Prescriptions for Health Care:

Candidates Introduce Rival Plans for the Nation's Medical System, as Harvard Professors Say Cost, Access Problems Continue to Worsen

This year, rising costs and widespread complaints about inadequate coverage have finally made health care a top presidential campaign issue.

For 40 years, the U.S. has been the only industrialized nation without a national health care plan. Roughly 15 percent of the population has plan no medical insurance, and that number is expected to increase, as medical costs continue to take up a larger and larger proportion of disposable income.

Faculty members and officials at Harvard Medical School and the School of Public Health declined this week to state personal opinions on the candidates' health care proposals. But several said they believe that health care reform will be one of the most pressing issues faced by the next administration.

"We have the highest health care costs and the least number of insured citizens of any industrialized country," said Dr. Robert J. Blendon, professor of Health policy and management at the Harvard School of Public Health. "In other industrialized nations there is no such thing as an uninsured' citizen."

Medical School Dean Daniel C. Tosteson '44 said that the high costs of health care are of increasing concern to the organizations that pay for most Americans' insurance, namely employers.

"Faced with health care bills that are increasing greater than inflation, [employers] are determined to contain these costs," Tosteson said.

Though he said he believes it is crucial that everyone have the necessary access to health care, Tosteson noted that unwillingness to support health care for members of the lower income tax bracket is what destroyed earlier plans for national health care.

"[Equal access to health care] was the intent of the Medicare and Medicaid programs when they began in the 60s" Tosteson said. "Taxpayers of the nation balked at contributing taxes to support programs to provide care."

The four major candidates currently running for president agree that the U.S. health care system needs to change. But they are far from unanimous in their ideas about what kind of changes should be pursued.

BUSH: TAX CREDITS

Last February, President Bush forwarded a health care plan intended to aid the 36 million Americans who are uninsured. The plan, now incorporated into his campaign platform, centers on providing tax credits to offset health care costs.

Under the Bush plan, families below the poverty line could receive either a voucher or a credit subtracted from their tax bill. Families with a total yearly income of less than $70,000 would be able to deduct up to $3750 of taxable income for health care or unreimbursed medical bills.

BUCHANAN: INCENTIVES

Of the candidates, conservative columnist Patrick J. Buchanan has the least detailed plan. Buchanan's plan is similar to Bush's in that he supports the establishment of incentives for employers and individuals who purchase insurance.

Buchanan also favors halting new Medicare regulations, and would issue vouchers to families to help pay the costs of long-term care of the elderly.

BROWN: NATL. INSURANCE

Democrat Edmund G. Brown Jr. is proposing the most drastic changes in American health care. Brown, the former governor of California, is calling for a system of national insurance similar to that of Canada.

In this system the 1500 private health insurance and public health care plans currently operating would be replaced with a single national insurance program. The program would establish set fees for doctors, hospitals and medical procedures, and would give everyone equal access to these services.

Brown also proposes increasing funding for "wellness and prevention" programs.

CLINTON: 'PAY OR PLAY'

Combining the private and public health care policies supported by the other candidates, Democrat Bill Clinton has come up with a "pay or play" model of health care. In Clinton's model, everyone would be covered either by private insurance plans provided through their employers--pay--or by a public program serving those who are uninsured or covered only by Medicaid--play. The Medicaid program would remain intact.

Clinton proposes to control health costs by negotiating fees with health care providers, encouraging the sharing of medical technology and having a federal board determine a core benefit package.

Not surprisingly, each of these health care remedies has its share of detractors as well as supporters. The Bush administration has criticized the Brown plan on the grounds that it would encourage the rationing of health care by making judgments as to which health care problems are "valid" and which are not.

In addition, though the Brown plan would be an improvement for lower income families by giving equal care to everyone, it would increase costs for middle income taxpayers while reducing their choices in treatment.

And critics of the Clinton "pay or play" proposal say that it would only reduce the amount of money available for health care since the government would have to help pay overhead expenses for thousands of insurance companies.

The Bush plan too--and the Buchanan plan, by extension--would have the down side of offering the least amount of government control, and therefore the least potential for cost control, said Blendon.

However, Bush's system would have the advantage of allowing people a choice between competing health care plans, Blendon noted.

Although Bush originally stated an intention to put his plan into effect as soon as possible, he announced last week that that will not take place anytime this year.

And with the presidential election in November, it seems likely that the final decision on which, if any, of these health care policies is implemented will rest at least in part with American voters.