By Susan J. Blumenthal, M.D., Jessica B. Rubin, Michelle E. Treseler, Jefferson Lin, and David Mattos*
The next president of the United States will confront major health policy decisions that will affect the lives of all Americans. With the first of the presidential caucuses and primaries only six months away, the pressure is on for the candidates to provide Americans with their plans to improve the nation's health care system -- and rightfully so. Despite spending over $2 trillion a year on health care -- 18% of the U.S. GDP and twice as much as any other nation -- the United States ranks only 45th in life expectancy and 37th in a World Health Organization study on the performance of national health systems. 1,2 The U.S. federal government currently spends more on health care than on Social Security and national defense combined, the next most expensive items, but Americans get the right treatment only 55% of the time.3 Expenditures on health care in the United States -- already the highest per person in the world -- are predicted to nearly double by 2016, to $4.1 trillion, or 20% of GDP. That means, if this trajectory is not altered, in less than a decade, 20 cents out of every dollar produced in America will be spent on health care. Currently, more than 75% of health care dollars are spent on patients with chronic diseases, yet an estimated 80% of all chronic diseases are caused by preventable factors, such as smoking, obesity, and physical inactivity.4,5 But despite these statistics, less than 5 cents of every health care dollar is spent on prevention and public health.
A recent poll conducted by the Kaiser Family Foundation found health care to be the second most mentioned issue that Americans would like to hear presidential candidates discuss and for the government to address.6 Iraq remains the foremost concern, yet it is important to note that health care tops the list of Americans' domestic priorities. This means that no presidential hopeful can effectively meet the needs of the American people without addressing the essential issues of access, affordability, efficiency, and quality of our nation's health care system. As evidenced in the recent debates, both Democratic and Republican presidential candidates are seeking to demonstrate to the American people an understanding of health care issues and their far-reaching impact on the health, economy, and security of our country.
The presidential candidates are generally in agreement that the next administration should work towards reducing health care costs, delivering high-quality patient care, placing an increased emphasis on prevention, and providing coverage for the estimated 45-47 million uninsured Americans (1 out of every 7 people). While most Democratic and Republican candidates propose that every American should have access to affordable health care, the debate on how to achieve this goal is reflected in their differing philosophies and proposed methods.
With our current sick care system, Americans cannot afford -- socially, politically, economically, or otherwise -- to remain on the sidelines. We have a window of opportunity to establish a real health care system with the upcoming 2008 presidential election. It is up to the presidential candidates and the American public to bring health care concerns to the forefront, and engage in meaningful dialogue about various proposals to provide quality health care to all Americans. And then it is up to us to vote. But how do we as members of the voting public effectively navigate, compare, and evaluate the presidential candidates' health care goals and proposals?
This article provides a detailed analysis, in chart form, of the presidential candidates' current health care proposals based on information provided on their websites (much of it in their own words) as well as from interviews and statements they have made to the press and in the debates thus far. While a few of the candidates have offered detailed proposals with specifics of implementation, most of them have only limited information available about their health plans.** We hope this side-by-side comparison will serve as a compass for voters trying to decide which candidate will write the best prescription for a healthier future for all Americans in the next decade and beyond. This prescription will not be filled, however, unless our next president can successfully resolve issues raised by various interest groups including insurance companies, the pharmaceutical industry, businesses, health care providers and hospitals. And the prescription will not be complete unless the presidential candidates also describe and integrate their strategies for increasing funding for scientific research, strengthening the public health infrastructure, and supporting enhanced investments in global health. Future articles will shine a spotlight on these issues and provide updates on the candidates' health plans as more information becomes available.
Links to Presidential candidates' health proposals/websites (alphabetical order)
*Susan J. Blumenthal, M.D., M.P.A., served as Assistant Surgeon General of the United States and Deputy Assistant Secretary for Health in the U.S. Department of Health and Human Services. She is a Clinical Professor at Georgetown and Tufts University Schools of Medicine and Distinguished Advisor for Health and Medicine at the Center for the Study of the Presidency (CSP) in Washington D.C.
Michelle Treseler, a recent honors graduate of the College of William and Mary, serves as Special Assistant to Dr. Blumenthal at the Center for the Study of the Presidency. Jessica Rubin, a junior at Yale University, Jefferson Lin, a senior at Williams College, and David Mattos, a junior at Harvard University, are health policy interns at CSP.
**A comprehensive review was undertaken of the candidates' campaign websites as well as information readily available on the Internet about their health care plans. Readers are encouraged to visit the candidates' websites listed below for more information and updates on the specifics of their health care proposals.
Please cite Susan J. Blumenthal, M.D., Jessica B. Rubin, Michelle E. Treseler, Jefferson Lin, and David Mattos. U.S. Presidential Candidates' Prescriptions for a Healthier Future: A Side-by-Side Comparison. Huffington Post 9 July 2007. in any future use of this material.
1 CIA: The World Factbook, June 19, 2007.
2 "Health Systems Performance Assessment," World Health Organization.
3 Goldman, DP and McGlynn, EA, "US Health Care: Facts About Cost, Access, and Quality," RAND Health Report Jan 2005.
4 "Chronic Disease Prevention and Health Promotion," National Conference of State Legislatures, July 6, 2007
5 "What is Self Improvement?" Duke University Medical Center, July 6, 2007
6 "Kaiser Health Tracking Poll: Election 2008--June 2007," Kaiser Family Foundation, June 20, 2007.