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Tough Choices Ahead: Candidates Ignore Pain of Needed Cuts to Health Costs |
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From The Commonwealth Fund: Commentary on The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey on the Presidential Candidates Health Reform Proposals by Dallas L. Salisbury, president and CEO of the Employee Benefit Research Institute and a member of The Commonwealth Fund Commission on a High Performance Health System. President Franklin D. Roosevelt's tenure saw the first proposals for universal health insurance. The creation of Medicare and Medicaid in 1965 was seen by most as major reform, but by 1968 President Nixon was talking of a health care cost crisis, demanding more reform and proposing a universal coverage program. The nation experimented with managed care just long enough to determine that although it did hold down costs, it also limited individual choices and allowed tough decisions on care that consumers did not like. Researchers at the Heritage Foundation, a conservative think tank, suggested in that debate of the early 1990s that the answer was an individual mandate, an end to employment-based coverage and major changes in the tax treatment of health insurance benefits. Most would support the option of purchase into the federal employee program. Barack Obama (D-Ill.) does not favor a mandate, but did say in New Hampshire that his first preference was a single-payer system---he just doesn't think it could become law. As recently as the final New Hampshire Republican debate the candidates condemned the "socialist" proposal of an individual mandate "coming from the Democrats." Republicans mainly suggest that moving to an individually based system where individuals have to pay more will bring a market solution: lower spending.
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