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John McCain |
Hillary Clinton |
Barack Obama |
Frank Moore |
Party Affiliation |
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Stated goal |
- Provide access to
affordable health care for all by paying only for quality health care,
having insurance choices that are diverse and responsive to individual
needs, and encouraging personal responsibility.
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- Affordable and
high-quality universal coverage through a mix of private and public
insurance.
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- Affordable and
high-quality universal coverage through mix of private and expanded
public insurance.
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- When they say
ÒaffordableÓ, watch out! I
will push for free, universal, pre-natal to the grave health care.
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Date plan announced |
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- May 24, 2007 for cost,
August 23, 2007 for quality, and September 17, 2007 for coverage
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Overall approach to expanding access to coverage |
- Remove the favorable
tax treatment of employer-sponsored insurance and provide a tax credit
to all individuals and families to increase incentives for insurance
coverage; promote insurance competition; and contain costs through
payment changes to providers, tort reform and other measures.
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- Every American
required to have coverage, with income-related tax subsidies available
to make coverage affordable. Private and public plan options would be available
to individuals through a new Health Choices Menu operated through the
Federal Employee Health Benefits Program (FEHBP). Coverage through
employers and public programs like Medicare continues.
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- Require all children
to have health insurance, and employers to offer employee health
benefits or contribute to the cost of the new public program. Create a
new public plan, and expand Medicaid and SCHIP. Create the National
health Insurance Exchange through which small businesses and individuals
without access to other public programs or employer-based coverage could
enroll in the new public plan or in approved private plans.
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- I will have free,
universal, pre-natal to the grave health care. Everybody would be in the same system. Every doctor, nurse, hospital,
including alternative medicine, would be in the same system. Preventative health and
nutrition will be important parts of the health care plan. I will pay for it by cutting the
military, and by cutting the ÒporkÓ and by funneling royalties for drugs,
etc. that are based on research done by public universities and the
government back into the system.
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A. Requirement to obtain or offer coverage |
- No provision.
Opposes mandates for coverage.
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- Individuals must
have health insurance coverage.
- Large employers must
provide an employee plan or contribute to the cost of coverage.
- Most small employers
are not required to offer or contribute to coverage costs but are
provided incentives to do so.
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- Require all children
to have health insurance.
- Require employers to
offer ÒmeaningfulÓ coverage or contribute a percentage of payroll toward
the costs of the public plan.
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- Everybody, in every
state, will be covered equally. All people will have equal access to free, universal, pre-natal
to the grave health care.
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B. Expansion of public programs |
- Give veterans
ability to use their VA benefits to pay for timely high quality care
from providers in the best locations.
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- Medicaid and SCHIP
safety net strengthened Òfor the most vulnerable populationsÓ to plug
gaps, such as lack of coverage for poor, childless adults.
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- Expand Medicaid and
SCHIP.
- Create a new public
plan so that small businesses and individuals without access to other
public programs or employer-based coverage could purchase insurance.
Plan coverage would offer comprehensive benefits similar to those
available through FEHBP.
- Coverage under the
new public plan would be portable.
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- We will need to
train more doctors, nurses, general practitioners with the focus moving
to primary care.
- Bring military
hospitals home! (along with
the military) This will put
to good use the well-trained nurses and doctors of the military health
care system. This system
could be converted for use by the general public. Veterans would be
covered, like everyone else, under the universal health care system.
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C. Premium subsidies to individuals |
- Provide a tax credit
of $2,500 (individuals) and $5,000 (families) to all individuals and
families for the purchase of insurance.
- Require any state
receiving Medicaid to develop a financial "risk adjustment" bonus
for high-cost and low-income families to supplement tax credits and
Medicaid funds.
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- Refundable tax
credit to help working families pay for coverage.
- The value of the
credit would be set to ensure that premiums could not exceed a fixed
percentage of family income, while maintaining price consciousness among
consumers.
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- Make federal
income-related subsidies available to help individuals buy the new
public plan or other qualified insurance.
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D. Premium subsidies to employers |
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- Refundable small
business tax credit to provide an incentive to offer employee coverage.
(High-income small businesses would not qualify.)
- A Òretiree health
legacy initiativeÓ would provide qualifying public and private sector
employers offering retiree health plans with a tax credit to offset
catastrophic health expenditures, Òas long as savings are dedicated to
workers and competitiveness.Ó
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- Federal subsidies
would partially reimburse employers for their catastrophic health care
costs if the employers guaranteed that premium savings would be used to
reduce employee premiums.
