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Presidential Candidates Address Health Care Crisis

(November, 1999)

Two Democratic presidential hopefuls, Vice President Al Gore and former Senator Bill Bradley, are recognizing that our health care system is in crisis.

Vice President Gore proposes a plan he says would make health insurance available to all children. Senator Bradley went further, proposing a plan he says could cover most of the nation's uninsured, numbering 44.3 million. Although neither candidate endorses a single-payer style reform, both acknowledge the political importance of talking about health care. Bradley called access to health care "a big problem that affects almost all Americans." In criticizing Bradley's proposal, Gore didn't debate the need for action but said his competitor's plan could endanger another health care priority: keeping Medicare funded. Bradley would fund his program with $65 billion per year taken from the projected federal surplus; Gore says the surplus should be reserved to help fund Medicare.

$ to Insurance Companies

The core of the Bradley plan is a cash infusion to private insurance companies. Under the plan, poor families would receive tax credits to be paid directly, as premiums, to private insurers. Families could buy insurance through the Federal Employees Health Benefits Program, a system of private companies who cover federal workers. Or families could buy from other insurance companies.

Bradley says 95% of the uninsured would be eligible for his plan, but experts doubt that very many of those eligible will actually get coverage. For instance, the subsidies would give up to $1,200 per year to a family of four with income under $32,800. But finding a policy that covers a family for that amount ($100 per month) may be difficult or impossible in many places.

Privatizing Medicaid

The Bradley plan would replace much of the Medicaid program with the private insurance plan described above. Acute care would be covered under this federal plan, while coverage of long-term nursing home care for the indigent would remain a state-run program.

But early experiments with private insurance companies providing Medicaid and Medicare benefits have found many such companies unwilling to provide coverage for what the government programs pay; in other words, private insurance has tended to be more expensive than the traditional plans. At the same time, some states have found serious quality problems among private Medicaid HMOs.

The Bradley proposal would also make health insurance premiums non-taxable for everyone; that would provide another tax break to the wealthy. Presidential candidates may not have much to offer this year in the way of solutions to the health care crisis. But at least the debates assume that the crisis belongs to all of us, and deserves a society-wide solution.