Health Care ’08: How Do the Candidates Compare?

Republicans

Perhaps the most striking aspect of the Republicans’ health care plan is their lack of one. Not a mention of health care in the “issues” section on Rudy Giuliani’s or John McCain’s Web sites; only Mitt Romney has a couple sentences describing his views. Closer to the election, things will undoubtedly change, but it is clear that this issue is of less importance in the Republican primaries.

Through speeches and statements made to the press, however, one can garner an idea of how the leading Republicans—Guiliani, Romney, and McCain—plan to address the health care problem in this country. As you would expect, it is markedly different from the Democrats.

All three emphasize a shift away from government and employer run systems to a place where the free market and personal responsibility rule.

Guiliani feels that part of the problem with our health care system is that the government and employer dominated structure gives people less personal choice. He wants to take more people out of the employer-based health care model and into the free market to increase competition and drive down costs, making health insurance more like car or home insurance. Making private insurance affordable would mean offering tax cuts—to the tune of $15,000 per family, $7,500 for an individual—and encouraging more people to set up personal Health Savings Accounts (HSAs), to which people could contribute pre-tax income to pay for future medical expenses. 

McCain has a similar approach—emphasizing tax credits for low-income citizens and creating more HSAs—as well as expanding community health centers.

For the Republicans, cost and prevention come in the same bullet: by making people more financially responsible for their health care, it incentivizes healthy behavior and makes people more value-conscious; money not spent at the doctor is money in your health savings account.

Interestingly, the candidate who has the most impressive health insurance track record—Mitt Romney—rarely talks about it. As Governor of Massachusetts, Romney mandated universal health insurance for every citizen, making it the first state to do so and a model (or a guinea pig, depending on your perspective) for other states that want to follow suit. However, because Republicans in general are averse to having government mandates, Romney is instead emphasizing market reform—not government controlled programs or mandates—as a way of increasing coverage. He would also allow states to tailor programs to their needs.