Health care reform in the United States presidential election, 2008
Encyclopedia
This article discusses the debate that occurred over the issue of health care reform in the United States presidential election, 2008.
John McCain
's proposals focused on open-market competition rather than government funding or control. At the heart of his plan were tax credits - $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. To help people who are denied coverage by insurance companies due to pre-existing conditions, McCain proposed working with states to create what he calls a "Guaranteed Access Plan".
Barack Obama
called for universal health care
. His health care plan proposed creating a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance.
The Philadelphia Inquirer
reported that the two plans had different philosophical focuses. They described the purpose of the McCain plan as to "make insurance more affordable," while the purpose of the Obama plan was for "more people to have health insurance." The Des Moines Register characterized the plans similarly. The Commonwealth Fund
concluded that, compared with McCain's approach, Obama's plan could provide more people with affordable health insurance that covers essential services, achieve greater equity in access to care, realize efficiencies and cost savings in the provision of coverage and delivery of care, and redirect incentives to improve quality.
Critics of McCain's plan argued that it would not significantly reduce the number of uninsured Americans, would increase costs, reduce consumer protections and lead to less generous benefit packages. Critics of Obama's plan argued that it would increase federal regulation of private health insurance without addressing the underlying incentives behind rising health care spending. Mark Pauly suggested that a combination of the two approaches would work better than either one alone.
Various analyses of the two candidates' plans came to widely varying predictions of their costs and effects. A comparison by The Tax Policy Center, a project of the Brookings Institution
and the Urban Institute
estimated that Obama's proposals could cost $1.6 trillion over 10 years, while the tax-related provisions of McCain's proposals could cost $1.3 trillion over the same period. A comparison by The Lewin Group, a subsidiary of UnitedHealth Group
, published in October 2008, found that the McCain plan would reduce the number of uninsured by 21.1 million and cost $2.05 trillion over 10 years, while the Obama plan would reduce the uninsured by 26.6 million and increase federal spending by $1.17 trillion over the same period. Estimates prepared by HSI Networks found that the McCain plan would reduce the uninsured by 27.5 million at an annual cost of $287 billion, and the Obama plan would reduce the uninsured by 25.5 million at an annual cost of $452 billion.
A poll released in early November, 2008, found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it as fourth, tied with the war in Iraq. Affordability was the primary health care priority among both sets of voters. Obama voters were more likely than McCain voters to believe government can do much about health care costs.
, universal health care
, or health coverage mandates. Instead, he favored tax credits of up to $5,000 for families to get health insurance. His plan focused on enhancing competition in the health care industry as a way to lower costs. To that end, McCain's plan would have allowed citizens to purchase health insurance nationwide instead of limiting them to in-state companies, and to buy insurance through any organization or association they choose as well as through their employers or buying direct from an insurance company. In an October 2007 statement, McCain said: "In health care, we believe in enhancing the freedom of individuals to receive necessary and desired care. We do not believe in coercion and the use of state power to mandate care, coverage or costs."
On April 29, 2008, McCain detailed his health care plan in the context of his campaign for President. His plan focused on open-market competition rather than government funding or control. At the heart of his plan are tax credits: $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. He says the money could be used to purchase insurance and force insurance companies to be competitive with their costs in order to attract consumers. McCain would pay for the tax credits by eliminating the tax break currently offered to employers for providing health insurance to employees. A critique of McCain's health care plan published in Health Affairs projected that the loss of tax benefits would cause businesses to drop 20 million people from employer-sponsored coverage, while the individual insurance market would grow to 21 million people. To help people who are denied coverage by insurance companies due to pre-existing conditions, McCain proposed working with states to create what he called a "Guaranteed Access Plan". He did not provide details, but pointed to states such as Florida and North Carolina where such systems are in place. His health care plan had an estimated annual cost of $7 billion, according to McCain's health-policy experts. His campaign acknowledged that the health plan he had outlined would have the effect of increasing tax payments for some workers, primarily those with high incomes and expensive health plans.
