Leading Democratic Candidates

CHART #1: SIDE-BY-SIDE COMPARISON OF LEADING DEMOCRATIC CANDIDATES’ HEALTH PLANS
By Susan J. Blumenthal, M.D., Jessica B. Rubin, Michelle E. Treseler, Jefferson Lin, and David Mattos*
Hillary Clinton John Edwards Barack Obama
Stated Goals for ! Provide affordable, quality health ! Provide universal health care that ! Provide affordable,
Coverage coverage for all Americans11 cuts costs and provides better comprehensive, and portable
! Decrease costs, promote wellness care2 health insurance for every
and prevent illness American7
Mandatory Insurance No information found ! All residents required to have ! Believes that if health care
Requirement insurance coverage except in cases becomes affordable, most
of extreme financial hardship or Americans will buy it3
religious beliefs2 ! Mandatory health insurance
coverage for children only3
! Young people up to age 25 may
continue coverage through
parents’ plans7
Costs of Plan No information found ! $90 billion to $120 billion4 ! $50 billion to $65 billion5
How costs are covered ! 7 step strategy for reducing health ! Proposes a new tax credit to ! Four steps to modernize U.S.
care costs includes: national subsidize insurance purchased health care system to contain
prevention initiative, “paperless” through health markets that will be health care costs, including:
health information technology available on a sliding scale for offering Federal reinsurance to
system, transformation of care for middle and lower income families some employers for unexpected or
chronically ill, ending insurance and refundable for families catastrophic illnesses, ensuring
discrimination, establishing an without income tax liability2 that patients receive quality care,
independent “Best Practices” ! Repeal Bush’s tax cuts for people adopting health information
Institute, smart purchasing with annual incomes greater than technology, and increasing market
initiatives, and malpractice reforms11 $200,0002 competition7
! Cost savings used to help finance ! Allow tax cuts on dividends and
coverage for uninsured6 capital gains and for individuals
with annual incomes of more than
CHART #1: SIDE-BY-SIDE COMPARISONS OF LEADING DEMOCRATIC CANDIDATES’ HEALTH PLANS
$250,000 to expire in 20105
! May increase estate taxes on
inheritances valued at more than
$7 million5
! Partnerships among Federal and
state governments, employers,
providers, and individuals7
! Provide subsidies for families that
don’t qualify for Medicaid or
SCHIP7
Estimated savings At least $120 billion/year nationally6, 11 ! 100,000 to 150,000 lives/year2 ! Up to $2,500/year/family7
! $2,200/year/family6,11 ! $100 billion to $150 billion/year2 ! Up to $200 billion/year nationally7
! $25 billion in savings for ! $2,000 to $2,500/year/family10 ! Savings achieved through
businesses6, 11 ! Estimated savings of up to $162 investments in health IT,
! $77 billion from use of health IT11 billion/year from use of health prevention, reducing
IT10 uncompensated care, and
increasing insurance industry
competition7
! Estimated savings of up to $77
billion/year from use of health IT7
Implementation No information found ! Insure all Americans by 20122 ! Sign universal health care plan
Timeline into law by end of first term in
office (2012)7
Coverage for Children No information found ! Commit necessary Federal ! All children required to have
resources to allow states to expand coverage7
SCHIP to all children and their ! Expand eligibility for SCHIP7
parents below 250% of poverty ! Young people up to age 25 can
line2 continue coverage through
parents’ plans7
Medicaid Expansion No information found ! Commit necessary Federal ! Expand eligibility for Medicaid7
resources to cover all adults under
the poverty line2
New Federal/Public No information found ! Proposes public insurance plan ! Establish new national health plan
Plans modeled after Medicare but • Will provide affordable,
separate and apart from it2 portable health coverage that
is similar to plan available to
Federal employees7
• Open to individuals without
access to group coverage, to
2
those who are self-employed,
and to small businesses that
want to offer insurance to
their employees7
• Simple enrollment7
• Uninsured can pick from
among a group of plans7
! States can continue to experiment
with their plans, provided they
meet minimum standards of
national plan7
! Provide income-related Federal
subsidies for those who do not
qualify for Medicaid or SCHIP to
buy into the new public plan or
purchase private insurance7
! Offer Federal reimbursement to
employers for unexpected or
catastrophic illnesses if they
guarantee to use savings to reduce
cost of worker’s premium7
Insurance Pools ! Establishes large insurance pools ! State and regional Health Markets ! Establish National Health
that lower administrative costs by (non-profit purchasing pools) that Insurance Exchange for
spreading risk and preventing offer choice of competing consumers to either enroll in new
companies from shifting costs as insurance plans to individuals and public plan or shop among private
