Oregon Sen. Ron Wyden likes to say he's the only person in the Senate not running for president, calling himself the "Senate's designated driver." But that doesn't mean the Democrat's many White House-hungry colleagues aren't at least paying lip service to the issue Wyden is interested in—health care.
And the feverish activity is the same at the state level in Oregon, where ex-Gov. John Kitzhaber, a former emergency-room doc, and state legislators have their own ideas.
None of the presidential candidates' proposals resembles what's being proposed by Wyden, who says, "Nobody has been willing to get the two big issues that drive this debate"—the federal tax code and cutting the link between employment and health insurance. But since one of these people may become president, here's a look at each proposal, complete with Dr. WW's prognosis for them.
Sen. Hillary Clinton (D-N.Y.)
The Plan: Focuses on keeping healthcare costs down by creating a nationwide "paperless" electronic medical record system similar to one currently used by the U.S. Department of Veterans Affairs. It also promises to hold back federal Medicare and Medicaid payments to private insurers who don't cover preventative care for obesity, diabetes and cancer, and to control spiraling drug costs by authorizing the Food and Drug Administration to approve far cheaper generic drugs. The savings, estimated by Clinton at $120 billion, would go toward providing health care for everybody without health insurance.
The Good: With healthcare costs soaring 6.9 percent in 2005, according to the National Coalition on Health Care, keeping costs down is a good way to start.
The Bad: Back in 1993, Clinton championed a plan that collapsed under its own weight when many conservatives, libertarians and health insurers dubbed it "government-run" health care. Although Clinton's new health plan wins praise from the industry group America's Health Insurance Plans, critics say Clinton has been swayed by those insurance companies' donations to her 2006 Senate re-election campaign—a total of $150,600, according to The New York Times.
Prognosis: Looking grim. Clinton's plan to open the door for generic competition and to limit advertising for drugs is sure to antagonize the pharmaceutical industry, a powerful lobby in Washington. And she was the poster girl for the failed reform effort she spearheaded 14 years ago as First Lady.
Sen. Barack Obama (D-Ill.)
The Plan: Requires all employers to offer health insurance, or face large penalties. Would create a fund to subsidize coverage for people who can't afford health insurance by eliminating President Bush's tax cuts for the top 1 percent, generating $103 billion in revenue annually, according to the Center on Budget and Policy Priorities, a nonpartisan research group.
The Good: Creates a National Health Insurance Exchange that would require participating private insurers to provide comprehensive benefits to everyone regardless of pre-existing conditions.
The Bad: No universal coverage until at least 2012, Obama says. Critics also say it doesn't provide coverage for everyone and lacks too many specifics.
Prognosis: More tests needed. Obama's plan promises to tackle disparities in the availability and the quality of health care, particularly for African Americans. But it offers no proposals on how to get that done.
Ex-Sen. John Edwards (D-N.C.)
The Plan: Seeks to lower healthcare costs by letting the federal government offer payments instead of patents for breakthrough drugs. The system would remain employer-based but put the burden on employers to provide comprehensive health care for their workers or buy into regional "health markets" that would include a government option. His plan would also require all Americans to have medical coverage.
The Good: By offering cash incentives to drug innovators instead of patents, supporters say Edwards would introduce greater competition, driving down prices for life-saving drugs.
The Bad: Edwards plans to fund the $120 billion plan partly by eliminating Bush tax cuts for Americans who make over $200,000—still only 2 percent of Americans—making Edwards' call for "collective sacrifice" sound kind of hollow. But if that's the worst we can say...
Prognosis: Guarded, but Dr. WW says, "Keep up the fight." Edwards' plan was the first to be announced by a major presidential candidate in the 2008 election, setting the bar high with a comprehensive plan that would cover all Americans, something that neither Clinton nor Obama promises. Of course, Edwards also trails Clinton and Obama in the polls.
Ex-Gov. Mitt Romney (R-Mass.)
The Plan: As governor, Romney worked with state Democrats in 2006 to pass his "Massachusetts plan" that required adults to have health insurance or face tax penalties. Now, with his bid for conservative support in the Republican primary in full swing, Romney seems to be backing away from the plan, which requires businesses that don't provide insurance to pay $295 a year per employee into the system. The money collected will help pay for Medicare-Medicaid, state-subsidized policies, and affordable policies that residents can buy on their own.
The Good: Insurance coverage for almost everyone in the state, without raising taxes.
The Bad: The financing for the new system is already being threatened by the rising cost of healthcare premiums, growing at twice the rate of inflation, according to the National Coalition on Health Care.
Prognosis: On life support, given that Romney is distancing himself from the plan, failing even to mention in speeches to conservatives what he once called "one of our great accomplishments." The Cato Institute, a conservative-leaning libertarian think tank that carries weight in GOP primaries, calls Massachusetts' plan "an unprecedented expansion of government power."
Ex-Gov. John Kitzhaber (D-Ore.)
The Plan: The Oregon Better Health Act, proposed this legislative session by Kitzhaber, would have pooled federal Medicare and Medicaid money with employers' healthcare tax deductions to pay for basic health care for everyone in the state.
The Good: Provides universal health insurance coverage.
The Bad: Critics say the health benefit package for individuals would probably be inadequate due to lack of funds.
Prognosis: DOA. The bill, Senate Bill 27, died in the 2007 Legislature.
State Sen. Ben Westlund (D-Tumalo)
The Plan: The Healthy Oregon Act (Senate Bill 329), introduced by Westlund and Sen. Alan Bates (D-Ashland), would issue "Health Cards" to every Oregonian who wants one every 12 months, allowing them to get basic coverage from Accountable Health Plan, a contractor subsidized with state funds. Oregonians already with insurance do not have to sign on to the plan. Creates an Oregon Health Fund Board overseeing private insurers to control costs, set reimbursement rates, and set standards for basic health coverage.
The Good: Access to basic health care for everyone.
The Bad: Unlike Kitzhaber's plan, this bill does not include pooling of federal Medicaid dollars, putting the bill on uncertain financial footing., And its full cost remains unknown since the basic benefits package has not yet been determined. Also, if you need additional coverage, you're on your own.
Prognosis: Good news: Dr. WW thinks this one's gonna pull through. The bill is on the Gov. Ted Kulongoski's desk for signature. He's expected to sign.
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