WHAT ARE THE ISSUES?

What are the key health care issues in this election?
There are several key issues related to health care in the 2008 Presidential election. The two parties sharply differ in their approaches to some of these issues, while differences are less clear in other areas. The key issues and how the candidates are addressing them include:

• Universal health care: Is Everyone Included? – Candidates from the two parties clearly differ on how to achieve the goal of covering all Americans.  All of the Democratic candidates support the goal of expanding health insurance to everyone. The Republicans propose that health insurance needs to be more affordable so that more people can afford it, but stop short of saying that universal coverage is an explicit goal.
• Mandates: Is Insurance Required or Not? – Requiring people to have insurance coverage, or requiring employers to provide or subsidize it, is a key point of difference across the plans of the candidates. All of the Democratic candidates support some type of Mandate for insurance coverage, with Clinton requiring coverage soon, and Edwards proposing that everyone should be required to be covered once reforms are made.  Obama would require coverage only for children, although he has left open the possibility of requiring adults to purchase insurance if it proves to be the only way to meet the goal of universal coverage.  All of the Democratic candidates include provisions by which employers would be required to provide coverage or contribute to the cost of covering their workers. None of the Republican candidates support Mandates for individuals or employers, and insist that individuals should be free to make their own decisions about purchasing health insurance. The Republicans stress that insurance coverage should be de-coupled from employment status, and that tax codes should be changed so that individuals would have the same tax advantages of coverage as employers currently have, regardless of whether their insurance is employer-based or individually purchased. 
• Federal Programs: How Big and How Much? – One key issue concerns whether the federal government should invest more money to expand federal programs – Medicare, Medicaid, SCHIP and other programs – to provide greater access to health care for the elderly, poorer families and children. The Democratic candidates all suggest that some investment in federal programs is needed, although they do not specify the amount or type of funding they envision. The Republican candidates do not suggest that increased federal spending will be necessary, but rather suggest that slowing down the rate of inflation in health care costs and making federal and state programs more efficient are strategies that would expand access to health care.
• Tax breaks: Help for Families and Individuals?  – Many of the candidates from both parties propose tax deductions or credits to assist individuals and families in purchasing health insurance and/or covering medical expenses. The Democratic candidates have focused on subsidies or tax incentives to help people cover the cost of insurance premiums, while Republicans have taken a broader view, focusing on tax incentives for premium assistance as well as to help with other medical expenses such as deductibles, co-pays and other out-of-pocket expenses. Candidates have provided varying levels of detail about the specific amounts or limitations on the tax creditsor deductions they envision in their plan. 
• Insurance Markets: Private or Public? – Only one candidate, Kucinich, has proposed replacing the current system, which relies heavily on private insurance markets, with a public single payer system. All other candidates support private insurance markets supplemented with public insurance programs to provide access to those who cannot afford private insurance.  But the Democrats propose regulations designed to limit insurers from penalizing individuals with poor health histories or significant health risks, while the Republicans have not emphasized regulations designed to protect consumers.  Democrats also propose new insurance connectors that allow individuals to pool together to get affordable coverage. The Republican candidates focus more on encouraging people to purchase coverage through markets, shopping across state lines and being allowed to retain their coverage even if they change jobs or locations.   
• Involving the Consumer: Greater Choice and Responsibility? – Several of the Presidential candidates, especially Republicans, propose to allow Americans more choices in their health care by raising the limits on what they can invest in Health Savings Accounts (HSAs) and allowing them to shop for health insurance across state lines. Some candidates propose greater use of incentives and rewards for health consumers who take greater responsibility for their health through changes in diet, exercise, and other health-related behaviors.
• Efficiency and Effectiveness: How to Achieve It? – Candidates in both parties believe that significant improvements can be made in the efficiency and cost of our health care system by investing in information technology, prevention programs, Chronic disease management, and other programs to improve the health care delivery system and the administrative processes systems in health care. The candidates of both parties have provided few details on exactly how they would implement these changes or fund the investments that would be required.
• Funding Health Care: Limit Tax Breaks for the Wealthy to Finance Health Care? – Several of the Democratic candidates propose to limit current tax breaks for those making over a certain amount ($200,000 to $250,000) to provide additional money for expansion of federal health care programs. The Republican candidates do not think that the elimination of current tax breaks or new tax increases are necessary to provide greater access to health care for Americans.
• The Pharmaceutical Industry: Quality versus Cost?- Many candidates in both parties have proposed changes in the drug industry, ranging from allowing Americans to purchase drugs from other developed countries to requiring the use of generic drugs in federal programs such as Medicare and Medicaid. Some candidates have also suggested letting the federal government negotiate for lower drug prices for Medicare and Medicaid beneficiaries.
• Malpractice Reform: When is it Too Much? – Several of the candidates from both major parties have proposed changing the medical liability legal system to limit frivolous malpractice lawsuits to reduce the overall costs of health care. The candidates have not provided details on their plans to limit unnecessary litigation or how they would implement them.

The Health Care Solutions Group is a non-partisan health institute focused on supporting improvement in the health care system. This site will provide health care reform plan information proposed by the presidential candidates and will include analysis, related news, commentary from health policy experts and additional voter resources.