Close to 400 students, faculty and staff packed Sommer
Hall and crowded around television sets at the
Bloomberg School of Public
Health on Sept. 13 to hear representatives of George
Bush and John Kerry face off in a debate titled "Access to
Public Health Care: The Presidential Positions."
The American system currently gobbles up 14 percent of
the gross domestic product, whereas Germany, for instance,
which has one of the next most expensive plans, spends just
9 percent of its GDP for health care — and manages to
insure 100 percent of its population.
Exposing how the two candidates' visions of how to
shore up America's health care system contrast sharply were
Bush proxy Gail Wilensky, a senior fellow with Project
HOPE, and Kerry representative Christopher Jennings,
president of Jennings Policy Strategies.
Alfred Sommer, dean of the Bloomberg School, moderated
the debate and allotted time for three sessions of
questions, one from members of the audience and two from an
expert panel, which was seated on stage between the
speakers.
Panel members were Jonathan Weiner, professor, Health
Policy and Management, and deputy director, Health Services
R&D Center; Michael Gibbons, assistant professor, Health
Policy and Management, and associate director of the Johns
Hopkins Urban Health Institute; Alex Dominguez, science and
health reporter for the Associated Press; and Jonathan Bor,
medical reporter for The Baltimore Sun.
For Bush, Gail Wilensky
PHOTO BY HPS/WILL KIRK
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Wilensky stressed that Bush was for individual
empowerment through health savings accounts; Jennings spoke
of Kerry's desire to bolster the existing system and to
bring more people into it.
In their opening salvos, the two speakers mapped out
their candidates' disagreements. Wilensky said that Kerry's
much costlier plan — with a price tag of $1.5
trillion over 10 years vs. Bush's $128 billion —
would expand the price of health care but do nothing to
reduce the bottom line. Bush's plan, she said, would not
only bring in 7 million uninsured (as compared to Kerry's
bid to include 28 million additional recipients), but it
would also make patients more cost-conscious by emphasizing
high-deductible policies that would exempt insurance
companies from paying for routine preventive care.
Jennings countered by saying that Bush's plan neither
increases the number of people eligible for coverage nor
makes health insurance more affordable. He cited
independent sources that contend that during George Bush's
watch health care premiums have increased by a factor of
three to four times increases in wages, drug prices have
ballooned at three times the rate of inflation, 5 million
more people are now uninsured, the Children's Health
Insurance Program has actually lost members, and Medicare
is now on schedule to become insolvent 13 years earlier
than previously indicated.
Debate highlights:
Who should be covered?
Wilensky said Bush has no problem with providing insurance
to all Americans below the poverty line and would allow
potential Medicare beneficiaries to choose a plan on their
own. Kerry would extend coverage to those with incomes 200
percent to 300 percent above the poverty line and would
automatically enroll all those eligible.
Curbing Malpractice Suits.
Bush would curb malpractice suits against physicians, thus
reducing insurance premiums by 2 percent, a savings of $32
billion. Kerry would put into place a better system for
reporting and rooting out physician errors and would nip
frivolous lawsuits in the bud by not allowing any lawyer to
try malpractice cases who has had three or more thrown
out.
Mental Health Parity.
Mental health premiums carry higher co-payments than
traditional types of health insurance, and a bill to bring
these two expenses more in line with each other has died in
Congress. Wilensky said that Bush has been supportive of
the general idea of mental health parity and she presumed
that in the next four years Bush would focus more on this
issue. According to Jennings, Bush made an explicit
commitment over one year ago to support mental health
parity but to date has done nothing to see that this
measure is passed.
Importing Cheaper Drugs from
Canada. Wilensky cautioned that if drugs are bought
over the Internet, patients will not know if their dosages
are correct, if they've been stored properly or even if the
manufacturer is correctly identified. Furthermore, she said
that the notion that Canada could supply the entire United
States with drugs is ridiculous; demand, she said, would
quickly drive up prices. Jennings said Kerry would beef up
FDA oversight so that the safety of imported drugs could be
guaranteed.
Preventive Health Care.
Bush believes that while preventive care will save money,
chronic care is a much bigger problem. Kerry, Jennings
said, wants to head off the deaths that obviously can be
prevented. "Congress won't regulate tobacco," he said, "but
Kerry-Edwards will fix that, along with other bipartisan
agreements that are now being blocked."
Summing up. "To govern is
to choose," Jennings said. "If we want to build on
quicksand, we can. George Bush has decided to extend his
tax cuts and make them permanent. John Kerry will roll back
those cuts to Clinton-era levels and use that money to make
a reasonable investment in health care."
"George Bush," Wilensky said, "wants to empower
individuals to satisfy their health care needs by allowing
them to shop around for the right insurance company. George
Bush would also take steps to discourage the medical
malpractice suits that now foster defensive — and
thus expensive — medical practice. The fact that
health care issues were not solved during the prosperous
1990s indicates these problems will not go away without
some belt tightening."
To see and hear the debate, go to the webcast at
www.jhsph.edu/healthdebate/index.html.
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