RESEARCH General Health

POLITICS AND HEALTH CARE
Bush and Gore hope their health plans win hearts and votets of elderly

Mark Reutter, Business Editor
(217) 333-0568; mreutter@uiuc.edu

10/1/2000

CHAMPAIGN, Ill. -- The fact that the Democratic and Republican presidential candidates advocate prescription drug coverage for seniors tells us less about the future of U.S. health-care delivery than it does about the present-day clout of the nation's 33 million elderly.

"Look at (Vice President) Al Gore," said Robert F. Rich, a UI political scientist who has written extensively on health-care reform. "He rails against unfeeling HMOs, wants Medicare to cover prescription drug bills for seniors, and, poof, his poll numbers climb. George Bush sees his poll numbers going south, especially the women's vote, so his prescription is to seize the same issue."

How to handle medical costs and coverage has been percolating in national politics ever since Republicans in Congress beat back President Clinton's health-care initiative in 1994, UI economist Richard J. Arnould said.

"What was not achieved then on the federal level dropped down to the state level, where the embarrassing matter of families without health insurance, especially children, has been tackled piecemeal," Arnould said. "But despite a booming economy, there are no fewer uninsured Americans today than in 1994."

The Bush plan would use the states to provide short-term relief for prescription drug bills. Some $48 billion in federal block grants would be distributed to help the states buy drugs for low-income elderly. Bush would then take another $110 billion to partially privatize Medicare, giving beneficiaries a choice of private insurance plans with prescription drug coverage at a lower market-based cost.

"Medicare is almost sacrosanct among the elderly – it's 'cut government waste, but don't you touch my Medicare,' " said Richard J. Kaplan, a UI law professor who founded the Elder Law Journal, a UI research publication. "Neither plan is radical," Kaplan continued. "Bush's plan is in keeping with Republican ideas to limit government bureaucracy, whereas Gore's plan is in keeping with Democratic ideas to expand a government program to include prescription-drug coverage."

Medicare, however, differs from private insurance in that "it takes all comers," Kaplan pointed out. "Private insurance is essentially based on profiling. It seeks to enroll only those people whose lifestyles or pre-existing medical conditions will not cost the insurer a lot of money."

So the real question is not the cost of private prescription drug plans, Kaplan said, "but whether those with pre-existing medical conditions or in need of expensive drugs could ever get enrolled in such plans."