President George W. Bush wants to use the tax code to encourage people to buy health insurance for themselves. Sen. John Kerry wants the federal government to pay the bills whenever an individual's medical costs climb above $50,000 in a single year. Those are the core differences between the healthcare prescriptions from the Republican incumbent and his opponent, the Democratic senator from Massachusetts.
For President Bush, tax cuts are at the heart of his conservative, small-government outlook: He says he wants to give individual Americans control over more of their own income, and allow less money to be available for the government. Sen. Kerry takes a traditional Democratic approach: He believes in the efficacy of government programs and wants to pay for his healthcare proposals by repealing the Bush tax cuts for people earning more than $200,000 a year.
Small government vs. big government, tax cuts vs. spending for social purposes-this clash of philosophies permeates the beliefs and ideas of the two candidates and is clearly expressed in their approaches to healthcare.
The price tag for the Bush proposal is an estimated $102 billion over 10 years. The Kerry plan would cost almost 10 times as much, about $650 billion over a decade. The Bush plan would bring coverage to an estimated 6 to 10 million people who currently lack health insurance. The Kerry proposals are estimated to expand coverage to 27 million uninsured people.
Significantly, neither man claims he can figure out how to bring health insurance to all of the 43 million Americans who have no coverage. Most of them are full-time workers, and their spouses and children. The majority of Americans get their health insurance on the job. If they don't, insurance is often expensive and difficult to obtain, especially for individuals and families with health problems.
Both candidates prefer taking an approach of modest gradualism, at least compared with recent political history. Even Kerry, although a staunchly liberal Democrat, doesn't aspire to the dramatic proposals of former President Bill Clinton, who promised as a candidate in 1992 to bring healthcare to all uninsured Americans, to safeguard continuity of coverage for those who already had it and to bring inflation in healthcare under control. Clinton failed in all of those bold goals, despite having his party in control of both the Senate and the House for the first half of his first term. Actually, the Democratic Congress never even brought his proposals up for a final vote before the Republican surge in the election of November 1994 returned the GOP to control of the House for the first lime in a generation.
So neither Sen. Kerry nor President Bush claims he can control health costs while bringing everyone under the sheltering umbrella of a good insurance policy.
BUSH'S TAX CREDITS AND HEALTH ACCOUNTS
President Bush wants to use the tax code in the health arena. He would provide tax credits of up to $1,000 for an individual and $3,000 for a family to help defray the cost of buying coverage. He has proposed such tax credits before, but Congress has not enacted them. However, Congress did create a new Health Savings Account (HSA) as part of last year's legislation that added prescription drug coverage to Medicare for the first time. The Health Savings Account combines a high-deductible insurance policy with a tax-free savings account similar to an individual retirement account. The policy deductible must be at least $1,000 a year for an individual and $2,000 for a family.
In addition, the annual contribution to a savings account varies depending on the size of the deductible: It can be as much as $2,600 for an individual and up to $5,150 for a couple. Someone age 55 or older can add another $500 per year to the individual account. Funds left in a Health Savings Account at the end of each year in the plan can be rolled over into the next year and grow tax-free. …