Health Care Reform Tops Domestic Agenda in 2008 Presidential Race

Barack Obama has called for a new public insurance program for Americans who do not qualify for Medicaid or SCHIP and do not have access to employer-paid insurance.

Representative Ron Paul, MD, has said he is rethinking the entire health care system. He believes the free market should determine health care costs to increase choice and make it more affordable. The costs would be covered by tax code changes allowing tax deductions.

Representative Duncan Hunter noted during a recent debate that allowing Americans to buy insurance across state lines would lower costs. Opposed to government-subsidized health care, he said a government plan would not motivate consumers to keep costs down.

Representative Dan Tancredo wants market-based solutions to health care problems. He has said that immigration enforcement would save money in the health care system and drive down costs. He supports association health plans that band small businesses together and for unemployed individuals, and he believes state governments should be the primary source of relief.

A Single-Payer Option?

One group that is dissatisfied with both Democrats’ and Republicans’ plans is Physicians for a National Health Program (PNHP). Don McCanne, MD, a PNHP senior health policy fellow, told ENT Today that a single-payer program is needed because our current model of a multitude of private plans and private programs is failing us. Cost increases are intolerable, more are going without insurance, and the fastest growing problem is under-insurance, leaving those with health care needs financially vulnerable. We are spending enough to provide comprehensive health care for everyone, but our fragmented system of health care financing has failed to direct our resources where we need them.

The PNHP claims that the Democratic proposals would leave millions without coverage and the Republican plans would fail to realistically address major concerns in health care financing. Instead, the group recommends a single, universal risk pool that is equitably funded through the tax system as the most efficient, effective, equitable, and least expensive model.

On the other hand, critics point out that single-payer coverage is unaffordable and would give the government too much power. Additionally, some of the universal-care opponents have said that many people aren’t insured because they choose not to be.

Whether any form of universal coverage can make its way through a divided Congress is another issue. As New York Times reporter Robert Pear said in an October 6, 2007 article, The debate now raging here over the children’s health insurance program offers a cautionary lesson to Democrats running for president. It shows how hard it will be to persuade many Republicans to sign on to their vision of universal coverage.