Presidential Candidates Debate Health Care Proposals In Preparation For Iowa Caucuses

Presidential candidates have debated their health care proposalsin preparation for the Iowa caucuses on Thursday, the ChicagoTribune reports (Pearson/Chase, Chicago Tribune,12/31/07).

Democratic presidential candidate Sen. Barack Obama(Ill.) on Monday at a Perry, Iowa, community center defended hisproposal against claims made by rival former Sen. John Edwards(D-N.C.). In response to claims by Edwards that Obama should notnegotiate with health insurers and pharmaceutical companies, Obamasaid, "I'd have a big table, and everybody would be invited."He added, "Yes, I'd invite the drug companies and the insurancecompanies and the HMOs. They'd have seats. They just wouldn't be ableto buy every chair." He also said that C-SPAN would televise thenegotiations to increase the influence of the public and reduce theinfluence of special interests. According to Obama, "That's howyou get things done, not by shouting" (Eichel, PhiladelphiaInquirer, 1/1).

Edwards on Sunday in northern Iowaaddressed questions by the Obama campaign about comments he made lastyear about the role of special interests in health care reform. Incomments made in a story on the Web site www.mydd.com,Edwards said that he would "try to bring everybody to the table"on health care reform, although during his campaign he has said thathe would not negotiate with special interests. Edwards on Sunday saidthat he meant health insurers would continue to play a role in thehealth care system under his proposal. He said, "What I wastalking about then was what we needed to do to actually bring aboutuniversal health care and the difference between single-payer,government-run health care and what I'm proposing." Edwardsadded, "I don't eliminate insurance companies from the healthcare fix. ... People have choice in my health care proposal between aprivate plan and a government-run plan" (Chicago Tribune,12/31/07). On Friday during a campaign event in Dubuque, Iowa,Edwards "tried to distinguish himself from his Democraticrivals" on health care and other issues, the New York Timesreports (Bosman/Luo, New York Times, 12/29/07).

DrewAltman, president and CEO of the KaiserFamily Foundation, said that health care is "not a wedgeissue" and is not "emerging as a pivotal distinguishingissue" in the presidential primaries. However, Altman said,"We're in the early stages of health care re-emerging as a topnational issue. It's the next great debate" (Feder Ostrov, SanJose Mercury News, 12/25/07).

Additional Developments

• Sen. Hillary Rodham Clinton (D-N.Y.): Clinton on Wednesday\tplans to launch a television ad in Iowa that will ask voters to\t"take the first step" in efforts to address health care\tand other issues through their support for her in the caucuses. In\tthe ad, Clinton says, "As we start this new year, America is at\ta crossroads," with "47 million people without health\tcare." She adds, "All the men and women across the state\twho have whispered their health care problems to me -- bills they\tcan't pay, parents they can't afford to care for, insurance\tcompanies who refuse to help" have "welcomed me into your\thearts and your homes" (Glover, AP/Kansas\tCity Star, 1/2). In related news, Clinton on Dec. 23\tduring an appearance at the Iowa\tVeterans Home reiterated her promise to provide adequate health\tcare and other benefits to U.S. troops who return from the wars in\tIraq and Afghanistan. Clinton said that "no one has given more\tto our country than our country's veterans." She added, "I\tbelieve that when you sign up to serve our country, our country must\tserve you with the health care, the compensation and the support\tthat you so richly deserve" (Lorentzen, AP/Lexington\tHerald-Leader, 12/25/07).

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• Former New York City Mayor Rudy Giuliani (R): The New\tYork Times on Friday examined consultant work\tprovided by Giuliani to Purdue\tPharma in efforts to defend against federal allegations that the\tcompany misled the public about the potential addictiveness of the\tpain medication OxyContin. According to the Post,\tGiuliani participated in two meetings between Purdue Pharma\tofficials and the Drug Enforcement\tAdministration acting administrator, and, as a "celebrity,\tMr. Giuliani helped the company win several public relations\tbattles." In addition, Giuliani "became the public face"\tof Rx\tAction Alliance -- a group of pharmaceutical companies,\tphysicians and law enforcement authorities that seeks to fight\tprescription drug abuse, the Post reports\t(Meier/Lipton, New York Times, 12/28/07).

