By Annie Hayashi, Jennie McKee, Peter Pollack, and Carolyn Rogers

Democrats and Republicans square off in race for White House

In the second in a series of reports on presidential candidates and their stances on issues of importance to orthopaedic surgeons, AAOS Now examines the proposals for reforming the current healthcare system put forth by former Gov. Mike Huckabee, R-Ark.; Rep. Dennis Kucinich, D-Ohio; Rep. Ron Paul, R-Texas; and Gov. Bill Richardson, D-N.M.

Information in this article is based on public documents and records; AAOS Now also contacted the candidates’ campaign offices, but was not always successful in obtaining replies to our inquiries.

Mike Huckabee on health: Follow my lead
“We don’t have a healthcare crisis in America, we have a health crisis,” said former Arkansas Gov. Mike Huckabee at an October presidential candidates forum.

The Republican hopeful, who dropped 110 pounds in 2 years after being diagnosed with type II diabetes in 2003, believes the country needs to make a fundamental shift to a preventive healthcare system. In speeches, the marathon runner points to his own weight loss as an example of how a healthy lifestyle and preventive care can help reduce health-related costs nationally.

“If we don’t change the health of this nation by focusing on prevention, we’re never going to catch up with the costs no matter what plan we have.”

The former Baptist minister calls the U.S. healthcare system “irrevocably broken,” and calls for “a consumer-based system, not socialized medicine” on his official campaign Web site.

“Our employer-based system almost totally removes the consumer from normal free-market practices,” he said. “Consumers are shielded from the true cost of care, as well as from decision making, and kept in the dark about quality. Consumers have virtually no incentive to seek out high-quality, low-cost care.”

Costs have skyrocketed because the party paying for the health care—the employer—and the party using the health care—the employee—are not the same. Moving from an employer-based system to a Washington-controlled model would do nothing to change those flaws.

Huckabee’s consumer-based health system would include the following features:

• The use of incentive systems to reward people for making prevention and wellness a priority
• Portable health insurance that belongs to individuals—not their employers—and therefore could not be lost if they changed jobs or took time off to care for children or elderly parents
• Health savings accounts (HSA) that would be available to all people, regardless of their deductible limits

Other measures endorsed by Gov. Huckabee include reforming medical liability laws, adopting electronic record keeping, making health insurance tax-deductible for consumers and businesses, and issuing tax credits for health insurance costs to low-income families.

Dennis Kucinich: Eliminate for-profit health care
Rep. Dennis Kucinich, a Democratic congressman from Ohio and the former mayor of Cleveland, claims to be the only presidential candidate with a plan for a universal, single-payor, not-for-profit healthcare system.

Rep. Kucinch, who co-authored legislation that would establish universal healthcare coverage for all Americans, proposes a plan that would provide comprehensive benefits, including dental, mental health, vision, and long-term care services. It would impose no deductibles, copayments, or cost-sharing. Only public or not-for-profit providers would be allowed to participate.

In a recent interview with The Boston Globe, the congressman explained why he believes his views on health care are unique.

“With 47 million Americans without any health insurance at all and another 50 million underinsured, isn’t it really time to look at other models that exist that are workable for all the other industrialized nations in the world?” he continued. “When you think about it, the only thing that’s stopping us is the hold that private insurers have on our political system … corporate profits, stock options, executive salaries, advertising, marketing, the cost of paperwork.”

During his speech at the Great Los Angeles Health Care Rally on August 11, 2007, Rep. Kucinich emphasized his belief that health care is a “basic human right” that can be met with a universal, not-for-profit healthcare system.

“Let me tell you about the America that can be,” he said. “The America that can be recognizes that all the money that’s spent on health care right now is enough to meet every basic healthcare need. As president of the United States, I’m determined to change the system so that we have health care for all of our people.”

Ron Paul touts HSAs, “negative outcomes insurance”
Rep. Ron Paul is the only major presidential candidate who is also a physician, having practiced as an obstetrician-gynecologist for more than 40 years. Described by Time magazine as a “libertarian Republican,” Rep. Paul previously ran for president in 1988 on the Libertarian Party ticket. He tends to view the rights and responsibilities of the federal government using a very strict interpretation of the U.S. Constitution, and this philosophy also affects his positions on healthcare issues.

As an alternative to directly limiting what he calls “costly and destructive” litigation, Rep. Paul has introduced the Freedom from Unnecessary Litigation Act—a bill that would provide tax credits for “negative outcomes insurance.” Such insurance would be available to patients for purchase before surgery or other major medical procedures and would provide compensation for any harm suffered during that treatment.

Addressing the subject of dwindling Medicare reimbursements, the candidate believes that continued reductions in provider reimbursements are the wrong way to address Medicare’s fiscal crises. He proposes a market-based Medicare system based on programs such as Medicare health savings accounts (HSAs), which he believes would control costs by making individuals responsible for their own healthcare choices without sacrificing quality. The transition to such a system, says Rep. Paul, could be financed through “reductions in foreign aid, militarism, corporate welfare, and government waste,” while allowing the government to keep its promises to current beneficiaries.

Bill Richardson’s three Cs of health care
According to Gov. Bill Richardson, health care needs to focus “on the three critical areas of coverage, cost, and care.” He refers to his healthcare program as “guaranteed coverage with real choices.”

Veterans would get a “Heroes Health Card,” which would provide them with a choice of physicians wherever they lived. He would also end the policy of excluding preexisting conditions from insurance coverage.

To address the issue of cost, Gov. Richardson proposes a sliding scale tax-credit for those who need assistance in paying for their healthcare coverage. He would also offer immediate relief for those who have used high-interest credit cards to pay for medical debt. In addition, through a number of cost-cutting and containment measures, he expects “to save the government $110 billion per year.”

Gov. Richardson has outlined the following six “common-sense” steps to improve care:

• Ensure that healthcare providers have the tools they need, including electronic medical records and reimbursement for providing proven preventive care
• Promote evidence-based care, through a public-private partnership to research the comparative effectiveness of new drugs, devices, tests, and treatments
• Improve patient safety by expanding training programs, requiring healthcare facilities to report preventable errors, and supporting hospitals that are working to improve patient safety and prevent avoidable hospitalizations
• Expand the healthcare workforce, including more primary care providers, including incentives to encourage primary care and rural physicians
• Promote chronic disease and mental health management
• Champion full parity between mental health and physical health benefits in all health plans
• Reduce healthcare disparities by expanding insurance and outreach to underinsured minority groups

“I am a strong believer in investing in science and technology,” Gov. Richardson has said. “I will substantially boost the National Institutes of Health and National Cancer Institute budgets.”

For more information:
Gov. Mike Huckabee: http://www.mikehuckabee.com
Rep. Dennis Kucinich: http://www.dennis4president.com
Rep. Ron Paul: http://www.ronpaul2008.com
Gov. Bill Richardson: http://www.richardsonforpresident.com