KATIE GILCHRIST DAVID DONNELL

Aside from the continuing battle with Iraq and the many issues that stem from that conflict, healthcare, it seems, may be the hottest topic of discussion for the 2008 presidential (and congressional) election year. With elections still a full 17 months away, numerous candidates have announced in both parties and many of them have already unveiled at least the beginnings of their respective plans to "reform" healthcare in this country.

Are any of these so-called "proposals," "plans," and "commitments" anything more than posturing and empty political rhetoric? That is the million dollar question. It is also one that will remain unanswered until the post-January 2009 era. The more important thing now is to know what our various candidates propose and to determine, if we can, what healthcare would look like under each different scenario.

At the end of May, the Republicans had yet to engage in this debate in a very substantive manner, although several Republican candidates have indicated that the topic will be a priority for them in coming months. Tommy Thompson, who served as President Bush's health and human services secretary when Medicare Part D (prescription drug benefit) was established, has stated that he wants healthcare to be "the dominant issue" in his campaign — but he has not announced a real plan. Rudy Giuliani has indicated his opposition to the Democrats' universal healthcare plans and has stated that he would use vouchers instead to provide healthcare for the low income U.S. population, but he has not announced a detailed plan either. Finally, on the Republican side, Mitt Romney has not yet unveiled any real plan for healthcare reform on a national level, but he did sign legislation in 2006 requiring all Massachusetts residents to have health insurance by July this year — a scheme cited by Democrat John Edwards as similar in some respects to his plan for national healthcare reform. In short, the Republicans' position on the issue is largely unknown.

Not so with the Democrats. Between Hillary Rodham Clinton, Barack Obama, and John Edwards, there has been much discussion about the details of various plans for reform. In late March, these three, along with four other Democrats (Dodd, Gravel, Kucinich, and Richardson), appeared at a forum and confirmed that, although their plans to implement it would differ, they all favor universal healthcare coverage. The seven Democrats also agreed that any plan for healthcare reform would necessarily include a greater investment in prevention and management of chronic illnesses, the establishment of federally regulated insurance pools, and a national requirement for health records to be electronic.

Edwards, who was the first candidate to announce a detailed plan, states that he would see all Americans insured by 2012 and that he would raise taxes to pay the $100 billion annual bill for his plan. Specifically, Edwards has proposed eliminating the Bush Administration's tax cuts for families with $200,000-plus incomes and requiring the IRS to work harder to collect taxes.

Obama has not discussed the cost of his plan, which was unveiled in late May, but has indicated that to pay for the plan he would implement tax increases on persons with incomes exceeding $250,000 and would increase the inheritance tax on estates valued at greater than $7 million.

Clinton says she wants healthcare to be "the No. 1 voting issue in the '08 elections." She has indicated that she wants to provide answers to our healthcare dilemma that will not cost the country enormous additional amounts of money, stating that she does not "think we should start with the position where we say we're going to increase all of these costs by putting more money into a system that is broken. We have to fix the system." Clinton has not yet announced a detailed plan, but has stated that her plan will allow Medicare to negotiate for lower drug prices, will require all insurance plans participating in Medicare or Medicaid to cover cancer screenings and immunizations, and will end "discrimination" by insurers based on pre-existing conditions.

As is evident from these brief glimpses into the current positions of some of the presidential candidates, there is much to study and evaluate about how the next president will impact this country's healthcare system going forward. Certainly, we do not have a perfect system. Certainly, there are issues that must be addressed in order to better address both the availability and the affordability of healthcare for all Americans. Which candidate will craft the proposal that is most likely to come to fruition and meet these objectives? Clearly, that is a question of the utmost importance to all Americans — but especially to healthcare providers and those of us in professions related to and dependent on the future of our healthcare system.


July 2007