Two Presidential Candidates Discuss Health Care During Recent Appearances

Summaries of two recent developments in the presidential campaign related to health care appear below.

• Sen. Hillary Rodham Clinton (D-N.Y.): Clinton on Friday at a news conference in Des Moines, Iowa, defended her recent criticism of the health care proposal announced by rival Sen. Barack Obama (D-Ill.), the New York Times reports. Clinton said, "I think contrasts are legitimate. My goodness, there are big differences between me and ... Sen. Obama on health care." Clinton has announced a health care proposal that would require all U.S. residents to obtain health insurance, but the Obama proposal would require coverage only for children, the New York Times reports. She added, "I think that is a legitimate issue in this campaign. He has a health plan that doesn't cover every American. My plan does." In response to a question about whether her campaign would air advertisements that criticize the Obama proposal, Clinton said, "I don't know what we're going to do -- you'll have to stay tuned" (Phillips, New York Times, 12/15).
  
  
• Former Sen. John Edwards (D-N.C.): Edwards last week during an appearance at a high school library in Marshalltown, Iowa, said that all U.S. residents do not have health insurance because of opposition from the industry, the Pittsburgh Post-Gazette reports. He said, "Why don't we have universal health care? We don't have it because of the drug companies and the insurance companies and their lobbyists." He added, "Why do we have that mess of a prescription drug bill? Because the insurance lobbyists wrote the thing" (O'Toole, Pittsburgh Post-Gazette, 12/16). During an appearance on Friday at the Iowa City Public Library, Edwards criticized Obama for his willingness to negotiate with pharmaceutical companies and health insurers as part of his health care proposal. "I know some people suggest we'll be able to sit at the table with drug companies and oil companies and think they can get their power away. Right," Edwards said, adding, "I'll tell you when they'll (corporations) lose their power: when we take it away from them" (Jones, Chicago Tribune, 12/16).

Editorial Examines Giuliani Record
Former New York City Mayor Rudy Giuliani (R), "one of the least conservative" Republican presidential candidates, is "quite liberal" on some issues related to health care and other policy areas, a Washington Times editorial states. According to the editorial, on abortion, Giuliani says that he would "encourage adoptions" but would "respect a woman's right to make a different choice," and he also supports the use of federal funds for embryonic stem cell research. However, Giuliani has proposed tax breaks -- $15,000 for a family of four -- to help U.S. residents purchase health insurance, a plan supported by many conservative Republicans (Washington Times, 12/15).

Opinion Pieces

• David Himmelstein and Steffie Woolhandler, New York Times: Former President Richard Nixon in 1971 "sought to forestall single-payer national health insurance" with a proposal to "combine a mandate, which would require that employers cover their workers," with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income," and the plan, although "never passed, refuses to stay dead," Himmelstein and Woolhandler, professors of medicine at Harvard University and co-founders of Physicians for a National Health Program, write in a New York Times opinion piece. Clinton, Edwards and Obama have proposed "Nixon-like reforms" for health care, and their plans "resemble measures that were passed and then failed in several states over the past two decades," according to the authors. In addition, as governor of Massachusetts, Romney "tweaked the Nixon formula in 2006 when he helped devise a second round of Massachusetts health care reform: employers in the state that do not offer health coverage face only paltry fines, but fines on uninsured individuals will escalate to about $2,000 in 2008," the authors write. The state "reform efforts promised cost savings, but none included real cost controls," the authors write, adding, "As the cost of health care soared, legislators backed off from enforcing the mandates or from financing new coverage for the poor." According to the authors, the "mandate model" for health care "reform rests on impeccable political logic: avoid challenging insurance firms' stranglehold on health care," but "it is economic nonsense," as the "reliance on private insurers makes universal coverage unaffordable." The major Democratic presidential candidates "sidestep an inconvenient truth: only a single-payer system of national health care can save what we estimate is the $350 billion wasted annually on medical bureaucracy and redirect those funds to expanded coverage," the authors write, adding, "How sad that the leading Democrats are still kicking around Nixon's discredited ideas for health reform" (Himmelstein/Woolhandler, New York Times, 12/15).
  
  
• Paul Krugman, New York Times: The willingness of Obama to negotiate with pharmaceutical companies and health insurers as part of his health care proposal "comes off looking, well, naïve," according to Times columnist Krugman. Obama is "being unrealistic here, believing that the insurance and drug industries -- which are, in large part, the cause of our health care problems -- will be willing to play a constructive role in health reform," Krugman writes, adding, "The fact is that there's no way to reduce the gross wastefulness of our health system without also reducing the profits of the industries that generate the waste." According to Krugman, as a result, "drug and insurance companies -- backed by the conservative movement as a whole -- will be implacably opposed to any significant reforms." He adds, "Anyone who thinks that the next president can achieve real change without bitter confrontation is living in a fantasy world" (Krugman, New York Times, 12/17).
  
  
• David Broder, Washington Post: The presidential debates last week in Iowa indicate "sharply contrasting positions" on health care and other issues among Democratic and Republican candidates, "setting up an election of large consequence," Post columnist Broder writes. "When it comes to ... health care, the Republican plans rely on the magic of the marketplace -- competition and consumer choice -- to improve quality and reduce costs," and the "Democrats would increase government leverage on drug prices," Broder writes (Broder, Washington Post, 12/16).

Broadcast Coverage
NPR's "Talk of the Nation/Science Friday" on Friday included a discussion with Uwe Reinhardt, a James Madison professor of political economy at Princeton University; J. Fred Ralston, chair of the health and public policy committee at the American College of Physicians; and Donald Berwick, president and CEO of the Institute for Healthcare Improvement, about how to improve access to care within the U.S. health care system (Flatow, "Talk of the Nation/Science Friday," NPR, 12/14). Audio of the segment is available online.