TODD BOULDIN
Visting Asst. Professor of Relgion and Social Science
1. What issues are involved in the debate about health care reform?
The essential issue in the health care debate is whether health care insurance is a universal right that should belong to all Americans, and if so, whether it is the role of the federal government to guarantee universal access or coverage. Republicans respond to the desire for reform with incentives to increase access to insurance, while Democrats respond to the desire for reform with mandates to insure universal coverage. Some Libertarians and conservatives suggest that the federal government should not involve itself with health insurance coverage at all because it is an individual or state choice.
2. Why is the health care issue so prevalent to the candidates in the upcoming presidential race?
The debate over health care reform has been brewing ever since Senator Clinton’s failed attempt to reform the system between 1993 and 1994. At that time, 40 million Americans were without health insurance at any point in time. Now that number has increased to 47 million and includes people with pre-existing conditions that insurance companies will not cover and those who work part-time jobs that do not offer health insurance benefits.
There are other realities that drive the debate, as well. Large corporations, such as General Motors, now push for reform because the cost of employer provided insurance is damaging corporate profit.
Health insurance premiums have skyrocketed past the rate of inflation because of the use of the system by those without insurance and unable to pay, because of the high costs of malpractice insurance for physicians and because of the expense of medical research and technologies.
Americans often avoid preventative care because they cannot afford to see a doctor, thus increasing the cost of catastrophic care later. Medicare is gradually going broke as more baby boomers retire, and Medicaid has bankrupted state budgets. But it is the fact that most Americans have had a collection of negative experiences with the health care system that is driving the desire for reform and placing health care back in the list of top issues on the minds of voters in 2008.
3. How do Republicans approach the issue of health care reform?
Conservatives generally believe that it is the role of the federal government to provide incentives for the market to create increased access to health care insurance, and to give individuals incentives to purchase insurance while not mandating that they do so. Conservatives do not believe that the federal government should provide health care insurance or create a program to administer health insurance. Rather, they favor approaches, such as the deregulation of insurance, a cap on medical malpractice jury awards and the creation of tax incentives to encourage the purchase of insurance by individuals.
Libertarians or libertarian Republicans such as Rep. Ron Paul propose steps to encourage free market competition among insurance providers and the deduction of health care premiums and deductibles from federal taxes.
4. How do Democrats approach the issue of health care reform?
While a few more liberal Democrats such as Rep. Dennis Kucinich propose a single-payer system in which the federal government would pay for and provide coverage for all Americans. The leading Democratic candidates favor a goal of universal coverage through a mix of private and governmental insurance.
Senator Clinton’s plan would mandate that all Americans must purchase insurance, similar to the state laws requiring the purchase of automobile insurance. Her plan would give incentive for coverage through tax deductions for premiums and deductibles, the elimination of pre-existing condition limitations and the guarantee of consumer choice with a range of insurance options.
Senator Obama’s plan mandates that only children must be covered, but his plan attempts universal coverage through a requirement that employers provide “meaningful coverage” through an employee benefit or an employer contribution to a public fund. He also proposes the expansion of Medicaid and the SCHIP program, as well as the creation of a plan for small businesses and self-employed individuals.
01-17-2008
