Health promises scarce among US presidential candidates
CMAJ 2000;162:1032
Unlike 1992, when Bill Clinton rode the promise of universal health care right into the White House, this year's American presidential candidates are much more circumspect about using health care reform as a campaign issue. None is advocating any grand design to throw a safety net over the 44 million Americans who have no health insurance, but all are advocating incrementalism. And none is even hinting at a single-payer national health service like Canada's — especially given the American media focus on ER shutdowns and growing waiting lists in Ontario, Quebec and most other provinces. Yes, these made headlines south of the border this winter.
In their run-up to the primaries, Democratic contenders Al Gore and Bill Bradley put forward proposals to expand health insurance to children through the State Children's Health Insurance Program (CHIP), provide tax breaks to small businesses to offer health insurance, add a prescription drug benefit to Medicare (the program that covers the nation's elderly and some disabled patients) and provide scaled subsidies to families with limited incomes so that they might buy into the Federal Employees Health Benefits Program. That giant program, which is available to federal employees, pools hundreds of private plans to get members better rates and more options. Bradley, who lost the race to Gore, also would have required parents to buy insurance for their kids. On the Republican side, Texas Governor George Bush and Arizona Senator John McCain would also make CHIP money more readily available and would expand the range of Medicare and Medicaid. Bush, who appeared certain to win the race, would push a national program to allow individuals to sue their HMOs for shoddy care or denial of coverage; this is already law in Texas. McCain had advocated a law to empower people to insist that insurers and HMOs conform to certain service levels.
Clinton too has waded into the campaign, pushing a $110-billion package of health insurance initiatives including expansion of CHIP and Medicare and Medicaid, offering tax credits for small businesses that provide workers with insurance and allowing workers as young as 55 to buy into Medicare; it is now available only to those 65 or older. He hopes Congress will act on his bill before he leaves next January, but there is little chance of that happening.
Even the insurance industry has come on board with a renewal of its famous Harry and Louise campaign, which in the early 1990s lampooned the Clinton attempts to impose a federal bureaucracy over the nation's health care. It has now modified its message to advocate making it easier for people to buy private insurance, government subsidies for low-income workers and tax credits for small employers. — Milan Korcok, Florida
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