easily6 employers2 plans: creates rules and standards
! Choice between private and public for participating private insurance
insurance, though the system may plans to ensure coverage that is
evolve to a single-payer approach more affordable and accessible7
over time if businesses and • All plans offered must be at
individuals prefer the public plan2 least as generous as new
public plan7
! Insurers required to justify above-
average premium increase to
National Health Insurance
Exchange7
! Exchange acts as a “watchdog” by
evaluating plans and making
differences between them
transparent7
3
Employer Mandate No information found ! Businesses and other employers ! Employers have to share cost of
required to either cover employees ensuring workers either by
or pay a percentage of their offering insurance or paying a
payrolls to a fund that would help percentage of their payroll toward
individuals purchase health the costs of the national plan to
insurance11 provide coverage7
! Can choose to purchase insurance ! Smallest businesses are exempt
through Health Markets for lower from requirement (exact size not
costs and reducing administrative yet reported)8
burdens2
Disease Prevention ! All insurers who are already ! Change reimbursement rules to ! Promote prevention and
participating in a Federal health emphasize primary care10 strengthen public health to prevent
program, like Medicare, Medicaid ! Health Markets to offer primary disease7
or FEHP, required to cover and preventive services at little or ! Support school-based screening
prevention as a condition of doing no cost2 programs, clinical services,
business with the Federal ! Incentives reward individuals who physical education, and health
government6 schedule free physicals and enroll education programs 7
! Provide financial incentives like in healthy living programs9 ! Expand funding of prevention and
reducing co-payments to increase ! Redesign Federal insurance public health activities to ensure a
utilization of preventive care1 programs to include incentives for strong workforce, including
! Public-private collaborations to families to use wellness worksite health promotion
ensure that prevention is programs10 programs7
emphasized in schools, ! Include health education efforts in ! Require coverage of preventive
workplaces, supermarkets, and government programs10 services in all Federally supported
communities through free ! Increase public health funding and health plans and new public plan
provision of preventive benefits6 improve coordination among including screenings and smoking
! Fund and train new health health departments10 cessation programs7
prevention outreach workers who ! Promote workplace interventions10 ! Increase funding for community
can effectively communicate with ! Support smoking cessation based preventive interventions,
the country’s diverse populations6 efforts10 including: sidewalks, biking paths,
! Support community efforts to walking trails, restricted tobacco
improve health (safe streets, and alcohol advertising to
walking and biking trails, safe and children, and wellness and
well-equipped parks, physical educational campaigns7
education programs) 10 ! Foster collaboration between
! Promote diabetes prevention governments at all levels7
programs in private plans10 ! Optimize organization of the
! Create a National Taskforce to existing 3000 health departments
4
provide school nutrition guidelines in the nation as well as
that emphasize healthy food collaboration with private
options10 partners7
! Increase funding for physical
education and healthy lifestyle
programs10
! Provide tax incentives for
businesses that promote healthy
living programs10
! Establish nationwide healthy
lifestyles campaign to promote
individuals’ healthy choices10
Chronic Disease ! Provide chronic care coordination ! New payment systems for ! Support providers to put in place
Management models, including medical Medicare to ensure that patients care management programs and
“homes”, accessible under have a medical “home” with a encourage team care through
Federally-funded plans6 doctor to coordinate their care10 medical “home” models to
! Ensure higher quality and better ! Require insurers offering health improve coordination and
coordination of care through plans through Health Care integration of care7
incentives for participation in Markets and other public plans to ! Require that Federal plans and
these programs for both patients use disease management new public plan utilize proven
and physicians11 programs10 disease management programs7
! Invest in programs that encourage ! Reimburse employer health plans
doctors to communicate with each for a portion of catastrophic costs
other and technologies that allow incurred above threshold if there
them to efficiently access patient is a guarantee that savings will be
information10 used to reduce cost of workers’
! Use technology to help Medicare premiums7
patients manage chronic
conditions and offer support such
as case managers to ensure patient
