printable version5 questions: Baker on health policy in the presidential campaign
An occasional feature in which a medical expert answers five questions on a science or policy topic of interest to the Stanford community
Laurence Baker
Health-care reform is sure to be a factor in Tuesday’s presidential election. Over the last four years, the number of people without health insurance has increased by 5 million, as costs have continued to spiral ever higher. The issue was certainly a subject that the candidates debated, but it remains to be seen what impact that debate will have on public opinion.
To gain a better understanding of how the campaigns affected the prospects for new health- care policies, Paul Costello, executive director of the medical school’s Office of Communication & Public Affairs, asked Laurence C. Baker, associate professor of health research and policy, for his thoughts on the discussion—and the rhetoric—in the presidential race.
1. Do you think either candidate’s case for health-care reform has given him an advantage on the issue heading into the election?
Baker: It’s not hard for them to make the case that the health-care system needs attention—opinion polls consistently report that the U.S. electorate thinks so—and both candidates hit the point regularly. But where they go from there, like most things in this campaign, differs markedly.
Kerry’s plan has more to offer those who are without coverage or worried that they will lose their coverage, but it also involves more government and is more expensive. Bush’s plan is much less aggressive. It doesn’t offer as much, but it’s also cheaper and oriented more toward the private sector.
Health care is a traditional Democratic issue. With the bolder plan I’d give Kerry the edge, but it’s a narrow one, given the deep-seated distaste for government in American politics.
More importantly, the debate hasn’t spent a lot of time on the actual substance of the plans. It isn’t clear who gains the advantage with all the rhetoric on tort reform, drug reimportation and accusations of government takeovers of the health-care system.
2. When all is said and done has America had a good debate about the possible solutions to the health-care crisis?
Baker: No. Neither candidate wants to talk about the realities of health-care reform.
Bush in particular seems prone to oversimplifying the issues. He promises large savings from tort reform based on widely disputed facts. He also makes overblown accusations about the costs of the Kerry plan and the impact that it will have on the amount of government control over health care.
Kerry also oversimplifies the benefits and minimizes the downsides of his plan, though without being quite so misleading.
This election does offer a choice between two very different visions of health reform—a smaller scale market-based reform and a larger-scale government-centered reform. At some level, I hope that this chance to think about different approaches helps further our national discussion, but I fear the rhetoric has seriously distorted the actual facts.
3. So what did they miss?
Baker: Getting a handle on America’s health-care problems will require important tradeoffs. Truly addressing the problem of the uninsured will require a broad, government-run program.
Dealing with rising health costs will require confronting the fact that they are rising mainly as a result of increases in the capabilities of the medical system that also produce benefits for patients.
Government-run programs may be able to handle the complex tradeoffs required to balance the costs and benefits of new therapies, but market systems probably have an advantage there. These are real tradeoffs, and they won’t go away. This debate will need to continue over more time (and with far greater substance) than we’ve had in this election.
4. What are American voters most likely to remember about health care from this presidential campaign?
Baker: I’m worried that it will just be that trial lawyers are the main reason that health-care costs are rising, and that importing drugs from Canada would save the system, neither of which is true.
5. Are you surprised at how much stem cell research has been talked about in the campaign?
Baker: The Republican Party is in a difficult position with stem cell research, constrained by the views of their right wing. The Bush administration’s convoluted policy position supporting stem cell research using only a small set of cell lines is one result. The reports of research successes lately only heighten interest in this area and emphasize the restrictions that Bush has imposed.
The Bush policy is politically vulnerable, so the Democrats use it. This gives Kerry an advantage, but how big isn’t clear—polls put this as an issue that many voters notice, but not as one of their top priorities.