ELECTION 2008

Democratic Presidential Candidates Propose Pragmatic Approaches to Universal Health Care To Avoid Pitfalls of 1990s Health Reform Effort

A number of Democratic presidential candidates -- including Sens. Barack Obama (Ill.) and Hillary Rodham Clinton (N.Y.) and former Sen. John Edwards (N.C.) -- support health care reform approaches "that borrow from the Massachusetts model," a law enacted last year in that state that "took key elements of the 1993 Clinton plan and made them practical politically," the Washington Post reports. Obama and Edwards have released plans to achieve expanded coverage using elements of the Massachusetts plan. Clinton has outlined an agenda to address health care costs, and is expected to focus on quality and "insuring everyone" later this year, according to the Post.

The Post reports that Massachusetts Institute of Technology economist Jonathan Gruber, who helped with the Massachusetts law, has consulted with the three leading Democratic candidates and is "possibly the [Democratic] party's most influential health care expert and voice of realism in its internal debates." Gruber said, "Plans which minimize the disruption to the existing system are more likely to succeed than plans that rip up the existing system and start over." He added, "It doesn't take a genius to see that. That's not to say that plans ripping it up wouldn't be better -- I just think they're political non-starters."

However, Ezekiel Emanuel -- a physician and bioethics expert who has consulted with some candidates and who is Rep. Rahm Emanuel's (D-Ill.) brother -- advocates replacing the current health care system with a plan that would allow people to buy health coverage with vouchers. Emanuel said that the proposals of the leading Democratic candidates are not "bold," adding, "I don't think they solve the problem."

Meanwhile, Republican presidential candidates -- including former Massachusetts Gov. Mitt Romney, who signed the 2006 health reform bill into law -- have depicted the Democratic candidates' proposals as "socialized medicine," the Post reports.

John Sheils, a health care expert at the Lewin Group, said that the Democratic candidates' proposals might not be entirely realistic. "There is an idea you can somehow do all these things controlling costs without anybody doing anything they don't want to do," Sheils said (Bacon, Washington Post, July 10, 2007).

Opinion Piece
"We believe that health insurance providers can promote health, improve quality and reduce costs, thereby creating the means to provide universal access," Aetna Chair and CEO Ronald Williams and Aetna Chief Medical Officer Troyen Brennan write in a Post opinion piece. "We are glad to see presidential candidates support these same goals," they write, concluding, "We hope that politicians and the public recognize that providing access to care that is proven effective and efficient is going to be critical to meaningful reform and that health plans have real expertise to bring to the table" (Williams/Brennan, Washington Post, July 10, 2007)