Not much has changed since the early nineties, when the Clintons promised to
make universal health coverage the top administration priority. Those plans
were roundly rejected by Congress and today, the crisis in the health care
system remains. Though some 100 million people are covered by health
insurance offered by HMOs, Americans voice dissatisfaction with the country's
health care delivery system saying that the trend towards HMOs has meant poorer
quality of care, though at a lesser cost.
The United States spends more on health care than any other nation, but the
large number of uninsured has meant the country rates poorly in terms of access
to quality health care. An estimated 44.3 million Americans - one in six -
have no health insurance. This includes eleven million children. But neither
party espouses universal health coverage, which was first unsuccessfully
floated by President Harry Truman back in 1945. Equally contentious is the
future of Medicare, founded in the 1960s to provide universal health care to
the elderly. Medicare is especially strained from catering to a rapidly
growing aging population: while 40 million Americans depend on Medicare today,
the number is likely to be 80 million by 2035.
Al Gore claims to have a greater commitment to the issue of making quality
healthcare available to all Americans. As Senator he has co-sponsored
legislation on health issues and as Vice President been outspoken about a
Patients Bill of Rights, access to quality healthcare for women and children
and mental health. He has pledged to make HMOs more accountable and improve
Medicare coverage. However, the Clinton administration, which promised to make the healthcare overhaul a major priority, failed to convince Congress of its
healthcare plan and effectively dropped the issue. This inaction has been
seized on by Bush and other critics, who point out that 8 million more
Americans have in fact lost insurance coverage under this administration.
However, Texas under Governor Bush has had one of the poorest public health
records in the country.
Bush has also made Medicare reform a priority in his campaign. "Medicare is an
enduring commitment of our country, but it must be modernized for our times,"
Should patients be allowed to sue HMOs?
Gore is a strong proponent of a patients bill of rights for all Americans,
which he says should allow patients to appeal HMO's medical decisions through
an independent process, and ensure access to emergency rooms, specialists and
clinical trials. " It's time to take the medical decisions away from the HMOs
and insurance companies, and give them back to the doctors, the nurses and the
health care professionals," he has said. His rhetoric has been criticized by
observers who feel that HMOs have cut costs by slashing unnecessary procedures
and waste. They point out that countries with universal health care would not
have covered most of those procedures and that most people claim they are happy
with their own HMO. "It is fruitless and unfair to blame all the ills of our
health care system on the HMOs, which are based on an attempt to maximize the
population's health within a pre-set budget," observed Jonathan Weiner,
professor at the Johns Hopkins School of Public Health, in July, 2000. "HMOs
are part of the cure for what ails us, not part of the disease."
Bush proposes allowing patients to appeal denials of care to an independent
review panel and, in some cases, to sue their HMO. In general, he believes in
giving states more flexibility in enforcing and regulating patients rights.
Should there be universal coverage for the uninsured?
Gore does not believe in guaranteeing universal healthcare access, except for
children. He estimates that all children can be insured by 2004 by expanding
the federal Children's Health Insurance Project and Medicaid. He also
proposes a 25 percent tax credit for people who buy health insurance because
they aren't covered at work. He is opposed to the medical savings accounts
proposed by Mr Bush, which he thinks will benefit wealthy Americans. His
critics say he does not go far enough on the issue, Boston Globe columnist
Ellen Goodman commented sarcastically: "Health care is reduced to a fight about
a patient's bill of rights that doesn't include the right to health care."
Bush does not believe in universal health care, but proposes making insurance
more affordable by giving low income families a tax credit of up to $2,000 to
buy their own insurance. He also says he will spend $3.6 billion to
increase the number of community health centers serving poor areas and allow
for tax free medical savings accounts for individuals and families to buy
insurance. He supports allowing small businesses, which account for 60 percent
of the uninsured, to buy lower cost insurance through trade associations.
What should be the future direction of Medicare?
Gore proposes putting Medicare in a "lock box," so that its surpluses, which
could be as high as $400 billion over the next decade, can only be used to
shore up the program. About one-third of Medicare beneficiaries have no
prescription-drug coverage at all and many of the rest pay high drug prices
despite their coverage. Gore has promised to provide free drug coverage for 13
million low-income recipients, while those with higher incomes would pay part
of the cost of their drugs. Critics point out that this will make the
government too big a force in the setting of drug prices.
Bush has proposed a comprehensive Medicare overhaul, named MediCARES, which he
says will modernize Medicare by giving seniors the choice to select benefits
they need most: annual physicals, hearing, eye, and dental care, and
prescription drug coverage. While this program is being phased in, he would
provide states with $48 billion to immediately help seniors with prescription
drug coverage, picking up all or most of the cost for seniors at 175 percent of
the federal poverty level. Long term care like nursing home stays not covered
by Medicare, will be fully deducted annually from taxes. Persons with elderly
dependents would be allowed to claim an exemption of about $2,750 annually.
Bush also proposes charging wealthy Medicare recipients more for coverage.
Should tobacco be regulated as an addictive drug?
Gore believes that Congress should give the Food and Drug Administration the
power to regulate nicotine as an addictive drug.
Bush does not take a position on whether the Food and Drug Administration
should regulate tobacco as an addictive drug. However, he proposes that
Congress and state legislatures should pass laws further restricting access to
tobacco by minors.
FRONTLINE's Dr. Solomon's Dilemma examines doctors' dual responsibilities to their patients and their bottom line in the age of HMOs.
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