, a health care advocacy group. Obama said, "The time has come for universal health care
in America [...] I am absolutely determined that by the end of the first term of the next president, we should have universal health care in this country." Obama went on to say that he believed that it was wrong that forty-seven million Americans are uninsured, noting that taxpayers already pay over $15 billion annually to care for the uninsured. Obama cites cost as the reason so many Americans are without health insurance. Obama's health care plan included implementing guaranteed eligibility for affordable health care for all Americans, paid for by insurance reform, reducing costs, removing patent
protection for pharmaceuticals, and requiring employers to either furnish meaningful coverage or contribute to a new public plan. He proposed providing for mandatory health care insurance for children.
Obama promised to “bring down premiums by $2,500 for the typical family.” His advisers said that the $2,500 premium reduction included, in addition to direct premium savings, the average family's share of the reduction in employer-paid health insurance premiums and the reduction in the cost of government health programs such as Medicare
and Medicaid
. Ken Thorpe of Emory University
issued estimates that support Senator Obama's proposal. Other health analysts, such as Joe Antos of the American Enterprise Institute
, Karen Davis of the Commonwealth Fund
and Jonathan B. Oberlander of the University of North Carolina at Chapel Hill
expressed skepticism that the Obama plan would achieve the stated level of cost savings.
For those not insured through employment, Obama proposed a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like, government-run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. The Obama campaign estimated the cost of the program at $60 billion annually. According to the Associated Press
, the program would need to attract young, healthy people into buying coverage to work, but at the state level guaranteed issue requirements have "often had the opposite effect." The plan requires that parents cover their children, but does not require adults to buy insurance. A critique of Obama's health care plan published in Health Affairs concluded that it does not address the core economic causes of rising health care spending, but would "greatly increase" federal regulation of health coverage.
, the 2008 Republican presidential front-runner
, unveiled his health care plan in Rochester, New Hampshire
, attacked the health care plans of Democratic presidential candidates as socialized medicine that was European and socialist
, and—citing incorrect numbers—said his chances of surviving prostate cancer
had been 82% in the United States, but would have only been 44% in England
under socialized medicine (the actual five-year relative survival rate
s for localized prostate cancer were comparable in the two countries: 100% in the U.S. and 99% in England). Giuliani repeated his claims in campaign speeches for three months before making them in a radio advertisement.
After the radio ad began running, FactCheck.org
, PolitiFact.com and The Washington Post
consulted leading prostate cancer experts and cancer statisticians who found Giuliani's cancer survival statistics to be false and misleading fabricated nonsense numbers obtained from an opinion article by Giuliani health care advisor David Gratzer
, a Canadian psychiatrist
and senior fellow at the Manhattan Institute
, a conservative think tank
.
Giuliani ignored a plea by the UK
Health Secretary
to stop repeating false statistics smearing the NHS
to attack Democratic health care plans as socialized medicine. Florida
's largest circulation newspaper, the St. Petersburg Times
, said that Giuliani's tactic of "injecting a little fear" exploited cancer, which was "apparently not beneath a survivor with presidential aspirations." A month later, The New York Times
belatedly declared Giuliani's statistics false, and Giuliani's false statistics were significant enough to make worst of 2007 lists in The Times
and The Washington Post.
Overview
Both of the major party presidential candidates offered positions on health care.John McCain
John McCain
John Sidney McCain III is the senior United States Senator from Arizona. He was the Republican nominee for president in the 2008 United States election....
's proposals focused on open-market competition rather than government funding or control. At the heart of his plan were tax credits - $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. To help people who are denied coverage by insurance companies due to pre-existing conditions, McCain proposed working with states to create what he calls a "Guaranteed Access Plan".
Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
called for universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
. His health care plan proposed creating a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance.
The Philadelphia Inquirer
The Philadelphia Inquirer
The Philadelphia Inquirer is a morning daily newspaper that serves the Philadelphia, Pennsylvania, metropolitan area of the United States. The newspaper was founded by John R. Walker and John Norvell in June 1829 as The Pennsylvania Inquirer and is the third-oldest surviving daily newspaper in the...
reported that the two plans had different philosophical focuses. They described the purpose of the McCain plan as to "make insurance more affordable," while the purpose of the Obama plan was for "more people to have health insurance." The Des Moines Register characterized the plans similarly. The Commonwealth Fund
Commonwealth Fund
The Commonwealth Fund is a private U.S. foundation whose stated purpose is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, especially for society's most vulnerable.-History:...
concluded that, compared with McCain's approach, Obama's plan could provide more people with affordable health insurance that covers essential services, achieve greater equity in access to care, realize efficiencies and cost savings in the provision of coverage and delivery of care, and redirect incentives to improve quality.