adherence with treatment plans10
! Provide incentives for private
plans to cover disease
management10
! Create new national standards for
inclusion of preventive and
chronic care management services
with minimal cost-sharing10
! Fund state efforts to expand home
care and reform long term care
5
system10
Long Term Care ! Pass legislation to provide respite ! Help finance state-level reforms7 No information found
services for caregivers of elderly ! Establish national standards for
and disabled Americans11 nursing home care10
! Support innovative alternatives to
nursing home care10
! Improve quality of care and crack
down on elder abuse through
expansion of inspections10
! Increase national enforcement
against abusive nursing home
chains10
! Increase penalties for nursing
homes that fail to meet standards
for quality care10
! Provide excellence awards and
grants to nursing homes to help
improve quality of care10
! Support respite care and other
support services for families,
nurses and other aides10
! Improve wages, training and
working conditions for long term
care aides10
! Establish Internet clearinghouse to
provide families with more
information about available
services10
! Cover agency-employed home
health aides under minimum wage
and overtime protections10
Nursing Shortage No information found ! Implement initiatives to retain an No information found
estimated 50,000 trained nurses
who may be leaving the profession
and recruit an additional 50,000
young people into the profession10
! Increase funding for nursing
schools10
! Foster partnerships between
6
nursing schools and hospitals in
order to increase the number of
nursing students by 30% over five
years10
! Provide tuition assistance for
nursing students who agree to
work in underserved areas10
! Improve workplace conditions
through Federal challenge grants
and mentoring programs10
Quality/Evidence-based ! Provide incentives to encourage ! Devise systems to pay doctors for ! Participating providers in new
Health Care doctors to keep up with research results, as opposed to current fee- public plans, National Health
advances and prescribe most for-service system10 Insurance Exchange, Medicare,
effective treatments6 ! Establish a non-profit or public and FEHB will be rewarded for
! Establish new Independent “Best organization, (perhaps within achieving performance thresholds
Practices” Institute: partnership IOM), to research and compile on physician-validated outcome
among public and private sectors best methods of providing health measures7
to finance comparative care10 ! Require providers and hospitals to
effectiveness research6 • Will evaluate devices and collect and report data to ensure
! Utilize best practices: provide drugs, compare standards are being met for
guidance for professionals on what effectiveness, and quality, IT, patient safety , and
drugs, devices, surgeries and disseminate findings to administration7
treatments work best6 health care providers and ! Establish independent Institute to
! Reduce use of inefficient and patients10 guide reviews and research on
ineffective treatments6 ! Incentives for the use of evidence- comparative effectiveness drugs,
based care and treatments10 devices and procedures to improve
! Use new technologies to provide medical decision-making7
doctors with easy access to the ! Require health plans to disclose
latest health information10 percentage of premiums spent on
! Partnerships among academic direct patient care7
medical centers, Medicare, and
other Federal agencies to ensure
practice of high-quality medicine
across the U.S. 10
! Public-private collaborations to
reorganize patient care, improve
internal communications, reduce
errors through electronic
prescribing and establish basic
quality benchmarks10
7
Transparency/Consumer ! Develop and institute a standard ! Institute “Consumer Reports” for ! Simplify paperwork for providers
Friendliness health form with a common health care: universal, easy-to-use ! Require hospitals and providers to
vocabulary that insurance report card to help individuals collect and publicly report
companies must use6 evaluate hospitals’ treatment measures of health care costs and
effectiveness —readily available quality7
on Internet and in hard copy10 ! Require health plans to disclose
! Require health plans to disclose percentage of premiums spent on
percentage of premiums spent on direct patient care7
patient care and administration10
! Require doctors and hospitals to
provide information on several
key quality measures10
Information Technology ! Estimated net savings of $77 ! Estimated savings of up to $162 ! Estimated savings of up to $77
(IT) billion/year6 billion/year10 billion/year7
! Require providers who participate ! Ensure protection of patients’ ! Invest $10 billion/year over the
in Federal programs to adopt privacy rights2 next five years for health IT
private, secure, and interoperable ! Require physicians who want to system7
health information technology6 participate in Federal insurance ! Adopt standards-based electronic
