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By Chris Schreiber While their Democratic rivals take on healthcare reform as a key campaign issue, Republican candidates have yet to clarify specific components of their healthcare platforms. Instead, traditional Republican issues—taxes, abortion, immigration, big government, and gun control—have taken the spotlight in the early stages of the race that will determine the party’s nominee for president. In what was once a crowded field, the list of possible nominees has been pared down substantially in recent weeks. Texas Gov. George W. Bush, whose status as front-runner has been cemented for months, has remained noticeably outside the healthcare debate. Bush’s record-breaking fund-raising efforts have already forced a slew of candidates out of the race, most recently Elizabeth Dole, who claims Bush sapped potential donors and made seeking the nomination fiscally impossible. In the lead for the nomination are Bush, publisher Steve Forbes, and Arizona Sen. John McCain, who has made the most significant progress in catching up with Bush in the polls. Utah Sen. Orrin Hatch, former Reagan administration official Gary Bauer, and former Ambassador Alan Keyes are all considered fringe candidates by most observers. Healthcare platform still to come Bush has maintained his lead in those polls without a detailed healthcare plan. So far, he has made only broad comments about his philosophical approach. In a statement on the issues, Bush said, “The role of government is to ensure that patients and healthcare professionals are treated fairly and consistently and that quality patient care is maintained.” Scott McClellan, deputy press secretary for the Bush campaign, said the governor would be “laying out his platform during the campaign in the months ahead.”
Bush’s record as governor Despite the lack of public comment on other issues, however, Bush has overseen some substantial health reform in Texas since he became governor in 1995, most notably a series of HMO initiatives. While he vetoed HMOreform legislation during his first year in office, saying that the bill offered too much protection for special interests, he signed a revamped version of the bill the following session and has since signed into law provisions that expand health coverage for women and the chronically ill by allowing them to go straight to specialists. Bush also signed legislation that prohibits the use of financial incentives by HMOs to limit medical services, and oversaw passage of a law that allows patients claiming they have been injured by an HMO to sue for restitution. Bush supporters say that tort reform passed at the same time has helped keep frivolous lawsuits out of the courtroom and has allowed only meaningful HMO challenges to proceed. In addition, the Texas Legislature passed a new Children’s Health Insurance Program this year, which is expected to insure more than 400,000 more children over the next two years. The bill was funded by revenue from the state’s tobacco settlement, and Bush signed it despite arguments from some public health advocates who claimed not enough money was dedicated to healthcare programs.
McCain supports HMO reform, tax incentives McCain is best known at the Capitol for his military career and has been in the news for repeated, unsuccessful attempts to pass campaign finance legislation. While he has said little about healthcare issues, McCain has advocated stepping up recruitment efforts for Medicaid-eligible children and has suggested tax incentives to persuade employers to offer health insurance for workers. His campaign Web site argues that HMO reform, tort reform, and an overhaul of the Food and Drug Administration are also necessary to improve access to health care. But McCain has not outlined specific plans or proposals on health care, has not submitted a budget, and has not commented on the cost of his reform proposals. Specific ideas from Forbes Forbes has been more specific than either McCain or Bush about his proposals for healthcare reform, but his ideas are also some of the most controversial.
He has drawn attention for advocating the use of medical savings accounts (MSAs) to deal with the uninsured population. Forbes has practiced what he preaches, setting up MSAs for his employees eight years ago. MSAs serve the same function as normal savings accounts, except the funds are used to pay for health care. Companies stock the accounts of their employees, with employees using the money for routine visits. Unused money is carried over, and when it is depleted, a catastrophic insurance backup kicks in. Forbes says MSAs would be both portable and affordable and wants to repeal Medicare provisions that restrict their use. He has also advocated a plan to give Medicare beneficiaries the right to choose their health plan and physician. “MSAs have proven to be ideal vehicles for moving uninsured working families out of the ranks of the uninsured,” Forbes said while campaigning in New Hampshire. “If Washington lifted the restrictions on MSAs, that alone would be a huge leap forward.” Forbes maintained that his employees hadn’t been “forced into managed care” while company healthcare costs had remained stable. But judging by an Oct. 28 town hall meeting in New Hampshire attended by McCain, Forbes, Hatch, Bauer, and Keyes, the Republican nomination will not hinge on concerned healthcare reform. Just three questions from the audience concerned health care, with Bauer supporting patients’ right to sue their HMOs, and Hatch claiming that he was responsible for “creating the modern generic drug industry.” Hatch went on to say, “I have got to tell you that I have spent most of my career trying to solve healthcare problems.” For the time being, however, no Republican candidate has pledged to continue that mission. |