Critics of McCain's plan argued that it would not significantly reduce the number of uninsured Americans, would increase costs, reduce consumer protections and lead to less generous benefit packages. Critics of Obama's plan argued that it would increase federal regulation of private health insurance without addressing the underlying incentives behind rising health care spending. Mark Pauly suggested that a combination of the two approaches would work better than either one alone.
Various analyses of the two candidates' plans came to widely varying predictions of their costs and effects. A comparison by The Tax Policy Center, a project of the Brookings Institution
Brookings Institution
The Brookings Institution is a nonprofit public policy organization based in Washington, D.C., in the United States. One of Washington's oldest think tanks, Brookings conducts research and education in the social sciences, primarily in economics, metropolitan policy, governance, foreign policy, and...
and the Urban Institute
Urban Institute
The Urban Institute is a Washington, D.C.-based think tank that carries out nonpartisan economic and social policy research, collects data, evaluates social programs, educates the public on key domestic issues, and provides advice and technical assistance to developing governments abroad...
estimated that Obama's proposals could cost $1.6 trillion over 10 years, while the tax-related provisions of McCain's proposals could cost $1.3 trillion over the same period. A comparison by The Lewin Group, a subsidiary of UnitedHealth Group
UnitedHealth Group
UnitedHealth Group Incorporated is a diversified health and "well-being" company. Headquartered in Minnetonka, Minnesota, UnitedHealth Group offers a spectrum of products and services through two operating businesses: United Healthcare and Optum. Through its family of subsidiaries and divisions,...
, published in October 2008, found that the McCain plan would reduce the number of uninsured by 21.1 million and cost $2.05 trillion over 10 years, while the Obama plan would reduce the uninsured by 26.6 million and increase federal spending by $1.17 trillion over the same period. Estimates prepared by HSI Networks found that the McCain plan would reduce the uninsured by 27.5 million at an annual cost of $287 billion, and the Obama plan would reduce the uninsured by 25.5 million at an annual cost of $452 billion.
A poll released in early November, 2008, found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it as fourth, tied with the war in Iraq. Affordability was the primary health care priority among both sets of voters. Obama voters were more likely than McCain voters to believe government can do much about health care costs.
John McCain
McCain was against publicly funded health carePublicly-funded health care
Publicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...
, universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
, or health coverage mandates. Instead, he favored tax credits of up to $5,000 for families to get health insurance. His plan focused on enhancing competition in the health care industry as a way to lower costs. To that end, McCain's plan would have allowed citizens to purchase health insurance nationwide instead of limiting them to in-state companies, and to buy insurance through any organization or association they choose as well as through their employers or buying direct from an insurance company. In an October 2007 statement, McCain said: "In health care, we believe in enhancing the freedom of individuals to receive necessary and desired care. We do not believe in coercion and the use of state power to mandate care, coverage or costs."
On April 29, 2008, McCain detailed his health care plan in the context of his campaign for President. His plan focused on open-market competition rather than government funding or control. At the heart of his plan are tax credits: $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. He says the money could be used to purchase insurance and force insurance companies to be competitive with their costs in order to attract consumers. McCain would pay for the tax credits by eliminating the tax break currently offered to employers for providing health insurance to employees. A critique of McCain's health care plan published in Health Affairs projected that the loss of tax benefits would cause businesses to drop 20 million people from employer-sponsored coverage, while the individual insurance market would grow to 21 million people. To help people who are denied coverage by insurance companies due to pre-existing conditions, McCain proposed working with states to create what he called a "Guaranteed Access Plan". He did not provide details, but pointed to states such as Florida and North Carolina where such systems are in place. His health care plan had an estimated annual cost of $7 billion, according to McCain's health-policy experts. His campaign acknowledged that the health plan he had outlined would have the effect of increasing tax payments for some workers, primarily those with high incomes and expensive health plans.
Barack Obama
On January 24, 2007, Obama spoke about his position on health care at Families USAFamilies USA
Families USA is an American non-profit consumer health-care advocacy organization. It was co-founded by attorney Ronald Pollack, its current executive director, and Philippe Villers, the organization's current President....