! Invest $3 billion a year in health programs to use interoperable IT health information systems
IT grants to develop a “paperless” that protects privacy10 including electronic health
health care system6 ! Offer financial incentives to records7
! Provide doctors with financial doctors and hospitals if needed to ! Phase in requirements for full
incentives to adopt health IT11 implement10 implementation of health IT and
! Require doctors receiving commit Federal resources for
technology grants to report key implementation7
quality measures10 ! Ensure that systems are developed
! Provide resources to hospitals for in coordination with health
medication dispensers that quickly providers and institutions,
and accurately fill prescriptions10 including rural and underserved
! Promote patient-doctor areas7
communication systems and ! Ensure protection of patients’
patient support systems via e- privacy7
mail10
! Institute computerized physician
order entry10
! Develop computerized patient
reminder systems10
! Use wireless handheld devices to
allow hospital staff to
communicate directly to
8
physicians10
Telemedicine No information found ! Assist rural hospitals and health No information found
centers to purchase and implement
telemedicine systems10
! Establish at least 15 Regional
Telemedicine Centers across the
country and share best practices10
Health Insurance ! Prohibit insurance companies from ! Establish national accounting ! Proposed health plan would
Regulations/Eligibility carving out benefits or charging standards requiring insurers to ensure that no American is denied
higher rates to people with pre- spend at least 85% of premiums access to health care because of
existing health conditions6 on patient care10 illness or pre-existing conditions7
! Insurers participating in pools ! Direct U.S. Department of Justice ! Eliminate excessive subsidies of
would be required to prove that to conduct an immediate and Medicare Advantage program and
they spend less on marketing comprehensive review of health pay some amount it would cost to
strategies and more on direct care- insurance market and make treat patients under regular
giving6 recommendations about how to Medicare7
ensure a competitive market10 ! Increase general regulations on
! Update the 2001 Patients’ Bill of mergers between health insurers7
Rights calling for common-sense
protections often available in
managed care10
! Make sure that patients are not
penalized for reasonably but
unknowingly using out of network
doctors10
! Require insurers to keep plans
open to everyone (regardless of
pre-existing conditions) and
charge fair premiums10
Malpractice/Professional ! Pass National Medical Error ! Require lawyers to have an expert ! Promote new models to address
Liability Disclosure and Compensation testify that malpractice has patient safety, strengthen the
(MEDiC) Act: Encourages occurred before bringing a suit10 doctor-patient relationship, and
liability protections for physicians ! Sanctions for lawyers who file reduce need for malpractice suits7
that disclose medical errors to frivolous cases10 ! Require providers to report
patients and who offer to enter into ! Revisit insurance company preventable medical errors and
negotiations for fair exception to national antitrust support hospital and physician
compensation 1 laws10 practice improvement programs7
! Provide resources and incentives ! Strengthen antitrust laws to
to state medical boards for more prevent insurers from
9
responsible discipline10 overcharging physicians for
! Create a knowledge bank that malpractice insurance7
encourages doctors to report
medical errors voluntarily10
Increasing Drug ! Remove barriers to generic drug ! Convene an expert panel to ! Increase competition in drug
Availability and competition11 identify whether there are market7
Reducing Their Costs ! Increase funding for Office of discoveries where prizes, not ! Allow Federal government to
Generic Drugs at the FDA to patent monopolies, would offer negotiate prices for medications
eliminate backlog of generic drug new incentives to researchers10 directly with pharmaceutical
applications11 ! Drug companies are guaranteed a companies under Medicare
! Give FDA authority to approve significant payment in exchange prescription drug benefit7
safe and effective biogeneric for allowing competition in ! Allow U.S. residents to purchase
drugs11 manufacturing and distribution10 medications from Canada and
! Allow Medicare to negotiate lower ! Give the FDA authority to other industrialized nations if
drug prices11 approve safe and effective generic drugs are safe and prices are lower
! Provide more oversight of drug biologic alternatives which will than in U.S.7
advertising, marketing excesses create more choices and lower ! Increase use of generics in Federal
and inappropriate financial costs10 and new public plans7
relationships with providers11 ! Ensure that electronic pedigrees ! Prevent large drug companies
! Reduce overpayments to private accurately document the sales path from keeping generics out of
