Looking for stark contrast between John Kerry and President Bush? Forget Iraq or the war on terror; instead consider the centerpieces of their domestic agendas.
The choice is basic: Should all of Bush’s tax cuts become permanent? Or should they be repealed for people making at least $200,000 a year to pay for dramatically reducing the number of uninsured Americans?
In the campaign for president, health care has received nowhere near the focus as the threat of terrorism and war in Iraq, but it could prove a crucial issue. Health premiums increased four times faster than workers’ earnings last year, according to the Kaiser Family Foundation. In March, a survey by the nonpartisan Commonwealth Fund found that 57 percent of Americans said health care would be a “very important” factor in their presidential choice.
None of Kerry’s domestic policy proposals are as costly as his health care plan.
He would spend at least $653-billion over 10 years to cut by two-thirds the more than 43-million uninsured Americans. To pay for it, the top 2 percent of taxpayers would see their tax rates return to the level they were when Bush took office.
Kerry pitches his plan to expand health coverage as not just a “moral” obligation, but as a way to help squeezed middle-class families and businesses facing double-digit premium increases. He estimates his health care plan will save families up to $1,000 per year on premiums.
“Clearly, we can do a better job of lowering costs for doing business in America,” the four-term senator said last week, campaigning in Iowa.
Among the most dramatic elements of Kerry’s plan: create a federal reinsurance pool that would reimburse businesses for three-quarters of any employee’s medical expenses that topped $50,000 a year.
Such catastrophic cases account for less than 1 percent of all claims, but nearly 20 percent of the nation’s health care costs. Kerry contends spreading the risk and cost of these cases would reduce uncertainty and lower premiums and expenses for employers, workers and insurers.
Similar to the federal government’s flood insurance program, Republicans and Democrats alike have supported the concept over the years. To be eligible for the federal reimbursement, employers would have to provide health insurance for every worker and offer preventive health care programs.
Critics say Kerry would merely shift private sector costs to taxpayers.
Bush also proposes to cut the number of uninsured Americans, but far more modestly and less expensively than Kerry.
Relying largely on tax credits and tax-subsidized health savings accounts, he would cover roughly 1.5-million to 4-million more people, at a 10-year cost of about $90-billion, according to independent analysts.
"The real choice is that President Bush says, “I believe in a low-tax America,’ and Sen. Kerry believes the upper end could pay higher taxes, but you address the number of uninsured very significantly,” said Robert Blendon, a professor of health policy and management at Harvard University.
But Bush has pushed dramatic health care initiatives, too. Adding a prescription drug benefit under Medicare, passed late last year, is expected to cost the federal government more than $534-billion over 10 years.
To address people’s lack of health coverage, Bush wants to encourage the uninsured to buy health insurance by offering tax credits. Families with more than two children could receive up to $3,000 a year in credits, depending on their income. A family earning $40,000 a year would receive a tax credit of about $1,700.
Kerry’s plan, despite its steep price tag, is far less sweeping than Bill Clinton’s ill-fated health care proposal of 1992. Rather than revamping the entire structure of America’s health care system, much of the cost of Kerry’s program is to expand existing programs.
He would raise the maximum income levels for children and parents to be eligible for Medicaid and the State Children’s Health Insurance Program, an effort to help working families caught in the middle - with too much income to qualify for government help but not enough to buy their own insurance.