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• Obama: Obama on Friday launched a television advertisement in\tIowa that promotes his health care proposal over those announced by\tEdwards and Clinton. According to the Washington Post\t"The Trail"\tblog, the ad "misrepresents some newspaper assessments" of\tthe Obama proposal. The ad cites a St. Paul Pioneer Press\tarticle that said the Obama proposal "guarantees coverage for\tall Americans" but omits the end of the statement: "but\tdoes not require all to have it." The ad also cites an Iowa\tCity Press-Citizen article that praised the Obama proposal as\t"the best." However, the ad fails to indicate that the\tarticle involved a comparison of the proposal to a single-payer\thealth care system, not the plans announced by Clinton and Edwards.\tIn addition, the ad cites a Post article that states\tthe Obama proposal would save "$2,500 for the typical family,"\talthough the article attributed the figure to Obama aides without\toutside verification (Kurtz, "The Trail," Washington\tPost, 12/29/07). On NBC's "Meet the Press" on\tSunday, Obama "sidestepped whether his spot was a stretch"\ton whether his proposal would expand health insurance to all U.S.\tresidents, the Chicago\tSun-Times reports (Sweet, Chicago Sun-Times,\t12/31/07). In related news, Obama last week in Mason City, Iowa,\tpromised to not "play politics" on the issue of health\tcare for veterans. Obama said that he would seek to improve health\tcare for veterans and provide them with mental health screenings.\tAccording to Obama, "We have to fund all the services that have\tbeen promised to our veterans. We can't play politics with it"\t(AP/Arizona Daily Star,\t12/27/07).

Polls

Almost two-thirds of U.S. residents support a health care system"in which everyone is covered under a program like Medicare thatis run by the government and financed by taxpayers," accordingto a recent poll commissioned by AP/Yahoo! News. The poll, conductedover the Internet by KnowledgeNetworks, included telephone contacts with more than 1,800residents followed by online interviews. The poll also found that 64%of respondents cited concerns about the possibility of unexpectedmajor medical expenses (Kuhnhenn/Tompson, AssociatedPress, 12/28/07).

In related news, a recent BostonGlobe poll of likely voters in the Jan. 8 New Hampshireprimary found that 80% of Democratic respondents believe the federalgovernment should provide health insurance, compared with 30% ofRepublican respondents (Mooney, BostonGlobe, 12/26/07).

Opinion Pieces

Summaries of several recent editorials and opinion pieces relatedto health care in the presidential election appear below.

• Edwards, Boston Globe:\t"I am running for president to make sure that every child can\thave the same opportunities in life that I've had," and one\t"thing we need to do is create universal health care in\tAmerica," Edwards writes in a Globe opinion piece.\t"Not only are health care costs putting a huge strain on\tAmerican families and our competitiveness in the global economy, but\tour broken health care system that leaves 47 million Americans\twithout health care is also a moral disgrace," Edwards writes,\tadding, "I have proposed a health care plan that calls for\tshared responsibility among people, businesses, and the government,\tand will ensure that every man, woman, and child in America has\taccess to affordable, quality coverage" (Edwards, Boston\tGlobe, 12/28/07).

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• Los Angeles Times:\t"A sick America can't be a working America," and "changes\tto the health care system will be necessary to keep us in good\thealth," according to a Times editorial. The\teditorial states, "The Congressional\tBudget Office reported this month that rising medical costs,\twhich far outstrip inflation, pose the No. 1 threat to the country's\tability to balance federal budgets in the future." The\teditorial, which recommends a health care "plan that would\tachieve universal coverage through an individual mandate, requiring\tevery American to buy health insurance," states that most\tDemocratic presidential candidates "line up with our approach"\tand "seek to expand coverage and to create new purchasing pools\tto expand choice." However, the "GOP candidates prefer\tmarket-based solutions such as health savings accounts, tax refunds\tfor those who buy individual coverage ... and boosting citizens'\tability to spend wisely by requiring greater transparency on prices\tand outcomes from health care providers," all of which are\t"appealing ideas in theory" but "will not improve\tcare for all Americans," the editorial states (Los Angeles\tTimes, 12/28/07).