, a health care advocacy group. Obama said, "The time has come for universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
in America [...] I am absolutely determined that by the end of the first term of the next president, we should have universal health care in this country." Obama went on to say that he believed that it was wrong that forty-seven million Americans are uninsured, noting that taxpayers already pay over $15 billion annually to care for the uninsured. Obama cites cost as the reason so many Americans are without health insurance. Obama's health care plan included implementing guaranteed eligibility for affordable health care for all Americans, paid for by insurance reform, reducing costs, removing patent
Patent
A patent is a form of intellectual property. It consists of a set of exclusive rights granted by a sovereign state to an inventor or their assignee for a limited period of time in exchange for the public disclosure of an invention....
protection for pharmaceuticals, and requiring employers to either furnish meaningful coverage or contribute to a new public plan. He proposed providing for mandatory health care insurance for children.
Obama promised to “bring down premiums by $2,500 for the typical family.” His advisers said that the $2,500 premium reduction included, in addition to direct premium savings, the average family's share of the reduction in employer-paid health insurance premiums and the reduction in the cost of government health programs such as Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
and Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
. Ken Thorpe of Emory University
Emory University
Emory University is a private research university in metropolitan Atlanta, located in the Druid Hills section of unincorporated DeKalb County, Georgia, United States. The university was founded as Emory College in 1836 in Oxford, Georgia by a small group of Methodists and was named in honor of...
issued estimates that support Senator Obama's proposal. Other health analysts, such as Joe Antos of the American Enterprise Institute
American Enterprise Institute
The American Enterprise Institute for Public Policy Research is a conservative think tank founded in 1943. Its stated mission is "to defend the principles and improve the institutions of American freedom and democratic capitalism—limited government, private enterprise, individual liberty and...
, Karen Davis of the Commonwealth Fund
Commonwealth Fund
The Commonwealth Fund is a private U.S. foundation whose stated purpose is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, especially for society's most vulnerable.-History:...
and Jonathan B. Oberlander of the University of North Carolina at Chapel Hill
University of North Carolina at Chapel Hill
The University of North Carolina at Chapel Hill is a public research university located in Chapel Hill, North Carolina, United States...
expressed skepticism that the Obama plan would achieve the stated level of cost savings.
For those not insured through employment, Obama proposed a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like, government-run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. The Obama campaign estimated the cost of the program at $60 billion annually. According to the Associated Press
Associated Press
The Associated Press is an American news agency. The AP is a cooperative owned by its contributing newspapers, radio and television stations in the United States, which both contribute stories to the AP and use material written by its staff journalists...
, the program would need to attract young, healthy people into buying coverage to work, but at the state level guaranteed issue requirements have "often had the opposite effect." The plan requires that parents cover their children, but does not require adults to buy insurance. A critique of Obama's health care plan published in Health Affairs concluded that it does not address the core economic causes of rising health care spending, but would "greatly increase" federal regulation of health coverage.
Rudy Giuliani's use of the term "Socialized Medicine"
On July 31, 2007, one day after naming his health care advisors, Rudy GiulianiRudy Giuliani
Rudolph William Louis "Rudy" Giuliani KBE is an American lawyer, businessman, and politician from New York. He served as Mayor of New York City from 1994 to 2001....
, the 2008 Republican presidential front-runner
Front-runner
Front-runner is a term to describe the leader in a race, whether political or athletic. The term arose from the close symbolism between political campaigns and athletic running events. The term is used in the U.S...
, unveiled his health care plan in Rochester, New Hampshire
Rochester, New Hampshire
Rochester is a city in Strafford County, New Hampshire, United States. As of the 2010 census, the city population was 29,752. The city includes the villages of East Rochester and Gonic. Rochester is home to Skyhaven Airport and the annual Rochester Fair....
, attacked the health care plans of Democratic presidential candidates as socialized medicine that was European and socialist
Socialism
Socialism is an economic system characterized by social ownership of the means of production and cooperative management of the economy; or a political philosophy advocating such a system. "Social ownership" may refer to any one of, or a combination of, the following: cooperative enterprises,...
