US presidential candidates clash over health care
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《英国医生杂志》
President George Bush accused John Kerry of wanting to introduce government run health, which would bring rationing and less choice
Credit: KEVORK DJANSEZIAN/AP
George Bush likened the efficiency of the American healthcare system to that of "the buggy and horse days," and John Kerry described the president as having "turned his back on the wellness of America." Last week, the two men were on stage together for the last time this election season, in the only one of the three campaign debates to focus exclusively on domestic issues.
Grim statistics composed the backdrop for their discussion of healthcare reform—45 million Americans are uninsured, five million have lost their insurance in the past four years, and insurance costs have risen by 36% under the current administration. And the statistics kept coming, as the candidates seemed more inclined to hurl numbers at each other than engage in direct dialogue.
Citing the hundreds of thousands of children who have lost health insurance in electoral battleground states, such as Wisconsin and Arizona, Senator Kerry touted his plan to provide coverage for all Americans: "We're the richest country on the face of the planet," but, "the only industrialised nation in the world not to do it."
"A plan is not a litany of complaints," replied President Bush, who went on to portray Mr Kerry's proposal as a radical and expensive reworking of the system. "We have a fundamental difference of opinion. I think government run health will lead to poor quality health, will lead to rationing, will lead to less choice."
John Kerry's main points on health care
Five million Americans have lost their health insurance since Bush took office
The White House has increased the costs of prescription drugs by blocking the import of generics and preventing Medicare from negotiating bulk rates
Increased coverage would bring down medical costs by promoting early diagnosis and more effective treatments
As president, Kerry would not appoint judges to the Supreme Court who might overturn the right to abortion
George Bush's main points on health care
Malpractice lawsuits are costing the system billions of dollars every year
Kerry's plan will transfer medical decision making from doctors and patients to government bureaucrats
Kerry has underestimated the costs of his proposal
Investment in information technology, such as electronic medical record keeping, will lower costs
Under Mr Kerry's plan, the government would contribute three quarters of the cost of "catastrophic" coverage greater than $30 000 (￡16 638; 24 032) a year ( BMJ 2004;329: 592, 11 Sep). "But let me just say to America," Mr Kerry explained, "I am not proposing a government run programme." Both candidates repeatedly emphasised the importance of consumer choice in their respective plans.
The president pushed once again for "health savings accounts," which would allow workers to purchase cheap insurance plans with high deductibles, while setting aside tax free earnings for spending on health care.
Reciting statistics that have been questioned by both the General Accounting Office and the Congressional Budget Office, Mr Bush asserted that spurious lawsuits cost Americans between $60bn and $100bn every year. He also said that investing in electronic medical record keeping would "wring some 20% of the costs out of the system," while Mr Kerry's plan would cost at least $1.2 trillion.
Mr Kerry argued that increased coverage would yield lower costs; early diagnosis of diabetes, he said, would save the system $50bn. He also promised to facilitate the import of generic drugs from Canada and to promote collective bargaining for lower drug prices. He intends to pay for most of his plan by repealing tax cuts for the richest Americans.
This year's shortage of influenza vaccine became an issue in the debate. "Vaccine manufacturers are worried about getting sued and so therefore they have backed off from providing this kind of vaccine," explained Mr Bush.
The candidates also exchanged views on abortion. Mr Kerry called abortion, "a choice between a woman, God, and her doctor," and challenged Mr Bush on whether he would seek to overturn the Supreme Court's decision supporting that choice. Mr Bush would only say that an "ideal world is one in which every child is protected in law and welcomed to life."(Daniel Engber)
Credit: KEVORK DJANSEZIAN/AP
George Bush likened the efficiency of the American healthcare system to that of "the buggy and horse days," and John Kerry described the president as having "turned his back on the wellness of America." Last week, the two men were on stage together for the last time this election season, in the only one of the three campaign debates to focus exclusively on domestic issues.
Grim statistics composed the backdrop for their discussion of healthcare reform—45 million Americans are uninsured, five million have lost their insurance in the past four years, and insurance costs have risen by 36% under the current administration. And the statistics kept coming, as the candidates seemed more inclined to hurl numbers at each other than engage in direct dialogue.
Citing the hundreds of thousands of children who have lost health insurance in electoral battleground states, such as Wisconsin and Arizona, Senator Kerry touted his plan to provide coverage for all Americans: "We're the richest country on the face of the planet," but, "the only industrialised nation in the world not to do it."
"A plan is not a litany of complaints," replied President Bush, who went on to portray Mr Kerry's proposal as a radical and expensive reworking of the system. "We have a fundamental difference of opinion. I think government run health will lead to poor quality health, will lead to rationing, will lead to less choice."
John Kerry's main points on health care
Five million Americans have lost their health insurance since Bush took office
The White House has increased the costs of prescription drugs by blocking the import of generics and preventing Medicare from negotiating bulk rates
Increased coverage would bring down medical costs by promoting early diagnosis and more effective treatments
As president, Kerry would not appoint judges to the Supreme Court who might overturn the right to abortion
George Bush's main points on health care
Malpractice lawsuits are costing the system billions of dollars every year
Kerry's plan will transfer medical decision making from doctors and patients to government bureaucrats
Kerry has underestimated the costs of his proposal
Investment in information technology, such as electronic medical record keeping, will lower costs
Under Mr Kerry's plan, the government would contribute three quarters of the cost of "catastrophic" coverage greater than $30 000 (￡16 638; 24 032) a year ( BMJ 2004;329: 592, 11 Sep). "But let me just say to America," Mr Kerry explained, "I am not proposing a government run programme." Both candidates repeatedly emphasised the importance of consumer choice in their respective plans.
The president pushed once again for "health savings accounts," which would allow workers to purchase cheap insurance plans with high deductibles, while setting aside tax free earnings for spending on health care.
Reciting statistics that have been questioned by both the General Accounting Office and the Congressional Budget Office, Mr Bush asserted that spurious lawsuits cost Americans between $60bn and $100bn every year. He also said that investing in electronic medical record keeping would "wring some 20% of the costs out of the system," while Mr Kerry's plan would cost at least $1.2 trillion.
Mr Kerry argued that increased coverage would yield lower costs; early diagnosis of diabetes, he said, would save the system $50bn. He also promised to facilitate the import of generic drugs from Canada and to promote collective bargaining for lower drug prices. He intends to pay for most of his plan by repealing tax cuts for the richest Americans.
This year's shortage of influenza vaccine became an issue in the debate. "Vaccine manufacturers are worried about getting sued and so therefore they have backed off from providing this kind of vaccine," explained Mr Bush.
The candidates also exchanged views on abortion. Mr Kerry called abortion, "a choice between a woman, God, and her doctor," and challenged Mr Bush on whether he would seek to overturn the Supreme Court's decision supporting that choice. Mr Bush would only say that an "ideal world is one in which every child is protected in law and welcomed to life."(Daniel Engber)