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- Employers would not pay for healthcare for their employees
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E. Tax changes related to health insurance |
- Reform the tax code
to eliminate bias toward employer-sponsored health insurance.
- Allow individuals
owning Òinnovative multi-year policiesÓ that cost less than the credit
to deposit the excess into expanded HSAs.
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- Employer-provided
health premiums would continue to be excluded from income taxes except
for Òthe high-end portion of very generous plans for those making over
$250,000.Ó
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- I would also pay for
my free, universal, pre-natal to the grave health care plan with
increased funds from changes in the tax rates. IÕll do away with all tax deductions for over $12,000
income. Instead, there will be a flat tax of 10% on annual income of
less than one million dollars for an individual and less than five
million dollars for a corporation. But the flat tax will jump to 75% on
annual income exceeding these limits.
- The 75% tax on annual
income exceeding these limits would take greed out of the picture for our
health care system.
- My tax plan would also
work to eliminate conflict-of-interest issues in the medical profession,
where treatment protocols become tied to profit motive.
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F. Creation of insurance pooling mechanisms |
- Allow association
plans that meet standards and certification requirements (see item ÒGÓ).
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- New Health Choices
Menu would be offered to all Americans through the FEHBP, offering the
same private plan options available to members of Congress along with a
public plan option similar to Medicare.
- Benefits would be at
least as good as an FEHBP benchmark plan, including mental health parity
and usually dental coverage.
- Employers could buy
coverage through the new Health Choices Menu on behalf of workers or
early retirees.
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- Create a National
Health Insurance Exchange through which individuals could purchase the
public plan or qualified private insurance plans.
- Require
participating insurers to: offer coverage on a guaranteed issue basis;
charge a fair and stable premium that is not rated on the basis of
health status, and meet standards for quality and efficiency.
- Require plans of
participating insurers to offer coverage at least as generous as the new
public plan.
- Exchange would
evaluate plans and make differences among them transparent.
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- I will work to
eliminate the private insurance system we have now.
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G. Changes to private insurance |
- Promote competition
and individual choice of insurance by allowing insurance to be sold
across state lines.
- Encourage innovative
multi-year insurance products.
- Allow small
businesses and self-employed to purchase insurance through any
organization or association. Such entities would have to meet rigorous
standards and certification. Coverage would be portable and would bridge
the time between retirement and Medicare eligibility.
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- Require private
insurers to provide coverage on a guaranteed issue and guaranteed
renewable basis.
- Prohibit insurers
from Òcarving out benefitsÓ or charging higher rates to people with
health problems or who are at risk of developing them. Limit premium
variations on basis of age, gender or occupation.
- Require insurers to
meet minimum loss ratio (including limiting marketing costs) and Òensure
high value for every premium dollar.Ó
- Require all insurers
that participate in federal programs to cover preventive services based
on recommendations of US Prevention Services Task Force and promote
chronic disease management.
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- Prohibit insurers
from denying coverage based on pre-existing conditions.
- Children up to age
25 could continue family coverage through their parentsÕ plan.
- In market areas
where there is not enough competition, require insurers to pay out a
Òreasonable shareÓ of premiums on patient care benefits.
- Prevent insurers
from abusing monopoly power through unjustified price increases.
- Require health plans
to disclose the percentage of their premiums that actually goes to
paying for patient care as opposed to administrative costs.
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- I will work to
eliminate the private insurance system we have now.
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H. State flexibility |
- Give states
flexibility and encouragement to experiment with:
- Use of private
insurance and risk-adjusted payments per episode under Medicaid;
- Alternative forms
of access, insurance policies and providers and different licensing
schemes for providers.
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- State option to band
together to offer same type of choices in a region of the country as
Health Choices Menu.
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- Maintain existing
state health reform plans if they meet minimum standards of the national
plan.
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- My plan will be a
national plan. Everybody,
in every state, will be covered equally. All people will have equal access.
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Cost containment |
- Adopt malpractice
reforms that limit frivolous lawsuits and excessive damages and provide
safe harbors for practice within clinical guidelines and safety
protocols.
- Promote competition
among providers by paying them only for quality and promote use of
alternative providers (e.g., nurse practitioners) and treatment settings
(e.g., walk-in clinics in retail outlets).
