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September 14, 2004

School Hosts Health Care Debate


Christopher Jennings, Gail Wilensky, and Dean Alfred Sommer, moderator of the debate

Christopher Jennings, Gail Wilensky, and Dean Alfred Sommer, moderator of the debate

A September 13 debate at the Johns Hopkins Bloomberg School of Public Health, "Access to Health Care: The Presidential Positions," exposed John Kerry's and George Bush’s sharply contrasting visions of how to shore up America’s health care system. The American system currently gobbles up 14 percent of the gross domestic product, whereas Germany, with one of the next most expensive systems, spends just 9 percent of its GDP for health care—and manages to insure 100 percent of its population.

George Bush’s representative, Gail Wilensky, PhD, said the president was for individual empowerment through health savings accounts; John Kerry’s proxy, Christopher Jennings, spoke of Kerry’s desire to bolster the existing system and bring more people into it. 

Gail Wilensky

Gail Wilensky

In their opening salvos, Wilensky and Jennings mapped out their candidates' disagreements. Wilensky, a senior fellow with Project HOPE, said that Kerry's much costlier plan—with a price tag of $1.5 trillion over 10 years versus 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 so that insurance companies would be exempt from paying for routine preventive care.

Christopher Jennings

Christopher Jennings

Jennings, president of Jennings Policy Strategies Inc., 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 which 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 (CHIP) has actually lost members; and Medicare is now on schedule to become insolvent 13 years earlier than before. 

Debate highlights:

Who should be covered?
Wilensky said Bush has no problem with providing insurance to all those 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 then 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 in Congress to bring these two expenses more in line with each other has died in Congress. Bush has been supportive of the general idea of mental health parity, said Wilensky, 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 U.S. with drugs is ridiculous: Demand would quickly drive up prices. Jennings said Kerry would beef up the Food and Drug Administration's 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 wants to head off the deaths that obviously can be prevented. “Congress won't regulate tobacco,” said Jennings, “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,” said Wilensky, “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.” —Rod Graham

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Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons or Kenna Lowe at 410-955-6878 or paffairs@jhsph.edu.