Bush and Gore's differences in governing philosophy are perhaps clearest in their approaches to reforming health care. Bush relies on the private sector, Gore proposes that the government step in to provide the coverage that the private sector won't, with the goal of eventually insuring universal health coverage through a combination of public and private sector coverage.
Bush plan includes tax credits to help the uninsured to buy insurance from private insurance companies, and supports making it easier for small businesses buy group insurance through industry associations. The tax credit would be refundable, up to $1,000 per individual. However even basic insurance plans cost significantly more than that, and his plan offers no requirement - or even an incentive - for private insurers to offer lower-cost plans, so it is debatable whether the working poor will actually be able to purchase insurance, even with the tax credit.
Gore would incrementally expand government sponsored coverage, starting with expanding the Child Health Insurance Program (CHIP) to include more children, and holding states accountable for signing up eligible children for the program. Future expansions would extend the CHIP program to the parents of children eligible for coverage under CHIP, and offering the "near-elderly" a low-cost "buy in" to join the Medicare program. Gore's proposal also offers a 25 percent tax credit to small businesses for the premium costs of covering employees, and supports strengthening the health care delivery systems serving the uninsured
Both candidates support some form of a "Patient's Bill of Rights." Gore supports the Dingle-Norwood bill currently languishing in Congress. This would provide patient access to specialists and emergency room services, and remove HMO "gags" which prevent doctors from telling patients about all the options available. The bill also insures the right to appeal decisions of the HMO, and the right sue HMOs. Bush supports a more modest proposal modeled on the Texas Patients Bill of Rights (which was passed by the Texas Legislature over his objections). This proposal includes access to specialists and the right of appeal to an independent review panel. It also includes a limited right to sue their HMO if they are hurt by a health care treatment decision. The similar proposal currently in the Senate is supported by insurance companies and HMOs.
Both candidates also support a prescription drug benefit for seniors. Gore supports including such a benefit in the existing Medicare program. Seniors would have 50% of the prescription drug benefit costs covered, up to $5,000 annually, and a new catastrophic prescription drug benefit. It would also provide cost-sharing protections for low-income beneficiaries. Bush supports giving seniors the opportunity to select a private insurance plan that may include prescription drug coverage. However, like the overall health care plan above, nothing in his plan requires insurance companies to offer such plans at a price seniors can afford.
It seems to me that Bush's proposals are geared toward directing taxpayer dollars into the hands of insurance companies and HMOs, rather than actually insuring that low-income people get the care they need. Gore's proposals more simply, and in my opinion, more cost-effectively, eliminate that middleman and provide for payment of taxpayer dollars directly into the hands of the providers of healthcare for poor and low-income people, for actual services rendered. If my tax dollars are going to be spent anyway, I'd prefer they were spent getting actual health care instead of maybe purchasing a health insurance policy that might or might not actually pay for health care. I guess I'm funny that way.
~Karen~
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