The coverage would be fully portable. Regardless of changes in employment, individuals can continue their coverage in the same plan on the same basis—allowing for greater continuity of physician care.Sen. Dodd’s office was contacted several times concerning his views on declining Medicare reimbursements and on tort reform, but declined to respond.

AAOS Now

Published 11/1/2007

Where do they stand on health care?

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

AAOS Now looks at presidential candidates’ positions on healthcare reform

With a field of nine Republicans and eight Democrats (officially announced at time of publication), there’s bound to be a diversity of opinions among the potential presidential candidates. With this issue, AAOS Now begins a series of reports on the candidates and their stances on issues of importance to orthopaedic surgeons.

We begin with a look at the proposals for reforming the current healthcare system put forth by Sen. Christopher J. Dodd, D-Conn.; former Sen. Mike Gravel, D-Alaska; Rep. Duncan Hunter, R-Calif., and Rep. Tom Tancredo, R-Colo. 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.

Christopher Dodd proposes Universal HealthMart
The cornerstone of Democratic presidential candidate Christopher J. Dodd’s healthcare proposal is his “Universal HealthMart,” which promises quality, affordable health care for all Americans. This health plan, phased in over four years, is based on the Federal Employee Health Benefits Plan (FEHBP)—the coverage all federal employees currently receive—and the shared responsibility of individuals, business, and government.

Sen. Dodd would fund his Universal HealthMart in several different ways. Individuals and businesses would contribute based on their ability to pay. According to the Los Angeles Times (July 27, 2007), premiums would be affordable “based on leveraged negotiating power, spreading risk, reduced administrative costs, and incentives for technology and preventive care.” Eliminating the inefficiencies in the current healthcare system would make higher taxes unnecessary to finance his healthcare plan.

Employers would be able to opt into the Universal HealthMart or choose a private insurer. Businesses—even small businesses—that opt in would have several plan choices at rates usually reserved for larger companies. Because the Universal HealthMart would represent millions of clients, Dodd believes that premiums would be driven down by rigorous competition among insurance companies.

Families and individuals would be guaranteed coverage, receiving services according to the plan they select and contributing based on their ability to pay. Individuals who do not have insurance and who fail to enroll in the Universal HealthMart when they see their healthcare provider would automatically be enrolled when they file their income tax returns or complete a W-4.

Christopher Dodd

Mike Gravel touts “single-payer health care vouchers”
Former U.S. Sen. Mike Gravel wants to completely revamp the U.S. healthcare system. This should come as no surprise, since the Democratic presidential candidate who’s best known for reading the top-secret Pentagon Papers into the public record in 1971 isn’t one to stick with the status quo.

According to Sen. Gravel, enacting a universal healthcare system is the best way for all Americans to obtain equal access to quality care. Under his “single-payer health care voucher plan,” the federal government would issue free, annual healthcare vouchers based on recipients’ projected healthcare needs. All Americans would be fully covered, he says, and could be treated by the healthcare professionals of their choice. No one would ever be denied health insurance for any reason. This voucher plan would also relieve businesses of the financial responsibility of insuring their workers.

Mike Gravel

Sen. Gravel also detailed the big changes he has in mind for Medicare and Medicaid—specifically, to eliminate them.

“One of the facets of the plan would be to keep in place Medicare and Medicaid and phase them out over time, because plans to put everybody on Medicare aren’t going to fly financially and just can’t be met,” said Sen. Gravel. “We know it [health care] costs less for young people and it costs more for old people. So, I don’t have any magic to take care of seniors. All I can say is that I can set up a structure that will have checks and balances where they’ll have a better say than they have today.”

The coverage would be fully portable. Regardless of changes in employment, individuals can continue their coverage in the same plan on the same basis—allowing for greater continuity of physician care.Sen. Dodd’s office was contacted several times concerning his views on declining Medicare reimbursements and on tort reform, but declined to respond.
“The vouchers will have a very modest co-pay and a very modest deductible,” explained Sen. Gravel during a healthcare forum held in Las Vegas on March 24, 2007. “Everybody will get the same product universally in the United States of America. And then, if you want more than the product you’ve got, you pay for it.”
Rep. Tom Tancredo has served in the U.S. House of Representatives since 1998 and promotes himself as a “solid pro-life, pro-gun, small government Republican.” The key issue of his campaign is illegal immigration; his ideas about healthcare reform center on the effects illegal immigrants have on the U.S. healthcare system.
“She was told not to worry about the price because government was paying for it. That plastic brace couldn’t have been worth more than $10, but the price tag was $525,” he said. “If we have socialized medicine, we’re going to have a lot of $500 wrist braces—and poor medical care.

Tom Tancredo’s plan combines tort, immigration reform

Tom Tancredo

According to Rep. Tancredo’s Web site, he sees two major problems in health care—the high cost of care and the number of the uninsured. He argues that tort reform, coupled with immigration enforcement, would lower costs and save the healthcare system billions of dollars. In 2004, he supported H.R. 4280—a bill that would have limited noneconomic damages in medical liability cases to $250,000 and punitive damages to $250,000 or double economic damages, whichever amount was greater.

On the issue of the uninsured, Rep. Tancredo states that as many as 25 percent of uninsured Americans are illegal immigrants and advocates either their deportation or their being “encouraged to leave.” He believes that state governments should be the primary source for support of unemployed citizens and legal immigrants, along with possible federal incentives or subsidies to ensure coverage. Rep. Tancredo also favors association health plans to give small businesses that currently do not offer health coverage to their employees the opportunity to work together to purchase insurance at a lower cost.

Repeated attempts at contacting the candidate’s office for statements or clarification of his positions on the topics of tort reform and Medicare reimbursement were not successful.

Duncan Hunter: “Freedom” is the answer to healthcare woes
Rep. Duncan Hunter (R-Calif.) has yet to lay out a comprehensive healthcare plan of his own, but he knows that he doesn’t want a government-run universal healthcare program.

“Socialized medicine will be a disaster for this country,” Rep. Hunter said. “The more space we put between the people who consume our medical services and the people who pay for it, the more expensive it’s going to be.”

Rep. Hunter frequently shares the story of a constituent who came to his office with a small plastic wrist brace she’d received after a minor injury.

Duncan Hunter

“We need a program that maintains consumer interest in the price of health care,” he said. “With a government-run system, prices will spiral out of sight, and we’ll get a healthcare system that is degraded for everyone.”

Since kicking off his campaign in January 2007, Rep. Hunter continually harkens back to the theme of “freedom,” calling it a “catalyst for improvement.”

If elected, he would end the policy banning the purchase of healthcare insurance across state lines. Because costs for the same coverage vary widely across the country, he would let Americans buy health policies across state lines to increase choices and competition while lowering healthcare costs.

Hunter would also like to see the return of the “family doctor,” and would be willing to give physicians tax breaks for $30 office visits and $50 house calls.

“I’d like to keep a private sector parallel to the insurance sector as competition for the insurance companies,” he said.

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