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• Paul Krugman, New York Times: The Democratic presidential\tcandidates are "offering strongly progressive policies on\ttaxes, health care and the environment," Times\tcolumnist Krugman writes. However, Republican presidential\tcandidates support "Bushonomics," although the "public\tis very unhappy with the state of the economy ... with a declining\tfraction of Americans receiving health insurance from their\temployers," he writes (Krugman, New York Times,\t12/31/07).

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• David Leonhardt, New\tYork Times: The only difference between Clinton and Obama\t"on any domestic policy that has received much attention"\tis the issue of a health insurance mandate, which Clinton has\tincluded in her health care proposal but Obama has not included in\this plan, Times columnist Leonhardt writes. "Outside\tof health care, the campaigns -- and we in the media -- have focused\ton more exalted concepts, like experience, change and judgment,"\tbut "there really are some other important differences between\tthe candidate," such as "policies as a whole" and\t"competing economic philosophies," Leonhardt writes,\tadding, "The fight over health insurance is just one part of\ttheir disagreement." According to Leonhardt, "Mrs. Clinton\tand Mr. Edwards favor a mandate because -- as they point out --\tthere will never be universal health care without one," and\t"skepticism about government tinkering" raised by Obama\t"helps explains his stance on a health care mandate." He\tadds, "Obama is right that some people would ignore a health\tcare mandate. But some wouldn't. As any good behavioral economist\tknows, there really are people who can afford health insurance and\twho would like to have it -- but who haven't gotten around to\tgetting it. A mandate would nudge some of them to do so, and the\twhole health care system would be better off as a result"\t(Leonhardt, New York Times, 1/2). \t

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• Jacob Sunshine, Seattle\tPost-Intelligencer: "There are many reasons\tphysicians and people in health care are lukewarm about John\tEdwards' presidential candidacy," and none "is bigger\tprobably than his professional past," Sunshine, a student at\tthe University of Washington\tSchool of Medicine, writes in a Post-Intelligencer\topinion piece. Sunshine writes, "In the '80s and '90s, he\tamassed a fortune as a trial attorney, in no small part through\tmalpractice cases against OB/GYNS in North Carolina," and "this\tmakes some people in health care uneasy." However, "no\tmatter how you feel about Edwards' past, of all the candidates\tseeking the presidency, he is the one most committed to improving\tthe public's health, in addition to health care," based in part\ton his "having the most progressive universal health plan"\tand his focus on poverty, Sunshine writes. He adds, "Make no\tmistake; those measures will not be easy. But by focusing on\tpoverty, in addition to his health plan, Edwards is in a position to\tdo a tremendous amount to improve our country's collective health"\t(Sunshine, Seattle Post-Intelligencer, 1/2).

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• Washington\tPost: "When it comes to health care, the way policy\tmakers define the problem determines the answer they produce,"\tas "Democratic presidential candidates tend to focus on the\tuninsured" and Republicans candidates tend to focus on "rising\tcosts," a Post editorial states. According to the\teditorial, "Both are important: The unaffordability of health\tinsurance won't be addressed without tackling health-care costs, but\treducing cost growth alone won't solve the insurance problem."\tA health care proposal announced by presidential candidate Sen. John\tMcCain (R-Ariz.) is the "most detailed and thoughtful of the\tRepublican proposals" but "does not put enough emphasis on\tdealing with the uninsured," the editorial states. In addition,\tMcCain "puts too much emphasis on the ability of consumers,\tonce they are aware of and responsible for health-care costs, to\tdrive down prices," and his "plan is weakest on the\tunderlying problem with the health-insurance market, in which\tinsurers have every incentive to cherry-pick the healthiest\tpurchasers," the editorial states. However, according to the\teditorial, "his suggestions for constraining costs and\treforming the irrational tax treatment of health insurance merit\tserious consideration by whoever is elected." The editorial\tstates, "The McCain plan represents an important improvement on\ta dead-on-arrival proposal from President Bush earlier this year,"\tadding, "Getting rid of the tax preference would be a good step\ttoward achieving a more rational system, one that does not favor\tsome purchasers of health insurance over others and does not\tencourage spending on gold-plated health care plans"\t(Washington Post, 12/22).

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