- Provide for vigorous
enforcement of federal protections against collusion, unfair business
and consumer practices.
- Invest in prevention
and care of chronic illnesses.
- Increase competition
and reduce administrative overhead costs of private insurance by
permitting sale of nationwide insurance (i.e., not regulated by the
states).
- Require drug
companies to reveal the price of their drugs; allow re-importation of
drugs; and encourage faster introduction of generics and biologics.
- Provide consumers
with more information on treatment options and require provider
transparency regarding medical outcomes.
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- Proposes a 7-Step
Strategy to Reduce Health Costs:
- A national
prevention initiative;
- A ÒpaperlessÓ
health information technology system;
- Chronic care
coordination to improve outcomes;
- Elimination of
insurance discrimination to help reduce administrative costs;
- An independent
ÒBest Practices InstituteÓ to help consumers and other purchasers and
plans make the right care choices;
- ÒSmart purchasingÓ
initiatives to constrain prescription drug and managed care
expenditures (permit the Secretary to negotiate prices for Medicare
prescription drugs, limit direct-to-consumer advertising of
prescription drugs and change patent laws to increase the availability
of generic drugs; and reduce payments to Medicare Advantage plans to
create more level reimbursement with traditional Medicare); and
- Linking medical
error disclosure with physician liability protection.
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- Invest $50 billion
toward adoption of electronic medical records and other health
information technology.
- Promote insurer
competition through the national Health Insurance Exchange and by
regulating the portion of health plan premiums that must be paid out in
benefits.
- Improve prevention
and management of chronic conditions.
- Initiate policies to
promote generic drugs, allow drug reimportation, and repeal the ban on
direct price negotiation between Medicare and drug companies.
- Pay Medicare
Advantage plans the same as regular (traditional) Medicare.
- Require hospitals and
providers to publicly report measures of health care costs and quality.
- Promote and strengthen
public health and prevention.
- Reform medical
malpractice while preserving patient rights by strengthening antitrust
laws and promoting new models for addressing physician errors.
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- My platform states: ÒAll
patents and copyrights will expire in 20 years. Inventions, products,
etc. which are developed with governmental money and/or public
institutions can not be patented.Ó My policy on patents would help medicine -- it would help eliminate
the obscene profit margin generated
by drug and device patents which now serve to create monopolies over a
lot of new products. When
it is no longer possible to set such obscene premiums on many drugs and
devices, they will be available at a much more reasonable price, closer
to the cost of production, and yet still allow a comfortable profit
margin for the companies that produce them.
- Royalties from
medicines and devices that were developed in public universities or by
the government will be returned to the public by way of funding the
health care system. So the
public will see a return on their investment in these public
institutions. These funds
could also help the education system I propose.
- With profit/greed no
longer the driving force in the health care system, medicine and coverage for the so
called Ònon-profitableÓ diseases and services would be better funded and
much improved. There will
be much more funding available for things like primary care, immunizations,
basic health care É things for the public good.
- Since my tax plan
will take profit/greed out of the equation, doctors will be paid at a
more reasonable rate.
- Science and Medicine
need the freedom to explore, not to be reduced to the search for what
will make the most money. My Guaranteed Minimum Income will also help make this possible.
- Preventative medicine
will cut costs. School
meals should be part of the health system. Growing food in schools, and healthy meals in schools
will cut medical costs and improve kidsÕ performance in school. This will also make schools more
a part of their communities, increasing the overall health of the
communities.
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Improving quality/health system performance |
- Change provider
payment to encourage coordinated care (eg., pay a single bill for high
quality heart care rather than individual services).
- Provide Medicare
payments for diagnosis, prevention, and care coordination and bar
payments for preventable medical errors or mismanagement.
- Require transparency
by providers with regard to medical outcomes, quality of care, costs,
and prices.
- Establish national
standards for measuring and recording treatments and outcomes.
- Promote deployment
of HIT.
- Where cost
effective, employ telemedicine and clinics in rural and underserved
areas.
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- Provide federal
recognition to Òphysician-drivenÓ maintenance of certificate (MOC) programs
that promote continuing education about latest advances in care and
procedures.
- Invest in
independent private-public, consensus-based organizations to certify
performance for enhanced reimbursement; identify gaps in existing
quality measures; set priorities for development of new quality
measures; and disseminate most effective protocols and treatments
through a Best Practices Institute.
