Presidential Politics and Health Care Issues Steven R Moore, RPh, MPH, FRSH Interim Chair, United States Branch, Royal Society

of Health;

Captain, United States Public Health Service, Rockville, Marylan 20852, USA With the national election approaching on November 3,1992 in the US, a large segment of the one-issue populace has focused on health care as its raison d’etre. Even those who are concerned with multiple issues or conform to party loyalty in voting, are both looking at health care and using this issue as a highlyemotional vote motivator. Seldom do most political analysts remember health and medical care figuring in the national election picture so prominently as vote predictors. In both the national races and local races, health care remains a steady undercurrent of interest. The two political parties have prominently displayed their platforms on health care. Although neither party has any type of public consensus or approval in their plan, they do present two very different viewpoints related to the federal role in health care. Both parties and presidential candidates portray themselves as the agents ofgreat change and assure the populace that their approach (however unproven) will be the certain solution to the nation’s health care problems. Currently, health care in the US is a patchwork of private practitioners, group practices, and managed care arrangements (eg health maintenance organisations). The luckiest individuals have either comprehensive health care entitlements or insurance that fully pays for health care costs. Another large segment has private insurance that largely pays health care costs but also has

monetary limits, co-pay requirements, or spend-down arrangements. An increasingly large segment of the population has no real coverage and it is either unavailable (due to existing poor health conditions or lack of employment), or simply cannot afford to pay the insurance costs. For those who have no coverage and are poor enough, federal Medicaid programmes usually provide support, as well as Medicare for elderly and disabled patients. For the lower wage-earner with no employee . health benefits, frustration and desperation are often the only reaction to the concern over health care. Both parties would seek to control costs by encouraging cost-efficient practice arrangements (eg health maintenance organisations or other controlled group plans). Both would

actively seek to optimize cost-saving or resource-saving care alternatives. Details are,


what constitutes these classifications

however, largely lacking. The

Republicans advocate a voucher system so that poor can openly purchase insurance in the most cost-


efficient manner. Additionally, income-tax deductions would allow middle class citizens funding to purchase needed insurance. Self-employed individuals or very small businesses could fully deduct the costs of insurance premiums from their income taxes ( (currently only a 25% deduction is allowed).,. Republican specific cost-saving measures include: the pooling of small businesses and individuals to create large negotiating entities for better commercial insurance rates; support of government research to demonstrate monetary efficiencies in medical care; reformation of the medical malpractice laws to diminish defensive medicine practices; and, diminished paperwork and administrative expenses through greater computerization of records. The Democratic plan would require that all employers provide health insurance for their workers through either a private insurance plan or a governmental plan (’play or pay’ plan). This public plan is largely unspecified and could feasibly entail either a larger scale Medicare-like scheme or simply a government-coordinated system of incremental existing health providers. For all the non-employed individuals, enrollment in the government plan would be guaranteed, with federal subsidies for those unable to pay premium costs. 1. Democratic cost controls would be managed through: federal control of health care costs in both the aggregate and by respective state; state developed fee ceilings for health care practitioners and providers; reform of malpractice laws; and, diminished administrative costs. Although these are the official party plans, anything is possible since virtually any dramatic change in the health care system is dependent upon Congressional legislation. Even though the current Congress has a Democratic majority in both houses, this is by no means a certainty when the dust settles after the November election. Even a president with the majority party in the Congress may get far fewer pieces of legislation approved than proposed. The November 3 election thus promises to be a very public referendum on health care by the voting populace. From the Presidential race to the almost 500 Congressional contests, the US public will be formulating the changes that will occur in the country.

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Presidential politics and health care issues.

Presidential Politics and Health Care Issues Steven R Moore, RPh, MPH, FRSH Interim Chair, United States Branch, Royal Society of Health; Captain, U...
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