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Health Care and the Presidential Election.

Many Republicans and Democrats in Washington see health care as capable of challenging the slim Republican majority in the House. But how will it play as a presidential campaign issue?

The candidates for the White House are playing to a public that cares a lot about health care, but doesn't understand how the current system works. Consider these two polls. Last year, an Employee Benefits Research Institute survey showed that 62 percent of people in preferred provider organizations or point of service plans didn't even know they were in managed care. And in May, a poll released by the Kaiser Family Foundation found that a majority of Americans care about the uninsured, but that there was no consensus about a solution.

What's a presidential candidate to do?

Al Gore is braving the details. During Gore's race with Bill Bradley for the presidential nomination, he countered Bradley's total revamping of Medicaid with a plan to beef up the present system.

George W. Bush is taking a quieter approach. His first speech devoted to health care didn't come until mid-April, and he's basing his proposals on private insurance. He's proposed a $41.6 billion package of tax credits and incentives to help lower-income families purchase insurance, and he's said he would give $4.3 billion to inner cities and rural areas to create health clinics.

Bush is stuck with a problematic record as governor of Texas. In a New York Times article that is a must-read for anyone charting Bush's health record, Adam Clymer vivisects the governor. Saying Bush "has not made health care a priority," Clymer points to Texas's unenviable uninsured rate of 27.5 percent and reports his Texas health commissioner's comment that lack of insurance isn't a major problem because even uninsured people get medical care. The commissioner has also been quoted as saying that teen pregnancy is high among Hispanics because it's acceptable in that community and that doctors don't support preventive care because it will hurt their practices.

While Gore may be talking more about health care than Bush, his recent record is less tangible. There was, of course, the failed Clinton health plan, but Gore has managed to avoid association with that. He is linking himself instead with Clinton's plan to provide prescription drug benefits as a separate insurance policy for older people in Medicare. And he has held some high-profile events to bring attention to that plan, such as going to a Connecticut pharmacy with a Medicare recipient struggling to afford the dozen drugs she needs.

Bush's alternative is to guarantee that every Medicare recipient has a choice of health plans, including some that offer prescription drugs. But Bush has not yet said where the money will come from.

Bush's one shining spot is an issue he's not likely to beat Gore on, and that's mental health. He's quietly added some money to the system in Texas. But with Tipper Gore's long-term advocacy and outspokenness on mental health, Bush's record isn't likely to win him many votes.

Both candidates were invited to speak at the inaugural meeting of the Association of Health Care Journalists, with the idea of having the candidates present their views and maybe even debate. But it was not to be. Only Gore accepted the invitation, and although the campaign's press release headlined his support for the Patients' Bill of Rights, Gore's speech focused on gun violence, wasting an opportunity to wrestle with health reform before an audience likely to understand the details.

Polls have ranked health care fairly high as an issue that's important to voters, and the number of those uninsured is up to 44 million. As of this writing, however, health care has yet to be a galvanizing issue. Looking back at the last few elections, I'm afraid this year is going to be another case of much noise and little action.

On a personal note, this is my last Capital Report. A column is a chance for a journalist to stretch and vent a little, and I've enjoyed it. But I've run out of fresh ways to complain about Washington's inability to come up with a workable health plan, or a good organ transplant policy, or effective safety standards for gene therapy.

Still, who knows? Maybe this election will prove me wrong about Washington. Maybe we'll get an intelligent discussion of some of the key health care issues. Maybe we'll get a president and a Congress working together to make sure all Americans have access to care, have a chance to receive a donated heart if they need one, and can feel safe volunteering to be in a government-approved experiment. Then maybe I'll have some new opinions, and I'll beg the editors of The Hastings Report to take me back.

Joanne Silberner is a health policy correspondent for National Public Radio.
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Author:Silberner, Joanne
Publication:The Hastings Center Report
Date:Jul 1, 2000
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