Health Care Debate Weighs Heavily in Presidential Election

JIM LEHRER:

Health care got much attention last night in the debate, and again today in the campaign. Susan Dentzer of our health unit begins our look. The unit is a partnership with the Henry J. Kaiser Family Foundation.

PRESIDENT GEORGE W. BUSH:

Our health care system is the envy of the world because we believe in making sure that the decisions are made by doctors and patients, not by officials in the nation's capital.

SUSAN DENTZER:

President Bush and Sen. Kerry locked horns in last night's debate over the twin devils of U.S. health care: Skyrocketing costs and rising numbers of people without health insurance.

SEN. JOHN KERRY:

And it's gotten worse under President Bush over the course of the last years. Five million Americans have lost their health insurance in this country.

SUSAN DENTZER:

On costs, moderator and CBS anchor Bob Schieffer cited a recent report commissioned by the advocacy group Families USA; it showed workers' health insurance premiums had risen 36 percent over the past four years.

BOB SCHIEFFER:

Who bears responsibility for this? Is it the government? Is it the insurance companies? Is it the lawyers? Is it the doctors? Is it the administration?

PRESIDENT GEORGE W. BUSH:

Gosh, I sure hope it's not the administration. No, there is a… look, here. There's a systemic problem. Health care costs are on the rise because consumers are not involved in the decision-making process. Most health care costs are covered by third parties. And therefore, the actual user of health care is not the purchaser of health care. And there's no market forces involved with health care.

It's one of the reasons I'm a strong believer in what they call health savings accounts. These are accounts that allow somebody to buy a low-premium, high-deductible catastrophic plan and couple it with tax-free savings. Businesses can contribute.

Employees can contribute on a contractual basis. But this is the way to make sure people are actually involved with the decision-making process on health care. Secondly, I do believe the lawsuits… I don't believe… I know that the lawsuits are causing health care costs to rise in America. That's why I'm such a strong believer in medical liability reform.

SUSAN DENTZER:

Sen. Kerry took a sharply different tack, arguing that the Bush administration had in fact contributed to higher costs. He pointed to a provision in the Medicare reforms enacted last year that effectively bars the government from negotiating lower prescription drug prices with pharmaceutical companies.

SEN. JOHN KERRY:

Medicare is paid for by the American taxpayer. Medicare belongs to you. Medicare is for seniors, many of them on fixed income to, lift them out of poverty. But rather than help you, the taxpayer, have lower cost, rather than help seniors have less expensive drugs, the president made it illegal– illegal– for Medicare to actually go out and bargain for lower prices.

Now, we also have people sicker because they don't have health insurance, so whether it's diabetes or cancer, they come to hospitals later and it costs America more. We've got to have health care for all Americans.

SUSAN DENTZER:

The candidates then tangled over extending health coverage to millions of uninsured Americans. According to a census bureau survey, 45 million Americans lacked health coverage in 2003. Sen. Kerry outlined his plans, which private analysts have estimated would cover up to 27 million of the uninsured.

SEN. JOHN KERRY:

We take over Medicaid children from the states so that every child in America is covered. And in exchange, if the states want to– they're not forced to; they can choose to — they cover individuals up to 300 percent of poverty. It's their choice.

SUSAN DENTZER:

The senator also described how he would open up the federal employees' health benefits program, which covers members of Congress and nine million other federal workers and their dependents. By gaining access to this large buying pool, he said, small businesses, older workers, and those between jobs could obtain affordable private coverage such as Blue Cross and Blue Shield plans.

SEN. JOHN KERRY:

We give you broader competition to allow you to buy into the same health care plan that senators and congressmen give themselves.

And most importantly, we give small business a 50 percent tax credit so that after we lower the cost of health care, they also get, whether they're self-employed or a small business, a lower cost to be able to cover their employees.

SUSAN DENTZER:

President Bush has also proposed a less costly set of tax credits to help individuals buy health insurance, a plan that analysts say would extend coverage to several million people. But the president didn't raise that last night. Instead, he emphasized what he said was a philosophical difference with Sen. Kerry.

PRESIDENT GEORGE W. BUSH:

If you raise the Medicaid to 300 percent, it provides an incentive for small businesses not to provide private insurance to their employees. Why should they insure somebody when the government's going to insure it for them?

We have a fundamental difference of opinion. I think government-run health will lead to poor-quality health, will lead to rationing, will lead to less choice.

SUSAN DENTZER:

And even though the evening closed with a cordial handshake, a wide gulf clearly separates the two candidates on almost every aspect of the health care debate.