managed care plans11 of a drug to help combat market7
counterfeiting and illegal drug
wholesaling10
! Require independent testing of
drugs and make information about
comparative effectiveness
available to the FDA and to the
public10
! Require new restrictions on drug
advertisements to ensure accurate
information about side effects and
efficacy10
! Double FDA resources dedicated
to enforcing direct-to-consumer
advertisement rules10
! Require independent comparative
testing of drugs as a condition of
FDA approval10
! Institute rules against gift-giving
from pharmaceutical companies to
10
physicians10
! Require Pharmacy Benefit
Managers (PBM) to disclose
dealings with drug industry10
Eliminating Health No information found ! Support medical research on ! Address disparities in access to
Disparities health disparities2 health coverage and promote
! Reduce pollutions and toxins that prevention and public health7
disproportionately harm ! Hospitals and health plans
communities of color2 required to collect, analyze, and
! Support language translation report health care quality for
services to address language disparities7
barriers2 ! Hold hospitals and health plans
accountable for differences found7
! Ensure diverse workforce to
provide culturally effective care7
! Implement and fund evidence-
based interventions, such as
patient navigator programs7
! Support and expand capacity of
safety-net institutions, which
provide a disproportionate amount
of care for underserved
populations7
Public Health No information found ! Establish single disease control ! Strengthen public health to protect
Preparedness Initiatives office with authority to direct and against natural and man-made
coordinate government’s response disasters7
to disease outbreaks10 ! Optimize organization of the
! Establish real-time, unified existing 3000 health departments
national tracking system for in the nation7
diseases and vaccines that is easily ! Foster collaboration between all
accessible to public health levels of government and private
officials10 sector partners7
! Direct NIH to do research on more ! Establish performance and
efficient vaccine production accountability indicators,
methods10 integrated and interoperable
! Establish national plan to increase communication networks and
reserves of needed vaccines9 disaster preparedness and
! Provide additional Federal support response7
11
to states to build their public ! Modernize public health
health systems10 infrastructure including labs7
! Increase public health funding and ! Examine agricultural, educational,
improve coordination among environmental and health policies
health departments10 to assess and improve their effects
on public health7
Mental Health No information found ! Acknowledges mental health care12 No information found
Please cite Susan J. Blumenthal, M.D., Jessica B. Rubin, Michelle E. Treseler, Jefferson Lin, and David Mattos. U.S. Presidential
Candidates’ Prescriptions for a Healthier Future: A Side-by-Side Comparison. Huffington Post July 8, 2007. <website> in any future use of
this material.
1
Michelle Andrews, “Candidates write their prescriptions,” US News and World Report 11 June 2007: 32-33.
2
“Universal Health Care Through Shared Responsibility." John Edwards 08. 15 March 2007 <http://johnedwards.com/about/issues/health-care-overview.pdf>
3
“Democratic Presidential Candidates Discuss Health Care Coverage Expansion Plans As Part of Debate.” Kaiser Daily Health Policy Report 4 June 2007.
<http://kaisernetwork.org/daily_reports/print_report.cfm?DR_ID=45323&dr_cat=3>
4
Kathleen Gray, “Edwards: Health cost cuts need to start with drug, insurance firms.” Detroit Free Press 14 June 2007.
5
“Presidential Candidate Sen. Obama Proposes Plan to Cover Uninsured, Improve Premium Affordability.” Kaiser Daily Health Policy Report 30 May 2007.
<http://www.kaisernetwork.org/daily_reports/print_report.cfm?DR_ID=45226&dr_cat=3>
6
"HEALTH CARE: Hillary Remarks on Reducing the Cost of Health Care." Hillary for President. 25 June 2007 < http://www.hillaryclinton.com/news/speech/view/?id=1789>
7
“Barack Obama’s Plan for a Healthy America.” Obama ’08. 26 June 2007. <http://www.barackobama.com/pdf/HealthPlanFull.pdf>
8
Karen Tumulty, “Obama Channels Hillary on Health Care.” TIME 29 May 2007.
10
“Reforming Health Care to Make it Affordable, Accountable, and Universal.” John Edwards 08. 26 June 2007. <http://johnedwards.com/news/headlines/20070614-health-
care-costs-quality.pdf>
11
“Hillary Clinton Announces Agenda to Lower Health Care Costs and Improve Value for All Americans.” Hillary for President. 24 May 2007.
12
Toner, Robin. “2008 Candidates Vow to Overhaul Health Care” The New York Times. 6 July 2007.
12

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Leading Democratic Candidates

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CHART #1: SIDE-BY-SIDE COMPARISON OF LEADING DEMOCRATIC CANDIDATES’ HEALTH PLANS

Hillary Clinton John Edwards Barack Obama

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