The Scum at the Top
Commentary on the Rats in Washington
David Durenberger: For health care security,
Kerry has the better plan
By David Durenberger
StarTribune
© October 27, 2004
The presidential candidates are debating whether Iraq or the
economy is headed in the right direction, but no one can
dispute that the health care trend line is going in the
wrong direction.
With 5 million more uninsured Americans, bringing the total
to 45 million (including a 12 percent increase in uninsured
Minnesotans in the last year), family insurance premiums up
more than $3,500 (including a 59 percent jump in Minnesota),
prescription drug costs up over 70 percent, and businesses
struggling to afford health care and stay competitive, there
can be no doubt that we need to change our policy course.
Regardless of how voters view the candidates on all other
issues, it is clear that the future of health care costs
for Minnesotans has already been determined by President
Bush's record of accomplishment. As a Republican, with
some experience, I sincerely regret having to say the
record over the last four years and the prescription for
reform the president is proposing give me little confidence
that this most challenging of all domestic priorities will
be adequately addressed over the next four years.
His Medicare Modernization Act enhances access to
prescription drugs for low-income, high-need seniors. It
authorizes demonstrations to identify quality of care and
chronic care management. But it all comes at a price
neither taxpayers nor Medicare beneficiaries will be able
to afford.
Drug companies have inflated prices from which "discounts"
are derived and the Republican Congress has protected the
drug companies from the price competition that Medicare
applies to doctors, hospitals, and home health, dialysis
and other care providers. President Bush and the GOP
Congress have placed the future of Medicare in the hands
of America's big health insurance plans and, again, protected
them from the reality of competition with a guarantee of up
to 123 percent higher payments than traditional Medicare.
The costs of all this will be borne not by those who profit
most from health insurance or services, but by seniors and
disabled Minnesotans whose Medicare premiums were increased
14 percent this year and will be 17 percent next year. With
a budget deficit of more than $400 billion a year, that
Medicare premium can only rise faster in the future. Plus,
those of us working past age 64 will pay up to 80 percent
of the costs to us of a Medicare program we have funded out
of family income for the last 38 years.
President Bush's embrace of Health Savings Accounts would
make little dent in the uninsured or in overall cost growth,
but they would cut benefits and shift costs to workers. His
Association Health Plans -- which are designed to pool
certain businesses together and permit them to avoid most
state consumer protection insurance laws -- would simply
attract businesses with younger, healthier workers at the
expense of others. His underfunded individual tax credits
to be used in the fatally flawed and discriminatory
individual market would -- like his other approaches --
undermine and weaken employer-based coverage and make it
even more difficult to find insurance coverage for the
least healthy among us.
The president constantly refers to Sen. John Kerry's health
reform proposals as "big government." Not true. As one
deeply involved in developing alternatives to President
Bill Clinton's reform proposals, I must say that what
Kerry proposes today for coverage expansion is in line
with what mainstream Republican senators like Jack Danforth,
John Chafee and I, working with Democrats like Bill Bradley,
John Breaux and Kent Conrad, tried to accomplish in 1994.
Indeed, the Kerry plan appears designed to be responsive to
those most in need -- people forced out of health care
coverage by premium cost increases -- without being
disruptive.
By providing employers and health plans with financial relief
from catastrophic expenses, it should stabilize and make
more affordable the employer-based insurance market. It
opens up programs like the Congress' own Federal Employee
Health Benefit Plan (FEHBP) and the Children's Health
Insurance Program, and provides new private health insurance
options -- not mandates -- for the uninsured.
By providing extra tax breaks for vulnerable groups like
55-to-64-year-olds, workers in between jobs, and small
businesses, it ensures that health care is made even more
affordable.
While far from perfect, it both builds on and learns from
the past and takes us in a long-overdue new direction.
In this election people are making decisions on the basis
of the candidates' stands on many issues. I have access to
all of the health care I need through both FEHBP and
Medicare. Like many Republicans, though, I believe our
national goal is access for all, not just some.
For people who cannot afford the health insurance they
need, for people whose access to care is threatened, the
issue of which presidential candidate is most likely to
come to their aid is their most important national security
issue. It is the national security position on which
President Bush and Sen. Kerry differ most and the one on
which Kerry has the clearer vision for restoring security
to all Americans.
David Durenberger, who was a U.S. senator from 1978 to 1995,
is chair of the National Institute of Health Policy at the
University of St. Thomas College of Business.
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