The Politics Of Health Care

The wail of an ambulance. For too many Americans, it is mood music, the accompaniment to their worst fears.

In the United States, 44 million people have no health insurance.

More than a third of the U.S. elderly population has no prescription drug coverage and can't afford to pay retail.

In the next year, close to a million seniors will be told their Medicare HMOs can no longer afford to take care of them.

While some might consider these depressing statistics, here's something to put them in context: Both Democrats and Republicans believe that health care issues could very well decide this year's presidential election. Correspondent Martha Teichner reports.

And we've seen both candidates running as fast as they can away from anything resembling the Clintons' disastrous attempt in 1993 to pass one big package of health care reforms.

"That was the lesson of the Clinton plan, that it's a mirage to think that there's a single plan that America across the board is willing to endorse to fix the health care problems," says Dr. Robert Blendon, professor of health policy and political analysis at Harvard University. He thinks the Republicans learned something else as well: that they couldn't ignore health care.

"That's what Gov. Bush's father got in trouble with: health care," explains the professor. It sounded like his answer in 1992 was "I'm just not going to deal with this problem," he says.

"So the son, absolutely, is not going to be caught in that position," Blendon says. "So whenever there's an issue that is on the voters' mind, and the vice president has a position, the governor will have a position."

So in Campaign 2000, Bush and Gore are agreeing on exactly the same list of health care problems that need fixing. They both want a prescription drug benefit for seniors under Medicare, coverage for the uninsured, and a patients' bill of rights, allowing people to sue their HMOs.

"The Democratic plans tend to cover a bit more people," says Blendon. "They tend to be more comprehensive."

"They tend to involve more government," he adds.

"The Republican plans are usually more modest," he continues. "They don't cover as much, but they're not as expensive." Says Blendon: "They would never ask for the same level of taxes."

Who will best serve the nation's health needs? Bush thinks private insurance companies. Gore thinks the state and federal governments.

And who are most likely to support a presidential candidate based on his health care position? Senior citizens, who vote in huge numbers.

Jackie Johnson lives in a suburb of St. Louis, on Social Security.

"My Social Security income is $870," she says. "My medicine is $450 a month," she adds, noting she also has a $122 condo fee.

Until her husband died two years ago, she got by. Now she has to cut corners to make it through the month.

"If anything comes up, it's grim," she says.

Jackie Johnson used to vote Republican. But she told her story to Al Gore when he stopped in the St. Louis area to launch his attack against the big drug companies.

"We should not be putting our seniors in a situation where they have to eat macaroni and cheese every day because they don't have enough money," he told her. "We're going to get you some help to pay for your prescription drugs."

Famous for its arch, beer and ball teams, St. Louis has an additional distinction this year. Politically, it is in play, so it's a place both Al Gore and George W. Bush wanted to be seen talking about health care.

But when Bush picked the inner-city Grace Hill Clinic for his photo op, he hadn't bargained for its medical director, Dr. Robert Edmonds.

"I have lived in the trenches of trying to provide quality, comprehensive health care to a community of families and their children," he says. "And the present non-system failed to support my doing that."

Half the people who use Grace Hill qualify for Medicaid. The rest are the working poor and uninsured. Bush wants to give families like them $2,000 tax credits to help them buy private health insurance.

"A premium for an insurance program in this country today is something like $6,000 a year (for a) family of four," says Dr. Edmonds. "It just doesn't compute," he says. "You don't have to be partisan....All you got to be is rational."

The answer, according to Dr. Edmonds, is some form of universal health care, and that's not what George W. Bush wants to hear. His position is that health care must be dealt with from a private point of view.

"Show me. I'm from Missouri," Edmonds says.

And "Show me the money" might be the appropriate slogan for this election. In the last year, the insurance industry has given money to both candidates. The law limits how much, but we're still talking $5 to Bush for every $1 to Gore.

Take a look at drug company contributions. Nearly $7.5 million go to the Republicans, not quite $2.5 million to the Democrats.

Says Alan Holmer, a spokesman for the pharmaceutical industry, "The concern we have with respect to Vice President Gore's plan is that it is a single, one-size-fits-all, take-it-or-leave-it big government plan, that we believe will inevitably lead to limitations on access to medicines and ultimately price controls on the pharmaceutical industry. That will reduce the revenues that is being plowed back into research and development that drives the new cures and the new treatments for patients."

Chip Kahn is one of those Washington lobbyists you hear about all the time, working congressional offices on behalf of the insurance industry. His message: Show us the money, enough money so the private sector can afford to take on drug benefits and coverage for the uninsured.

"The funds have got to come from someplace," says Kahn. "In the case of most Americans, they receive the coverage through their employers. But for the elderly, for the indigent who are qualified for Medicaid, the money comes from taxpayers."

Forty billion dollars is how much Republicans in Congress are talking about for prescription drugs.

"I think we're hearing the number $40 billion over five years," says Horace Deets, executive director of the American Association of Retired Persons. "I don't think that's going to be enough."

Bush hasn't mentioned a specific price tag. Gore's version will cost $200 billion. But all those numbers haven't quite registered with AARP members yet.

Deets says that half of them do not understand where the candidates stand on positions. The problem is "people really don't understand the details where the devil is hiding," he explains. "Where we see our role is trying to do the analysis and understand it."

If the elderly are in a position to determine the outcome of this election, then the AARP is in a position to mobilize its 34 million members, age 50 and up, to exercise their ballot box clout.

It did not go unnoticed that Al Gore showed up at the AARP national convention and George W. Bush did not. But the group says it's nonpartisan. It intends to force both candidates to flesh out those details where the devil is hiding on all of the priority issues for its members.

"They've indicated the prescription drug coverage is No. 1," says Deets, citing other issues including the patient bill of rights, managed care and long-term care. "The fourth issue is Social Security," he says, explaining that's the non-health issue.

In this election season, it isn't just the presidential canidates eager to get their fingerprints all over health care issues. Congress is just waiting to catch the drift of the political winds in November before styling the final terms of the prescription drug plan that is likely to emerge next year.

Why now? That's simple: Ballot fear.