, and—citing incorrect numbers—said his chances of surviving prostate cancer
Prostate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
had been 82% in the United States, but would have only been 44% in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
under socialized medicine (the actual five-year relative survival rate
Five-year survival rate
The five-year survival rate is a term used in medicine for estimating the prognosis of a particular disease.Analysis performed against the Surveillance, Epidemiology, and End Results database facilitates calculation of Five-year survival rates....
s for localized prostate cancer were comparable in the two countries: 100% in the U.S. and 99% in England). Giuliani repeated his claims in campaign speeches for three months before making them in a radio advertisement.
After the radio ad began running, FactCheck.org
FactCheck
FactCheck.org is a non-partisan, nonprofit website that describes itself as a consumer advocate' for voters that aims to reduce the level of deception and confusion in U.S. politics." It is a project of the Annenberg Public Policy Center of the Annenberg School for Communication at the University...
, PolitiFact.com and The Washington Post
The Washington Post
The Washington Post is Washington, D.C.'s largest newspaper and its oldest still-existing paper, founded in 1877. Located in the capital of the United States, The Post has a particular emphasis on national politics. D.C., Maryland, and Virginia editions are printed for daily circulation...
consulted leading prostate cancer experts and cancer statisticians who found Giuliani's cancer survival statistics to be false and misleading fabricated nonsense numbers obtained from an opinion article by Giuliani health care advisor David Gratzer
David Gratzer
David George Gratzer is a physician, columnist, author, Congressional expert witness, and a senior fellow at both the Manhattan Institute and the Montreal Economic Institute...
, a Canadian psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
and senior fellow at the Manhattan Institute
Manhattan Institute
The Manhattan Institute for Policy Research is a conservative, market-oriented think tank established in New York City in 1978 by Antony Fisher and William J...
, a conservative think tank
Think tank
A think tank is an organization that conducts research and engages in advocacy in areas such as social policy, political strategy, economics, military, and technology issues. Most think tanks are non-profit organizations, which some countries such as the United States and Canada provide with tax...
.
Giuliani ignored a plea by the UK
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
Health Secretary
Secretary of State for Health
Secretary of State for Health is a UK cabinet position responsible for the Department of Health.The first Boards of Health were created by Orders in Council dated 21 June, 14 November, and 21 November 1831. In 1848 a General Board of Health was created with the First Commissioner of Woods and...
to stop repeating false statistics smearing the NHS
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
to attack Democratic health care plans as socialized medicine. Florida
Florida
Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...
's largest circulation newspaper, the St. Petersburg Times
St. Petersburg Times
The St. Petersburg Times is a United States newspaper. It is one of two major publications serving the Tampa Bay Area, the other being The Tampa Tribune, which the Times tops in both circulation and readership. Based in St...
, said that Giuliani's tactic of "injecting a little fear" exploited cancer, which was "apparently not beneath a survivor with presidential aspirations." A month later, The New York Times
The New York Times
The New York Times is an American daily newspaper founded and continuously published in New York City since 1851. The New York Times has won 106 Pulitzer Prizes, the most of any news organization...
belatedly declared Giuliani's statistics false, and Giuliani's false statistics were significant enough to make worst of 2007 lists in The Times
The Times
The Times is a British daily national newspaper, first published in London in 1785 under the title The Daily Universal Register . The Times and its sister paper The Sunday Times are published by Times Newspapers Limited, a subsidiary since 1981 of News International...
and The Washington Post.
See also
- Health care in the United StatesHealth care in the United StatesHealth care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector...
- Health care reform in the United StatesHealth care reform in the United StatesHealth care reform in the United States has a long history, of which the most recent results were two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act , signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 , which amended the PPACA and...
- Health insurance in the United StatesHealth insurance in the United StatesThe term health insurance is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government...
- Uninsured in the United StatesUninsured in the United StatesThe number of persons without health insurance coverage in the United States is one of the primary concerns raised by advocates of health care reform. According to the United States Census Bureau, in 2009 there were 50.7 million people in the US who were without health insurance...
- United States presidential election, 2008United States presidential election, 2008The United States presidential election of 2008 was the 56th quadrennial presidential election. It was held on November 4, 2008. Democrat Barack Obama, then the junior United States Senator from Illinois, defeated Republican John McCain, the senior U.S. Senator from Arizona. Obama received 365...