninsured/Rising Health Care Costs
Bush: Bush will probably say the new health savings accounts created in the Medicare bill, which allow people to set aside dollars tax-free for health care and are combined with high-deductible insurance accounts, will make people more conscious of how much their health care costs.
Bush might also discuss "association health plans," which would allow businesses to join across state lines to have the same bargaining power that larger employers do when they purchase health care for their workers.
Bush will likely criticize Kerry's plan to open the federal employees' health insurance program to some Americans, saying it will cost taxpayers billions, as will Kerry's plan to have the government reimburse employers for some high-cost medical cases. [Bush praised HSAs as a means for consumers to have their own portable source of funds to cover health care costs and again painted Kerry's health care proposal as an unaffordable plan that would put the government in charge of health care.]
Kerry: Kerry has frequently made the case that Americans deserve to have the same kind of health care coverage that members of Congress have. He says helping to offset some of the most expensive medical cases will lower health insurance premiums for a family of four by as much as $1,000 a year.
Repeating a familiar Democratic criticism of health savings accounts, Kerry could say the accounts will benefit only the healthy and the wealthy, and that removing these people from the "risk pool" of health insurance will drive premiums up for everyone else.
Kerry might also note that governors and state insurance commissioners dislike Bush's proposal for insurance purchasing pools because they would not be subject to state regulations. [Kerry argued that his health care plan would extensively broaden coverage, especially for children, cut costs, and that he would pay for it by rolling back tax cuts on people who earn more than $200,000 a year.]
The Facts: Health savings accounts, which became available to consumers Jan. 1, appear to have some consumer appeal. Companies who sell the accounts say that about a third of the people who buy them were previously uninsured.
A recent study from the Kaiser Family Foundation found that more than a quarter of the firms they surveyed were either "somewhat likely" or "very likely" to offer a high-deductible health plan with a personal or health savings account option in the next two years.
Some health care analysts say Kerry's plan to open the Federal Employees Health Benefit program might not work out as envisioned. Consumers might not be able to get the same level of benefits that federal workers-including members of Congress-receive and might not have the same number of health plans to choose from. The premiums for coverage also might be higher than federal workers pay.
Stem Cell Research
Bush: Bush is expected to stress that he is the first president who ever approved federal funding for human embryonic stem cell research. [Bush said embryonic stem-cell research requires the destruction of human life. While science is important, Bush said, so is "balancing life."]
Kerry: Kerry will likely accuse Bush of placing restrictions on stem cell research funding and will say that such research is the link to finding cures for diseases such as diabetes and Alzheimer's. [Kerry said there are as many as 200,000 embryos that are in fertility clinics that are either going to be destroyed or left frozen. He said it was "respecting life" to use those embryos to help find cures for diseases.]
The Facts: Bush has placed curbs only on federally funded stem cell research, not privately funded research. Researchers have said stem cell research might lead to a cure for many diseases, such as diabetes or Parkinson's, but with Alzheimer's it might simply help medical experts better understand the progression of the disease rather than a cure.
Drug Importation
Bush: The president has said on many occasions that there is no way the government can guarantee the safety of imported drugs. Expect him to cite Food and Drug Administration inspections that have found counterfeit drugs shipped to the United States. [Bush did indeed tell his audience that safety is his primary concern when it comes to broad importation of less-expensive drugs. He said that former President Clinton also prohibited the practice due to safety concerns.]
Kerry: He is expected to point to the fact that consumers-and some state governments-are already importing drugs from other countries and that safety concerns are overblown. He might add that Bush makes the safety argument to protect his allies in the drug industry. [Kerry said that Bush should have allowed Medicare to purchase drugs on behalf of all seniors, similar to what the Veterans Administration does for veterans.]
The Facts: Several governors, including those in Illinois and Wisconsin, have set up Web sites to help people buy drugs from Canada and elsewhere, where the drugs often sell for less than if they were purchased in the United States.
FDA officials continue to warn the public that they cannot guarantee the safety of imported drugs. They say there is not enough money in any of the drug importation measures now before Congress to properly fund the mammoth task of implementing and monitoring imported drugs to determine their safety. Some agency officials have even raised the threat of terrorists tainting the nation's drug supply. Proponents of drug importation say the practice is ongoing in Europe with no threats to public safety.
Meanwhile, a study funded by a consortium of small business groups has dubbed Democratic presidential nominee John Kerry's health care plan bad for business, particularly small employers.
The plan advanced by the Massachusetts Democrat and his running mate, Sen. John Edwards, D-N.C., would impose at least 225 regulatory mandates on businesses, costs that would be borne disproportionately by small employers, according to the study. The report was prepared by the Center for Regulatory Effectiveness for several business groups, including the National Retail Federation, Associated General Contractors and the National Federation of Independent Business.
The study concludes that the Kerry-Edwards health plan fails to address the key reason smaller businesses are less able to offer their employees health insurance: the administrative burdens and costs associated with offering health insurance.
"Where will the money come from for this big government approach to health care reform?" asked Dirk Van Dongen, president of the National Association of Wholesaler-Distributors, which also commissioned the report.
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