The Health Care Answers We Need

The presidential candidates are feeling the pressure from voters to tackle the escalating health care crisis with bold and comprehensive solutions. So when the Center for American Progress and the Service Employees International Union invited all the candidates to Las Vegas on Saturday morning to debate health care, nearly all the Democratic candidates agreed to participate. (Alas, all the Republican candidates will be taking a pass.)

You can view the debate [1] and join a live blog and discussion [2].

At the onset of the debate, former Senator John Edwards is likely to be the center of attention, and not only because of the wrenching news of his wife’s recurrent cancer. Edwards has been driving the health care debate with a very detailed plan [3] to assure health coverage for everyone in America. Now the other candidates are determined to match him, though most have yet to offer specifics at this early stage of the race.

Of the other leading candidates, Illinois Sen. Barack Obama has rejected “tinkering and half-way measures.” He declared in January that he plans “in the next few months” to lay out a health care plan that will cover everyone “by the end of the next president’s term”—meaning his first term. And Senator Hillary Clinton, who as head of Bill Clinton’s health care task force, tried and failed to move an ambitious health care program, is somewhat more cautious, saying she won't lay out a plan until she “listens to what the people want.” As reported by Bloomberg News [4], on January 28, she said, “This time, we're going to build a consensus first.''

Congressman Dennis Kucinich doesn’t have the poll numbers to be treated as a leading candidate, but he will come with a clear and detailed plan for health care for all. He is a co-sponsor of H.R. 676, a “single-payer” plan covering all Americans in a public system. Kucinich can be expected to be a provocative challenger to the other candidates– especially those who feel the need to subsidize, and try to regulate, the private health insurance companies to get them to go beyond “cherry picking” —insuring only healthier Americans who bring in more profit—with more subsidies to private insurance companies.

[We at Campaign for America’s Future are promoting an important new “benchmark” health care plan written by Yale professor Jacob Hacker. The Health Care for America [5] plan would start with choice—allowing individuals and companies to continue with their current health care arrangements if they are happy with them. All employers would be required to provide their workers private insurance of good quality, or pay five percent of payroll to have their employees covered through a Medicare-style public plan. Hacker sees this approach [5] as essential to providing guaranteed coverage while controlling costs in the entire health care system.]

As we watch the debate on Saturday, how will we tell if the other candidates are as committed as Edwards and Kucinich to fundamentally solving the health care crisis? And how will we tell if Edwards or Kucinich has the plan and presentation that can get the job done?

What follows are some questions for every candidate, to help judge whether each is really serious about health care for all:

1. Will the candidate’s plan really cover everyone—with a decent guaranteed level of coverage—at an affordable cost?

Calling a plan “universal” is not enough. Massachusetts’ new ”universal” plan requires everyone to purchase health insurance, but the legislature has still not shown that it will devote the resources necessary (or exert the regulatory control over private insurance companies) to assure that everyone has a good health plans at an affordable premium.

2. Does the candidate offer a public plan, like Medicare, that has a predictable, guaranteed level of benefits that “cannot be taken away?”

Or, will the candidate rely on private insurance companies, using a combination of subsidies and heavy regulations to get private companies to do what their business model does not now allow them to: provide good health insurance at a decent price for all Americans. Does it include people with pre-existing conditions, the poor, older Americans not yet eligible for Medicare, and people with dangerous occupations?

Note: Edwards tries to do both, mandating regional buying pools that would heavily regulate private insurers and offering a public plan, like Medicare, that, if enough people chose it, might become the dominant health care plan for the nation.

3. Has the candidate thought through how his or her plan will be financed?

Edwards has bitten the bullet, calling for all employers to either provide health insurance to their employees or pay into a fund to finance his public plan. And he’s honest enough to know that additional progressive tax revenues will be necessary—he says forthrightly about $100 billion per year—which he would cover by rolling back the Bush tax cuts for the rich. It is true that after a successful health care reform, the whole country would end up paying less money for better and more comprehensive health care. But beware the candidate that tells you that there won’t be any up-front costs.

4. Will the candidate’s health plan control spiraling health care costs?

We pay much more per person for health care than any other developed nation—and all those other nations guarantee health care for all. A big part of the problem is the private health insurance system, which spends billions on advertising, administration and gaming the system to avoid paying claims. As a result, doctors and hospitals have to spend fortunes on paperwork to satisfy the different billing arrangements of hundreds of different reimbursement systems. By comparison, Medicare is a model of efficiency with a much better record of controlling costs than the private insurance industry, even while covering an expensive elderly population.

Jacob Hacker, and other advocates of Medicare-style plans, emphasizes a system that can share risk through broad pooling arrangements and control costs over much of the health care economy. If a candidate doesn’t go in that direction—if he or she depends entirely on the private health insurance system—we need to know how they ever expect to get a handle on rapidly growing health care costs.

5. Is the candidate’s health plan simple and clear enough that they can explain it—and get us to describe it to someone else?

Does anyone remember the 2004 John Kerry health care plan? It was a complicated system of subsidies and catastrophic insurance—best described with the boxes and arrows of complex flow charts—and completely incomprehensible to even a quite educated citizen. If a future president is going to overcome the rabid opposition of the special interests, he or she must offer a plan that is bold but simple, comprehensive yet understandable. And it had better resonate with important American values, including choice, fairness, compassion and efficiency.

We’re having a presidential debate about health care because the public demand for solutions is so strong. Leadership at the presidential level is crucial, but so is continued grassroots engagement.

The Campaign for America’s Future will be working with national organizations and grassroots groups to stimulate a public debate led by citizens demanding straight talk about health care. With grassroots pressure, we can force all the candidate—for the House, the Senate and the White House—to respond in detail to the five questions posed here, as well as to the concerns and values of the new progressive majority that is putting health care on the agenda for 2008 and beyond.