- Fund improvement of
web-based tools to provide consumers with user-friendly information on
provider performance and development of tools to promote informed
patient choice about treatment options.
- ÒIncentivizeÓ
quality through increased federal payments (e.g., Medicare and FEHBP)
for excellence in care and for innovative care delivery systems.
- Prohibit payment of
Ònever eventsÓ (such as preventable infections) in FEHBP and other
federal programs.
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- Support an
independent institute to guide comparative effectiveness reviews and
required reporting of preventable errors and other patient safety
efforts.
- Reward provider
performance through the National Health Insurance Exchange and other
public programs.
- Address health
disparities, promote preventive care and chronic disease management, and
require quality and price transparency from providers and health plans.
- Require health plans
to collect, analyze and report health care quality data for disparity
populations, and hold plans accountable.
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- In my health care
plan, the primary relationship is between the doctor and the patient –
this is fundamental to my plan. Insurance companies do not have a place in this plan.
- Currently the public
does not know what is really being charged for what, what the real costs
are, so they donÕt get outraged. The patient should know how much is charged for each
service. We donÕt need to
pay someone else to monitor these things, if the patient has the
information regarding costs and charges. My health care plan will respect people by having
this transparency, putting people back in charge of their own health
care.
- Right now, health
care is apportioned according to who has money and who has
insurance. For a medical
system to work, all doctors have to take all patients.
- My health care plan
will explore the following possibilities: Doctors could get paid a
certain amount per patient. Or per service. Or salaried. There are already models for this type of direct payment for
health services, as opposed to the model of using the big insurance
companies as middle-men.
- A key will be the
patient-doctor relationship as the base. Insurance companies are currently standing in the way
of that core relationship. The doctor and patient would decide what the patient needs. This will include all ancillary
services and alternative treatments.
- So there would be no
pre-authorizations needed. The decisions would be between the patient and doctor, based on
what is determined to be the best for the patient, not based upon, as in
the current model, what the insurance company wants to pay for.
- For quality control,
patients could rate doctors, and we will make this rating system
transparent. There could be
a Hearing or Second
Opinion system. And a board review system
of doctors and their treatment choices.
- Hospitals will not be
for-profit institutions.
- Community-based
health services will create jobs, and increase quality of life for
patients and the community itself, especially the elderly. It will be more effective, more humane, and cheaper.
- A combination and
coalescence of the prison/reform system, the education system, and the
health care system will improve all of them.
- Everyone will have
equal access, everyone will have the same health coverage as the
President has.
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Other investments |
- Support federal
research related to science-based care and cure of chronic disease.
- Promote education of
children about health, nutrition, and exercise.
- Support public
health initiatives to stem obesity and diabetes and deter smoking.
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- Provide federal
funding to address nursing though new training and mentoring programs,
linking nurse education and quality and encourage diversity and cultural
competency in healthcare workforce.
- Support initiatives
to reduce health care disparities, including funding for more accurate
data collection, development of quality measures targeted at reducing
racial and ethnic disparities, and prioritizing the development of
medical homes designed to improve quality for minorities.
- Strengthen consumer
protections for long-term care insurance.
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- Expand funding to
improve the primary care provider and public health practitioner
workforce, including loan repayments, improved reimbursement, and
training grants.
- Support preventive
health strategies including initiatives in the workplace, schools, and
communities.
- Support strategies
to improve the public health infrastructure and disaster preparedness at
the state and local level.
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- Well, free education
does more than any of these other plans.
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Financing |
- Not yet specified
although indicates that cost containment measures would make insurance
more affordable.
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- Campaign estimates
cost to be $110 billion a year when fully phased in. $35 billion to be
financed by savings from quality and modernization initiatives.
Additional $21 billion in savings from Medicare private plans,
recapturing Medicare and Medicaid payments to hospitals for the
uninsured, and constraining prescription drug costs. Also $54 billion in
revenue from limiting the tax exclusion for employer-paid health
insurance and discontinuing tax cuts for those with incomes over
$250,000.
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- Campaign estimates
cost to be between $50 to $65 billion a year when fully phased in.
Expects much of the financing to come from savings within the health
care system. Additional revenue to come from discontinuing tax cuts for
those with incomes over $250,000.
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